SlideShare ist ein Scribd-Unternehmen logo
1 von 27
Presented by :  H. Al-Buainain Supervised : Prof. Parashar PATHOGENESIS OF  GALLSTONES
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],ANATOMY
Liver Lobule
[object Object],[object Object],[object Object],[object Object],Composition of Bile
Cholesterol Metabolism ,[object Object],[object Object],[object Object],[object Object]
SYNTHESIS OF CHOLESTEROL ,[object Object],[object Object]
Synthesis of Cholesterol
[object Object],Chenodeoxycholic acid cholic acid Glycine or Taurine Glycocholic Acid Taurocolic Acid
Bilirubin synthesis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Role of Bile In Fat Digestion   Absorption ,[object Object]
[object Object],[object Object],[object Object],[object Object]
Emulsification
Role Of Bile Acid In Cholesterol    Homeostasis ,[object Object],[object Object]
ENTEROHEPATIC  CIRCULATION
CONTROL OF BILE SECRETION ,[object Object],[object Object],[object Object],- Bile salt
SIGNIFICANCE OF BILE   ACID ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],GALLSTONES
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cholesterol Stones
Cholesterol Gallstones  Formation ,[object Object]
Risk factors Gallstones    Formation
Types of Cholesterol stones ,[object Object],90-100% Solitary , Whitish > 2.5 cm 50 - 90% Multiple , Small ,# Variety of shape
PIGMENTED GALLSTONES - Calcium bilirubinate - Ca Soap - Bacteria has role in the synthesis - >  in Asia  - Mainly at bile duct -Periumpullary duodenal diverticula -Excess Bilirubin - > in  : -Elderly Pt. - Chronic haemolysis  - Alcoholic
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Complications
Conclusion ,[object Object],[object Object],[object Object]
THANK YOU

Weitere ähnliche Inhalte

Was ist angesagt?

Obstructive jaundice
Obstructive jaundiceObstructive jaundice
Obstructive jaundiceSilah Aysha
 
Obstructive jaundice.
Obstructive jaundice.Obstructive jaundice.
Obstructive jaundice.apollobgslibrary
 
Portal hypertension
Portal hypertensionPortal hypertension
Portal hypertensionMohit Chaudhary
 
Cholelithiasis and cholecystitis
Cholelithiasis and cholecystitisCholelithiasis and cholecystitis
Cholelithiasis and cholecystitisdrssp1967
 
Carcinoma gall bladder
Carcinoma gall bladderCarcinoma gall bladder
Carcinoma gall bladderYouttam Laudari
 
Gallstone presentation
Gallstone presentation Gallstone presentation
Gallstone presentation HAMAD DHUHAYR
 
Obstructive jaundice
Obstructive  jaundiceObstructive  jaundice
Obstructive jaundicemostafa hegazy
 
Choledocholithiasis...one step ahead
Choledocholithiasis...one step aheadCholedocholithiasis...one step ahead
Choledocholithiasis...one step aheadDr.Manojit Sarkar
 
Diasease of small intestine
Diasease of small intestineDiasease of small intestine
Diasease of small intestineNur Idris
 
Pancreatic Carcinoma
Pancreatic CarcinomaPancreatic Carcinoma
Pancreatic CarcinomaJibran Mohsin
 
Urinary Stones Disease - Urolithiasis
Urinary Stones Disease - UrolithiasisUrinary Stones Disease - Urolithiasis
Urinary Stones Disease - UrolithiasisMuhammad Eimaduddin
 
Cholecystitis
CholecystitisCholecystitis
CholecystitisSoumar Dutta
 

Was ist angesagt? (20)

Renal stones
Renal stonesRenal stones
Renal stones
 
Obstructive jaundice
Obstructive jaundiceObstructive jaundice
Obstructive jaundice
 
Obstructive jaundice.
Obstructive jaundice.Obstructive jaundice.
Obstructive jaundice.
 
