Cholecystitis and Cholelithiasis

collaborative

MEDICAL. Medical management may include oral bile acid therapy. Antibiotics may be given to manage infection along with intestine lie, intravenous hydration, correction of electrolyte imbalances, and pain management with follow-up care. Criteria for outpatient treatment include that the patient is febrile, with no evidence of obstruction on lab appraisal and sonogram, no underlying medical problems, adequate pain control, and proximity to an acute care adeptness if needed from home. however, given the effectiveness of laparoscopic cholecystectomy, the only patients who will receive checkup dissolution are by and large those who are nonobese patients with very small cholesterol gallstones and a serve gallbladder. SURGICAL. There are respective surgical or procedural treatment options. The one seen most normally today is a laparoscopic cholecystectomy, which is performed early ( within 48 hours of acute onset of symptoms ) in the course of the disease when there is minimal excitement at the base of the gallbladder. It is considered the standard of care for the surgical management of cholecystectomy. The procedure is performed with the abdomen distended by an injection of carbon paper dioxide, which lifts the abdominal wall away from the viscera and prevents injury to the peritoneum and other organs. A laparoscopic cholecystectomy is done either as an outpatient routine or with less than 24 hours of hospitalization insurance. After the surgery, the patient may complain of pain from the presence of residual carbon dioxide in the abdomen. The traditional candid cholecystectomy is performed on patients with large stones arsenic well as with other abnormalities that need to be explored at the time of operation. This operation is particularly allow up to 72 hours after onset of acute cholecystitis. clock of the operation is controversial. early cholecystectomy has the advantage of resolving the acute circumstance early in its run. Delayed cholecystectomy can be performed after the patient recovers from initial symptoms and acute inflammation has subsided, generally 2 to 3 months after the acute event. Extracorporeal daze wave lithotripsy, similar to the type used to dissolve nephritic calculus, is now besides used for minor stones. For those patients who are not dependable surgical candidates, both methods have the advantage of being noninvasive. however, they have the disadvantage of leaving in seat a gallbladder that is diseased, with the same aptness to form stones as before treatment.

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Pharmacologic Highlights: Medication or Drug ClassDosageDescriptionRationaleOral bile acid therapy; ursodeoxycholic acid10–15 mg/kg per day for 6–12 moNonsurgical method to dissolve gallstonesUsed for small stones (< 10 mm in diameter) in a functioning gallbladder in nonobese patientsAntibiotics; ciprofloxacin, meropenem, imipenem/cilastatin, ampicillin/sulbactam, piperacillin/tazobactamVaries with drugAntibiotic regimen is focused on those appropriate for typical bowel flora (gram-negative rods and anaerobes): third-generation cephalosporin or aminoglycoside with metronidazoleManage bacteria that are typical bowel floraDemerol (drug of choice for pain control)25–100 mg IM, IVOpiates relieve pain and promote spasms of the biliary ductPain is severe; analgesia should be offered only after definitive diagnosis has occurred Other Drugs: The pain is treated by both analgesics and anticholinergics such as dicyclomine ( Bentyl ) during acute attacks. The anticholinergics relax the smooth muscle, preventing biliary contraction and pain. Antiemetics may be administered, particularly promethazine or procholperazine. If inflammation of the gallbladder has led to gallstones and obstruction of bile hang, refilling of the fat-soluble vitamins is important to supplement the diet. Bile salts may be prescribed to aid digestion and vitamin preoccupation deoxyadenosine monophosphate well as to increase the ratio of bile salts to cholesterol, aiding in the dissolution of some stones .