NMS. Surgery

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Part IV ♦ Gastrointestinal Disorders

CHOLELITHIASIS (GALLSTONES) I. Etiology: A. Bile precipitation

B. Risk factors: 4F’s—fat, fertile, female, forty. C. Classification: 1. Cholesterol stones: Most common. 2. Pigmented stones: Associated with hemolysis and hemoglobinopathies. 3. Calcium bilirubinate stones: Associated with infection or inflammation. II. Clinical presentation: RUQ pain after eating, “biliary colic”. III. Diagnosis: Ultrasound is the test of choice. IV. Treatment: A. Medical: Diet modification, ursodeoxycholate for cholesterol stone dissolution. TRUSTED SOURCE American College of Surgeons: Cholecystectomy: Surgical Removal of the Gallbladder . Available at https://www.facs.org/-/media/files/education/patient-ed/ cholesys.ashx B. Surgical: Cholecystectomy. 1. Indications : Symptomatic gallstones. 2. Operation: Laparoscopic cholecystectomy, consider cholangiogram. 3. Complications a. Biloma: Treat with antibiotics and drainage. b. Retained stone: Remove with ERCP. c. Common bile duct injury: Requires surgical intervention with roux-en-Y hepaticojejunostomy. V. Prognosis: Excellent with cholecystectomy.

CUT TO CASEBOOK See NMS Surgery Casebook , 3rd edition, Case 7.1: Asymptomatic Gallstones.

Cholecystitis I. Etiology:

A. Inflammation of the gallbladder. B. Usually from obstruction of the cystic duct. II. Classification: A. Acute: Usually from impacted stone at gallbladder neck.

B. Chronic: Usually from chronic gallstones and prior acute cholecystitis. C. Acalculous: Seen in the absence of stones, more common in critically ill patients.