Chronic Cholecystitis With Cholelithiasis | All About Cholelithiasis

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It is the Calculi (stones) in the Gall’s bladder that may obstruct the cystic or Common bile duct. Choledocholithiasis is the rocks in the Common bile duct.

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Chronic cholecystitis with cholelithiasis

Therapy for simple cholelithiasis is symptomatic. Cholecystitis develops when irritation and inflammation of the gallbladder mucosa gradually develop. Cholecystitis can be acute or chronic as well as calculous or acalculous.

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Types

 Composed primarily of pigment

  • It occurs when the balance that keeps cholesterol, bile salts, and calcium is altered, causing precipitation of these substances Conditions affecting balance: infection and altered metabolism of cholesterol.

Composed primarily of cholesterol

  • Bile in GB and liver become saturated with cholesterol.
  • Conditions affecting balance: infection and altered metabolism of cholesterol.
  • Bile in GB and liver become saturated with cholesterol.

Signs and symptoms

  • Silent cholelithiasis
  • Pain and biliary colic
  • Bile obstruction
  • Changes in the color of stool
  • Urine, vitamin deficiency, bleeding
  • Steatorrhea(fat in the feces)

Diagnostic studies

  • History & physical examination
  • Would these laboratory tests show increased or decreased levels?  
  • Liver function tests
  • WBC count
  • Serum bilirubin
  • Serum amylase
  • Abdominal x-rays
  • Ultrasonography – most accurate
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Percutaneous transhepatic cholangiography

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Treatment

  • Acute episodes focus on. 
  • Pain control. 
  • Morphine.
  • Dilaudid (hydromorphone).
  • Ketorolac (Toradol). 
  • Demerol (Meperidine).  
  • NSAIDS, anticholinergics.
  • Infection Control – antibiotics. 
  • Fluid and electrolyte balance.
  • IV fluid.
  • Antiemetics. 
  • Metoclopramide (Reglan). 
  • Ondansetron (Zofran).
  • Prochlorperazine (Compazine).
  • Fat-soluble vitamin replacement: A, D, E, K.
  • Bile salts: Ex: Decholin; enhance fat absorption.
  • Bile acids: Exs: Questran and Colestid.  
  • Bind bile salts and treat pruritus. 

Non surgical stone approaches stone removal

  • Endoscopic sphincterotomy (papillotomy).
  • Mechanical lithotripsy.   
  • Cholesterol solvents.
  • Extracorporeal shock wave lithotripsy.  

Cholecystectomy

  •  Gall bladder removed through Four puncture holes.
  •  Removal of GB via a right subcostal incision. 
  •  To Prevent Complications, primarily pulmonary.
  •  Wound Care.
  •  Dietary modification.

I tried to cover as much as I could for Cholelithiasis, but if you still have a question in your mind, feel free to give us comment.

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