ITS A LONG STANDING SWELLING AND IRRITATION OF GALL BLADDER
TREATMENT
NON SURGICAL TREATMENT
Analgesics may be given for pain .Severe pain require opiates ,which is given along with hyoscine butylbromide ( to counteract spasm of sphincter of Oddi ).Ptient should be put on low-fat diet until cholecystectomy.
MEDICAL DISSOLUTION OF GALL STONES
Gall stone can be dissolved as long as they are radiolucent and gall bladder is functioning.Some drugs can work such as bile acids ,chenodeoxycholic acid .Ursodeoxycholic acid .
EXTRACORPOREAL LITHOTRIPSY
Extracorporeal shock wave lithotripsy can disrupt gall stones and allow debris to pass into bile duct and beyond. It is suitable for patients with 1-3 stones in a functioning gall bladder.
SURGICAL TREATMENT
Prophylactic antibiotics e.g. 2nd generation cephalosporin should be given.Premedications.provision is made for peroperative cholangiography.
LAPAROTOMY
Give incision in right paramedian or right subcostal incision ( Kocher's incision ) and examine all abdominal organs .inclding gall bladder.
CHOLECYSTECTOMY
Isolate the gall bladder area with packs .Aspirate the gall bladder if it greatly distend through fundus via trocar and cannula attached to a suction apparatus.Grasp the neck of gall bladder with sponge-holding forceps.Display the junction of cystic ,common hepatic and bile ducts via dissection and identify cystic artery and its relation to common hepatic duct .Cholangiography is performed ,to confirm the anatomy of biliary tree and to check for stones in main duct .Ligate the cystic duct and then divide it .Dissect the gall bladder from its bed ,rom below and upwards .dividing the peritoneum on gall bladder. Secure hemostasis and close the abdominal wall.Drainage is not mandatory ,if used ,it should be a 3mm closed suction drain.
WITH SEVERE INFLAMMATION IN CALOT'S TRIANGLE
Open the gall bladder ,extractall stones and bile ,and excise as much of wall of gall ladder as possible.Cystic duct opening is closed by cargut suture from within .An alternative is cholecystostomt.
OTHER SURGICAL TECHNIQUES
CHOLECYSTOSTOMY
PERCUTANEOUS CHOLECYSTOLITHOTOMY
LAPAROSCOPIC CHOLECYSTECTOMY
MINICHOLECYSTECTOMY …..... read more
TREATMENT
NON SURGICAL TREATMENT
Analgesics may be given for pain .Severe pain require opiates ,which is given along with hyoscine butylbromide ( to counteract spasm of sphincter of Oddi ).Ptient should be put on low-fat diet until cholecystectomy.
MEDICAL DISSOLUTION OF GALL STONES
Gall stone can be dissolved as long as they are radiolucent and gall bladder is functioning.Some drugs can work such as bile acids ,chenodeoxycholic acid .Ursodeoxycholic acid .
EXTRACORPOREAL LITHOTRIPSY
Extracorporeal shock wave lithotripsy can disrupt gall stones and allow debris to pass into bile duct and beyond. It is suitable for patients with 1-3 stones in a functioning gall bladder.
SURGICAL TREATMENT
Prophylactic antibiotics e.g. 2nd generation cephalosporin should be given.Premedications.provision is made for peroperative cholangiography.
LAPAROTOMY
Give incision in right paramedian or right subcostal incision ( Kocher's incision ) and examine all abdominal organs .inclding gall bladder.
CHOLECYSTECTOMY
Isolate the gall bladder area with packs .Aspirate the gall bladder if it greatly distend through fundus via trocar and cannula attached to a suction apparatus.Grasp the neck of gall bladder with sponge-holding forceps.Display the junction of cystic ,common hepatic and bile ducts via dissection and identify cystic artery and its relation to common hepatic duct .Cholangiography is performed ,to confirm the anatomy of biliary tree and to check for stones in main duct .Ligate the cystic duct and then divide it .Dissect the gall bladder from its bed ,rom below and upwards .dividing the peritoneum on gall bladder. Secure hemostasis and close the abdominal wall.Drainage is not mandatory ,if used ,it should be a 3mm closed suction drain.
WITH SEVERE INFLAMMATION IN CALOT'S TRIANGLE
Open the gall bladder ,extractall stones and bile ,and excise as much of wall of gall ladder as possible.Cystic duct opening is closed by cargut suture from within .An alternative is cholecystostomt.
OTHER SURGICAL TECHNIQUES
CHOLECYSTOSTOMY
PERCUTANEOUS CHOLECYSTOLITHOTOMY
LAPAROSCOPIC CHOLECYSTECTOMY
MINICHOLECYSTECTOMY …..... read more
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