Portal hypertension
Portal hypertensionPortal hypertension
Portal hypertension
 
Cholelithiasis and cholecystitis
Cholelithiasis and cholecystitisCholelithiasis and cholecystitis
Cholelithiasis and cholecystitis
 
Peptic ulcer disease
Peptic ulcer diseasePeptic ulcer disease
Peptic ulcer disease
 
Chronic pancreatitis
Chronic pancreatitisChronic pancreatitis
Chronic pancreatitis
 
Gall stones
Gall stonesGall stones
Gall stones
 
Carcinoma gall bladder
Carcinoma gall bladderCarcinoma gall bladder
Carcinoma gall bladder
 
Peritonitis
PeritonitisPeritonitis
Peritonitis
 
Cholelithiasis
CholelithiasisCholelithiasis
Cholelithiasis
 
Gallstone presentation
Gallstone presentation Gallstone presentation
Gallstone presentation
 
Obstructive jaundice
Obstructive  jaundiceObstructive  jaundice
Obstructive jaundice
 
Choledocholithiasis...one step ahead
Choledocholithiasis...one step aheadCholedocholithiasis...one step ahead
Choledocholithiasis...one step ahead
 
Biliary Disease
Biliary DiseaseBiliary Disease
Biliary Disease
 
Diasease of small intestine
Diasease of small intestineDiasease of small intestine
Diasease of small intestine
 
Dyspepsia
DyspepsiaDyspepsia
Dyspepsia
 
Pancreatic Carcinoma
Pancreatic CarcinomaPancreatic Carcinoma
Pancreatic Carcinoma
 
Urinary Stones Disease - Urolithiasis
Urinary Stones Disease - UrolithiasisUrinary Stones Disease - Urolithiasis
Urinary Stones Disease - Urolithiasis
 
Cholecystitis
CholecystitisCholecystitis
Cholecystitis
 

Andere mochten auch

Cholelithiasis
CholelithiasisCholelithiasis
CholelithiasisNikhil Gupta
 
Cholelithiasis final year lecture
Cholelithiasis   final year lectureCholelithiasis   final year lecture
Cholelithiasis final year lectureMr Adeel Abbas
 
Case study on cholelithiasis
Case study on cholelithiasisCase study on cholelithiasis
Case study on cholelithiasiseducation4227
 
Cholelithiasis:Early diagnosis and prompt treatment.
Cholelithiasis:Early diagnosis and prompt treatment.Cholelithiasis:Early diagnosis and prompt treatment.
Cholelithiasis:Early diagnosis and prompt treatment.KETAN VAGHOLKAR
 
Anatomy of Cholelithiasis
Anatomy of Cholelithiasis Anatomy of Cholelithiasis
Anatomy of Cholelithiasis Athulyahomecare
 
Ulcerative colitis
Ulcerative colitisUlcerative colitis
Ulcerative colitisJagadeesh Babu
 
Anatomy of gall bladder
Anatomy of gall bladderAnatomy of gall bladder
Anatomy of gall bladdersangu prashanth
 
Gallstones
GallstonesGallstones
Gallstonescamiij1
 
Cholelithiasis disease of GIT
Cholelithiasis disease of GITCholelithiasis disease of GIT
Cholelithiasis disease of GITshafaatullahkhatt
 
Cholelithiasis - By Sir Faisal Ghani
Cholelithiasis - By Sir Faisal GhaniCholelithiasis - By Sir Faisal Ghani
Cholelithiasis - By Sir Faisal GhaniSara Memon
 
Crohn’s disease
Crohn’s diseaseCrohn’s disease
Crohn’s diseaseReynel Dan
 
Ulcerative colitis
Ulcerative colitisUlcerative colitis
Ulcerative colitisAhmed Abudeif
 
Crohns disease movie
Crohns disease movieCrohns disease movie
Crohns disease movieguestaca7f40
 
Powerpoint gallbladder
Powerpoint gallbladderPowerpoint gallbladder
Powerpoint gallbladdermcrlopez
 

Andere mochten auch (20)

Cholelithiasis
CholelithiasisCholelithiasis
Cholelithiasis
 
Cholelithiasis final year lecture
Cholelithiasis   final year lectureCholelithiasis   final year lecture
Cholelithiasis final year lecture
 
Gallstones
GallstonesGallstones
Gallstones
 
Case study on cholelithiasis
Case study on cholelithiasisCase study on cholelithiasis
Case study on cholelithiasis
 
Cholelithiasis:Early diagnosis and prompt treatment.
Cholelithiasis:Early diagnosis and prompt treatment.Cholelithiasis:Early diagnosis and prompt treatment.
Cholelithiasis:Early diagnosis and prompt treatment.
 
