Cholelithiasis - Causes, Symptoms And Treatment. Diseases of the gallbladder and biliary tract are common and, in many cases, painful conditions that may be life threatening and usually require surgery. They are generally associated with deposition of calculi and inflammation. Women have two to three times the incidence as men of developing cholelithiasis. The disease may also be more prevalent in persons who are obese, who have high cholesterol, or who are on cholesterol lowering drugs. The prognosis is usually good with treatment unless infection occurs, in which case prognosis depends on its severity and response to antibiotics. In most cases, gallbladder and bile duct diseases occur during middle age. Between ages 2. 0 and 5.
Incidence rises with each succeeding decade. Causes of Cholelithiasis Cholelithiasis stones or calculi (gallstones) in the gallbladder. Gallstones are made of cholesterol, caldurn bilirubinate, or a mixture of cholesterol and bilirubin pigment. They arise during periods of sluggishness in the gallbladder due to pregnancy. One out of every 1. Cholelithiasis, or gallstones in the common bile duct (sometimes called common duct stones). This condition occurs when stones pass out of the gallbladder and lodge in the hepatic and common bile ducts. A gallstone is a stone formed within the gallbladder out of bile components. The term cholelithiasis may refer to the presence of stones in the gallbladder or to the.Prognosis is good unless infection occurs. Cholangitis, infection of the bile duct, is commonly associated with choledocholithiasis and may follow percutaneous transhepatic cholangiography or occlusion of endoscopicstents. Predisposing factors may include bacterial or metabolic alteration of bile acids. Widespread inflammation may cause fibrosis and stenosis of the common bile duct. The prognosis for this rare condition is poor without stenting or surgery. Cholecystitis. Cholecystitis accounts for 1. The acute form is most common during middle age; the chronic form occurs most commonly among the elderly. Cholelithiasis - Causes, Symptoms And Treatment. Diseases of the gallbladder and biliary tract are common and, in many cases, painful conditions that may be life. Pancreatic Neoplasms Online Medical Reference - from diagnosis through treatment. Co-authored by Tyler Stevens and Peter Lee of the Cleveland Clinic. The prognosis is good with treatment. Cholesterolosis. The polyps may be localized or speckle the entire gallbladder. Cholesterolosis the most common pseudotumor. The prognosis is good with surgery. Biliary cirrhosis. This condition usually leads to obstructive jaundice and involves the portal and periportal spaces of the liver. It's nine times more common among women ages 4. The prognosis is poor without liver transplantation. Gallstone ileus results from a gallstone lodging at the terminal ileum; it's more common in the elderly. The prognosis is good with surgery. Postcholecystectomy syndrome commonly results from residual gal. It occurs in 1 % to 5 % of all patients whose gallbladders have been surgical. The prognosis is good with selected radiologic procedures, endoscopic procedures, or surgery. Acalculous cholecystitis is more common in critical. It may result from primary infection with such organisms as Salmollella typhi. Escherichia coli, or Clostridium or from obstruction of the cystic duct due to lymphadenopathy or a tumor. It appears that ischemia usually related to a low cardiac output. Signs and symptoms of acalculous cholecystitis include unexplained sepsis, right upper quadrant pain, fever, leukocytosis, and a palpable gallbladder. Cholelithiasis Symptoms and Signs Although gallbladder disease may produceno symptoms. Attacks commonly follow meals rich in fats or may occur at night. They begin with acute abdominal pain in the right upper quadrant that may radiate to the back. Other features may include recurring fat intolerance. Gallstone ileus produces signs and symptoms of small bowel obstruction - nausea. Its most telling symptom is intermittent recurrence of colicky pain over several days. Each of these disorders produces its own set of complications. Diagnosis and testing information Differential diagnosis is essential in gallbladder and biliary tract disease because gallbladder disease can mimic other diseases (myocardial infarction. Serum amylase distinguishes gallbladder disease from pancreatitis. With suspected heart disease. Tests used to diagnose gallbladder and biliary tract disease include: Ultrasound reflects stones in the gallbladder with 9. It's also considered the primary tool for diagnosing cholelithiasis. Percutaneous trashepatic cholangiography. Endoscopic retrograde cholangiopancreatography (ERCP) visualizes the biliary tree after insertion of an endoscope down the esophagus into the duodenum, cannulation of the common bile and pancreatic ducts, and injection of contrast medium. HIDA scan of the gallbladder detects obstruction of the cystic duct. Computed tomography scan, although not used routinely, helps distinguish between obstructive and non obstructive jaundice. Flat plate of the abdomen identifies calcified, but not cholesterol. Oral cholecystography, which is rarely used, shows stones in the gallbladder and biliary duct obstruction. Elevated icteric index, total bilirubin, urine bilirubin, and alkaline phosphatase support the diagnosis. White blood cell count is slightly elevated during a cholecystitis attack. Cholelithiasis treatment. Surgery, usually elective, is the treatment of choice for gallbladder and biliary tract diseases and may include open or laparoscopic cholecystectomy, cholecystectomy with operative cholangiography and, possibly, exploration of the common bile duct. Other treatments include a low- fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendendes due to vitamin K deficiency. Treatment during an acute attack may include insertion of a nasogastric tube and an I. V. line and, possibly, antibiotic and analgesic administration. A non surgical treatment for choledocholithiasis involves placement of a catheter through the percutaneous transhepatic cholangiographic route. Guided by fluoroscopy, the catheter is directed toward the stone. A basket is threaded through the catheter,opened, twirled to entrap the stone, closed, and withdrawn. This procedure can be performed endoscopically. Ursodiol (Actigall), which dissolves radiolucent stones, provides an alternative for patients who are poor surgical risks or who refuse surgery. Extra corporeal shock wave lithotrillsy (ESWL) has also been adapted for the treatment of gallstones. ESWL Is a non surgical procedure used to ('rush stones inside the gallbladder. A lithotripsy machine focuses sound waves against the gallstones to break Them into smaller pieces that can pass out of the gallbladder through the cystic duct and common bile duct intothe small intestine................................................................. SPECIAL NEEDS Lithotripsy is contraindicated in pregnant women and those who have a pacemaker or serious heart problems................................................................. Special considerations or prevention Patient care for gallbladder and biliary tract diseases focuses on supportive care and close postoperative observation: Before surgery, teach the patient to deep- breathe, cough, expectorate, and perform leg exercises that are necessary after surgery. Also teach splinting, repositioning, and ambulation techniques. Explain the procedures that will be performed before, during, and after surgery to help ease the patient's anxiety and help ensure cooperation. After surgery, monitor vital signs for signs of bleeding, infection, or at electasis. Evaluate the indsion site for bleeding. Serosanguineous drainage is common during the first 2. If, after a choledochostomy, a T- tube drain is placed in the duct and attached to a drainage bag, make sure that the drainage tube has no kinks. Also check that the connecting tubing from the T tube is well secured to the patient to prevent dislodgment. Measure and record T- tube drainage daily. Monitor intake and output. Allow the patient nothing by mouth for 2. Patients who have had a laparoscopic cholecystectomy may be discharged the same day or within 2. These patients should have minimal pain, be able to tolerate a regular diet within 2. The patient should ambulate after surgery. Provide antiembolism stockings to support leg muscles and promote venous blood flow, thus preventing stasis and clot formation. Administer adequate medication to relieve pain, especially before such activities as deep breathing and ambulation, which increase pain. At discharge, advise the patient against heavy lifting or straining for 6 weeks. Urge her to walk daily. Tell her that food restrictions are Unnecessary unless she has an intolerance to a specific food or some underlying condition (such as diabetes, atherosclerosis, or obesity) that requires such restriction.
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