Gall Bladder and Biliary Tract Surgery
What is Gall bladder and biliary tract
surgery?
Gall bladder stones are an extremely common disorder and are usually
asymptomatic. Some patients experience biliary colic, an intermittent
and often severe pain in the epigastrium or right upper quadrant, and at
times between the scapula because of temporary obstruction of the cystic
duct with a gallstone. If the cystic duct obstruction persists, the
gallbladder becomes inflamed and the patient develops cholecystitis, an
acute inflammation and infection of the gallbladder.
Signs and Symptoms:
The vast majority of patients with gallstones are asymptomatic.
Symptomatic gallstones typically manifest with right upper quadrant
abdominal pain, often accompanied by nausea and vomiting. The pain is
often severe, may abate over several hours (biliary colic), or may
progress to cholecystitis, with persistent pain and fever. On
examination, there is pain to palpation in the right upper quadrant
(Murphy's sign).
Diagnosis:
The imaging study of choice is a right upper quadrant ultrasound,
which, in the presence of cholecystitis, typically shows the presence of
gallstones, a thickened gallbladder wall, and pericholecystic fluid. In
those patients with symptomatic gallstones and a negative ultrasound
examination, endoscopic ultrasound may be helpful. 2 To confirm the
suspicion of cholecystitis, a hydroxyiminodiacetic acid (HIDA) scan can
be useful. The radionuclide material is concentrated in the liver and
excreted into the bile but does not fill the gallbladder because of
cystic duct obstruction.
Summary: Acute Cholecystitis:
- Right upper quadrant abdominal pain, nausea, and vomiting
- Ultrasound reveals
- Thickened gallbladder wall
- Pericholecystic fluid collection
- HIDA scan reveals non-visualized gallbladder
Treatment:
TThe primary treatment for symptomatic gallstone disease is
cholecystectomy which require gall bladder surgery, Prophylactic
cholecystectomy for silent gallstones is not warranted. Most
cholecystectomies in the World are done laparoscopically. A patient with
an acute episode that resolves should see a surgeon within a few weeks
and elective cholecystectomy should be considered. Patients who have
persistent right upper quadrant tenderness and develop fever or an
elevated white blood cell count should be seen more urgently.
Common bile duct stones can accompany acute
cholecystitis in up to 10% of cases. These stones can be removed
endoscopically before or after cholecystectomy, or surgically at the
time of laparoscopic or open cholecystectomy.
Most good-risk patients who undergo elective laparoscopic
cholecystectomy are sent home within 24 hours. Patients who undergo open
cholecystectomy may require hospitalization for several days. It is
estimated that 95% of patients experience relief of pain after
cholecystectomy. The remaining patients probably had symptoms not
related to gallbladder disease before surgery.
The primary treatment for symptomatic gallstone disease is
cholecystectomy. Prophylactic cholecystectomy for silent gallstones is
not warranted. 3 Most cholecystectomies in the world are done
laparoscopically. A patient with an acute episode that resolves should
see a surgeon within a few weeks and elective cholecystectomy should be
considered. Patients who have persistent right upper quadrant tenderness
and develop fever or an elevated white blood cell count should be seen
more urgently