Anatomy of Cholelithiasis
Anatomy of Cholelithiasis Anatomy of Cholelithiasis
Anatomy of Cholelithiasis
 
Gallstone+disease
Gallstone+diseaseGallstone+disease
Gallstone+disease
 
Ulcerative colitis
Ulcerative colitisUlcerative colitis
Ulcerative colitis
 
Anatomy of gall bladder
Anatomy of gall bladderAnatomy of gall bladder
Anatomy of gall bladder
 
Crohn\'s disease
Crohn\'s diseaseCrohn\'s disease
Crohn\'s disease
 
Gallstones
GallstonesGallstones
Gallstones
 
Cholelithiasis disease of GIT
Cholelithiasis disease of GITCholelithiasis disease of GIT
Cholelithiasis disease of GIT
 
Cholelithiasis - By Sir Faisal Ghani
Cholelithiasis - By Sir Faisal GhaniCholelithiasis - By Sir Faisal Ghani
Cholelithiasis - By Sir Faisal Ghani
 
Crohn’s disease
Crohn’s diseaseCrohn’s disease
Crohn’s disease
 
Ulcerative colitis
Ulcerative colitisUlcerative colitis
Ulcerative colitis
 
Crohns disease movie
Crohns disease movieCrohns disease movie
Crohns disease movie
 
Cholecystitis
CholecystitisCholecystitis
Cholecystitis
 
Powerpoint gallbladder
Powerpoint gallbladderPowerpoint gallbladder
Powerpoint gallbladder
 
Peritonitis
PeritonitisPeritonitis
Peritonitis
 
Appendicitis
AppendicitisAppendicitis
Appendicitis
 

Ă„hnlich wie Gallstone

Digestion and Absorption of LIpids
Digestion and Absorption of LIpidsDigestion and Absorption of LIpids
Digestion and Absorption of LIpidsNamrata Chhabra
 
Biliary secretions
Biliary secretionsBiliary secretions
Biliary secretionsDr.Nusrat Tariq
 
L30 gallstones student
L30 gallstones studentL30 gallstones student
L30 gallstones studentMohammad Manzoor
 
Bile physiology.pptx
Bile physiology.pptxBile physiology.pptx
Bile physiology.pptxFarrah Lee
 
Digestion2.ppt
Digestion2.pptDigestion2.ppt
Digestion2.pptAnnaKhurshid
 
Function of liver and effect of bile for digestion of fat
Function of liver and effect of bile for digestion of fatFunction of liver and effect of bile for digestion of fat
Function of liver and effect of bile for digestion of fatRenuYadav3305
 
L30 gallstones student
L30 gallstones studentL30 gallstones student
L30 gallstones studentMohammad Manzoor
 
liver, Biliary, & pancreatic secretions.pptx
liver, Biliary, & pancreatic  secretions.pptxliver, Biliary, & pancreatic  secretions.pptx
liver, Biliary, & pancreatic secretions.pptxDr.Nusrat Tariq
 
lipid2-121005091239-phpapp01 (1).pptx
lipid2-121005091239-phpapp01 (1).pptxlipid2-121005091239-phpapp01 (1).pptx
lipid2-121005091239-phpapp01 (1).pptxDailyBytes
 
LFT L - 4.pptx
LFT L - 4.pptxLFT L - 4.pptx
LFT L - 4.pptxPoonumTyagi
 
The Ultimate Guide to Understanding the Human Digestive System
The Ultimate Guide to Understanding the Human Digestive SystemThe Ultimate Guide to Understanding the Human Digestive System
The Ultimate Guide to Understanding the Human Digestive SystemDeepanshuYadav2
 
PHYSIOLOGY OF HUMAN DIGESTION
PHYSIOLOGY OF HUMAN DIGESTIONPHYSIOLOGY OF HUMAN DIGESTION
PHYSIOLOGY OF HUMAN DIGESTIONDeepanshuYadav2
 
cholesterol_metabolism_2_-_without_record.pdf
cholesterol_metabolism_2_-_without_record.pdfcholesterol_metabolism_2_-_without_record.pdf
cholesterol_metabolism_2_-_without_record.pdfahmedhatem369615
 
