Management of Cholecystitis and Cholelithiasis скачать в хорошем качестве

Management of Cholecystitis and Cholelithiasis

Please read and agree to the disclaimer before watching this video. . Daily Mini Been is Here NSAIDs *Nonsteroidal anti-inflammatory (NSAID) drugs e.g., diclofenac 50-75 mg intramuscular (IM) can help relieve biliary pain. Laparoscopic Cholecystectomy In an asymptomatic patient, there is no need for a cholecystectomy unless the calcified stones are more than 3 cm in diameter or the person is Native American, or is going for bariatric surgery (weight loss surgery that increases the risk of cholecystitis and cholelithiasis,) or a patient undergoing a cardiac transplant. *For the symptomatic gallbladder disease and even for the acute cholecystitis, the treatment of choice is outdoor based laparoscopic cholecystectomy. *Laparoscopic cholecystectomy helps relieve pain in patients with symptomatic cholecystitis for lesser than a month or the patients with episodic pain lasting for half an hour usually in the evenings, and the patients that present with the cholecystitis pain for one year or lesser. Laparoscopic cholecystectomy patients can go home the same day and return for work within a few days in contrast to the patients with open cholecystectomy surgery that can take a few weeks to recover. Laparoscopic cholecystectomy may be converted to open cholecystectomy in 2-8% of the patients, a higher number of conversions in surgeries for the acute cholecystitis patients. Bile duct injuries during cholecystectomy can occur in about 0.1% of the procedures by experienced surgeons. Cholecystectomy causes increased duodenogastric reflux and changed bile exposure to the intestine. This, in turn, results in an increased risk of esophageal, proximal small intestine, and colonic adenocarcinomas. During the Pregnancy *In pregnant women with cholecystitis, conservative management is advised; however, for the repeated attacks of biliary pain, or acute cholecystitis, a cholecystectomy can be performed. The procedure is preferred in the second trimester, and a laparoscopic route can be used. When to Administer Ursodeoxycholic Acid *Occasionally ursodeoxycholic acid can be used in patients that refuse cholecystectomy. This salt can take up to two years to help dissolve cholesterol stones. It is given in a dose of 8-30 mg/kg body weight in divided doses daily. This drug is usually effective in patients with a functional gallbladder with small floating cholesterol stones. In patients that are rapidly losing fats e.g., after bariatric surgery, Ursodeoxycholic acid 500-600 mg daily can be given to reduce the risk of gallstone formation. Such patients should also receive diets high in fat quantity. Lithotripsy Lithotripsy is usually not preferred in the US at least. Note: we will discuss the management of acute cholecystitis later. References: Current 2016 (Cholelithiasis) ... Disclaimer: This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only. Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional. ... Disclaimer: This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only. Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.