Cholecystitis provided the surgeon is experienced

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cholecystitis provided the surgeon is experienced. CHOLEDOCHOLITHIASIS Choledocholithiasis represents gallbladder stones that have migrated into the common bile duct via the cystic duct, stones which were left in the common duct following biliary tract surgery (retained stones), or stones that originated within the intra- or extrahepatic bile ducts primarily. The overall incidence of choledocholithiasis is difficult to know, but up to 15% of patients who undergo gallbladder surgery are found to have common duct stones. Specific clinical syndromes and biochemical tests can suggest the presence of common duct stones, but they are definitively Identified by radiographic evaluation of the biliary tree, including cholangiography. Considering the frequency with which calculi are found during cholecystectomy surgery, to avoid exposing every patient to the risks and costs of an intraoperative cholangiogram, a series of relative indications for performing this test have been developed. Indications for cholangiography include palpable choledocholithiasis, a dilated common bile duct, elevated liver function tests, or a recent history of jaundice, cholangitis, or pancreatitis. BILIARY COLIC AND PREGNANCY Gallbladder disease is occasionally first noted or becomes more troublesome during pregnancy. The most common clinical presentations are worsening biliary colic and acute cholecystitis. Jaundice and acute pancreatitis as a result of choledocholithiasis are rare. Radiological evaluation of symptoms suggestive of biliary tract disease can nearly always be limited to ultrasonography. Several series have demonstrated that the laparoscopic removal of the gallbladder during all stages of pregnancy is safe, resulting in minimal fetal and maternal morbidity. 10
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Medical Treatments ORAL DISSOLUTION In theory, biliary calculi, which specifically result from the cholesterol supersaturation of bile, should dissolve if the ratio of cholesterol to bile salts is reversed. In practice, this therapy (i.e. administration of chenodeoxycholic acid) is most effective for the treatment of small noncalcified cholesterol stones in patients with a functioning gallbladder. Successful therapy in many patients can require upward of 6 to 12 months, and necessitates periodic monitoring until the stones are dissolved. Approximately 50% to 60% of cholesterol stones measuring less than 10 mm in diameter respond; however, the gallstones recur in one-half of these patients within 5 years. Considering the duration, expense, potential side effects, and lack of a durable cure, oral dissolution therapy should be reserved for those patients who either cannot risk or do not want an operation. CONTACT DISSOLUTION Another approach to dissolving gallstones is to directly apply an agent that can solubilize cholesterol. While technically feasible, contact dissolution has at present a role limited to the treatment of cholelithiasis in patients who are not suitable for surgery.
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  • Winter '18
  • Jane doe
  • bile duct, Hepatology, Gallstone

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