Digestion biochemistry
Digestion biochemistryDigestion biochemistry
Digestion biochemistrysantusan
 
Lipid metabolism 2
Lipid metabolism 2Lipid metabolism 2
Lipid metabolism 2Dipali Kulkarni
 
Digestion and absorption
Digestion and absorptionDigestion and absorption
Digestion and absorptionFarhana Atia
 

Ă„hnlich wie Gallstone (20)

Bile
BileBile
Bile
 
Digestion and Absorption of LIpids
Digestion and Absorption of LIpidsDigestion and Absorption of LIpids
Digestion and Absorption of LIpids
 
Biliary secretions
Biliary secretionsBiliary secretions
Biliary secretions
 
L30 gallstones student
L30 gallstones studentL30 gallstones student
L30 gallstones student
 
Bile physiology.pptx
Bile physiology.pptxBile physiology.pptx
Bile physiology.pptx
 
Digestion2.ppt
Digestion2.pptDigestion2.ppt
Digestion2.ppt
 
Function of liver and effect of bile for digestion of fat
Function of liver and effect of bile for digestion of fatFunction of liver and effect of bile for digestion of fat
Function of liver and effect of bile for digestion of fat
 
L30 gallstones student
L30 gallstones studentL30 gallstones student
L30 gallstones student
 
Lipids (feb 2014)
Lipids (feb 2014)Lipids (feb 2014)
Lipids (feb 2014)
 
Lipids
LipidsLipids
Lipids
 
liver, Biliary, & pancreatic secretions.pptx
liver, Biliary, & pancreatic  secretions.pptxliver, Biliary, & pancreatic  secretions.pptx
liver, Biliary, & pancreatic secretions.pptx
 
lipid2-121005091239-phpapp01 (1).pptx
lipid2-121005091239-phpapp01 (1).pptxlipid2-121005091239-phpapp01 (1).pptx
lipid2-121005091239-phpapp01 (1).pptx
 
LFT L - 4.pptx
LFT L - 4.pptxLFT L - 4.pptx
LFT L - 4.pptx
 
The Ultimate Guide to Understanding the Human Digestive System
The Ultimate Guide to Understanding the Human Digestive SystemThe Ultimate Guide to Understanding the Human Digestive System
The Ultimate Guide to Understanding the Human Digestive System
 
PHYSIOLOGY OF HUMAN DIGESTION
PHYSIOLOGY OF HUMAN DIGESTIONPHYSIOLOGY OF HUMAN DIGESTION
PHYSIOLOGY OF HUMAN DIGESTION
 
7. lipid metabolism
7. lipid metabolism7. lipid metabolism
7. lipid metabolism
 
cholesterol_metabolism_2_-_without_record.pdf
cholesterol_metabolism_2_-_without_record.pdfcholesterol_metabolism_2_-_without_record.pdf
cholesterol_metabolism_2_-_without_record.pdf
 
Digestion biochemistry
Digestion biochemistryDigestion biochemistry
Digestion biochemistry
 
Lipid metabolism 2
Lipid metabolism 2Lipid metabolism 2
Lipid metabolism 2
 
Digestion and absorption
Digestion and absorptionDigestion and absorption
Digestion and absorption
 

Mehr von Saeed Al-Shomimi

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healingSaeed Al-Shomimi
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Saeed Al-Shomimi
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal CollectionsSaeed Al-Shomimi
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal TraumaSaeed Al-Shomimi
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancySaeed Al-Shomimi
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisSaeed Al-Shomimi
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstructionSaeed Al-Shomimi
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysisSaeed Al-Shomimi
 
Diabetic Foot Examination
Diabetic Foot ExaminationDiabetic Foot Examination
Diabetic Foot ExaminationSaeed Al-Shomimi
 
Solitary Thyroid Nodule
Solitary Thyroid NoduleSolitary Thyroid Nodule
Solitary Thyroid NoduleSaeed Al-Shomimi
 
Massive Blood Transfusion
Massive Blood TransfusionMassive Blood Transfusion
Massive Blood TransfusionSaeed Al-Shomimi
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular TraumaSaeed Al-Shomimi
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast CancerSaeed Al-Shomimi
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSaeed Al-Shomimi
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasSaeed Al-Shomimi
 

Mehr von Saeed Al-Shomimi (20)

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healing
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal Collections
 
Tube thoracostomy
Tube thoracostomyTube thoracostomy
Tube thoracostomy
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal Trauma
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancy
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute Panceriatitis
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstruction
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysis
 
DVT Current Concept
DVT Current ConceptDVT Current Concept
DVT Current Concept
 
Diabetic Foot Examination
Diabetic Foot ExaminationDiabetic Foot Examination
Diabetic Foot Examination
 
Solitary Thyroid Nodule
Solitary Thyroid NoduleSolitary Thyroid Nodule
Solitary Thyroid Nodule
 
Massive Blood Transfusion
Massive Blood TransfusionMassive Blood Transfusion
Massive Blood Transfusion
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular Trauma
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast Cancer
 
Liver Trauma
Liver TraumaLiver Trauma
Liver Trauma
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative Colitis
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The Pancreas
 
Ischemic Colitis
Ischemic ColitisIschemic Colitis
Ischemic Colitis
 
Gastric Carcinoma
Gastric CarcinomaGastric Carcinoma
Gastric Carcinoma
 

KĂĽrzlich hochgeladen

Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...narwatsonia7
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptxDr.Nusrat Tariq
 
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...narwatsonia7
 
Pharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingPharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingArunagarwal328757
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Timevijaych2041
 
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...narwatsonia7
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipurparulsinha
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingNehru place Escorts
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiNehru place Escorts
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️saminamagar
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowNehru place Escorts
 
Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Gabriel Guevara MD
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformKweku Zurek
 
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...narwatsonia7
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girlsnehamumbai
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknownarwatsonia7
 

KĂĽrzlich hochgeladen (20)

Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
Housewife Call Girls Bangalore - Call 7001305949 Rs-3500 with A/C Room Cash o...
 
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hsr Layout Just Call 7001305949 Top Class Call Girl Service Available
 
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in munirka  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in munirka DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Glomerular Filtration and determinants of glomerular filtration .pptx
Glomerular Filtration and  determinants of glomerular filtration .pptxGlomerular Filtration and  determinants of glomerular filtration .pptx
Glomerular Filtration and determinants of glomerular filtration .pptx
 
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
Call Girls Frazer Town Just Call 7001305949 Top Class Call Girl Service Avail...
 
Pharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, PricingPharmaceutical Marketting: Unit-5, Pricing
Pharmaceutical Marketting: Unit-5, Pricing
 
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any TimeCall Girls Viman Nagar 7001305949 All Area Service COD available Any Time
Call Girls Viman Nagar 7001305949 All Area Service COD available Any Time
 
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
Russian Call Girls Gunjur Mugalur Road : 7001305949 High Profile Model Escort...
 
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
 
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
Call Girls ITPL Just Call 7001305949 Top Class Call Girl Service Available
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
 
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment BookingCall Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
Call Girls Service Nandiambakkam | 7001305949 At Low Cost Cash Payment Booking
 
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service ChennaiCall Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
Call Girls Service Chennai Jiya 7001305949 Independent Escort Service Chennai
 
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️call girls in green park  DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
call girls in green park DELHI 🔝 >༒9540349809 🔝 genuine Escort Service 🔝✔️✔️
 
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call NowKolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
Kolkata Call Girls Services 9907093804 @24x7 High Class Babes Here Call Now
 
Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024Asthma Review - GINA guidelines summary 2024
Asthma Review - GINA guidelines summary 2024
 
See the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy PlatformSee the 2,456 pharmacies on the National E-Pharmacy Platform
See the 2,456 pharmacies on the National E-Pharmacy Platform
 
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
Housewife Call Girls Hsr Layout - Call 7001305949 Rs-3500 with A/C Room Cash ...
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
 
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service LucknowVIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
VIP Call Girls Lucknow Nandini 7001305949 Independent Escort Service Lucknow
 

Gallstone