Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous gall bladder stone patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
Call Now for appointments –+91-9972446882 .
Gall bladder stone and its complications
Incidence of gall bladder stone increases with age. At age 60, approximately 25% of women and 12% of men have gallstones. In some countries (e.g., Sweden, Chile) and among certain ethnic groups (e.g., Pima Indians), the incidence of gallstones may approach 50% for gall bladder stone treatment in Bangalore.
Type of symptoms of Gall bladder stone
- Those who are asymptomatic, those with symptoms, and those who develop complications. This is generally a stepwise progression. The majority of people with gallstones never become symptomatic.
- Of the asymptomatic patients with gallstones, only 1% to 2% per year will manifest symptoms of biliary colic. It is unusual (<0.5% per year) for an asymptomatic patient to develop complicated gallstone disease without first suffering symptoms.
- Complications develop in ~3% of patients with symptomatic biliary colic per year. These complications include acute cholecystitis, choledocholithiasis, cholangitis, pancreatitis, and gallstone ileus.
Asymptomatic gallstones
How is it diagnosed ?
Asymptomatic gallstones-
Are usually discovered on routine studies performed on healthy patients or patients being investigated for a symptom not related to the presence of gallstones. This may include radiopaque stones found on routine x-ray or gallstones visualized during obstetric ultrasonography. Common abdominal symptoms such as dyspepsia, bloating, eructation, or flatulence without associated pain are probably not caused by gallstones. Gallstones may also be discovered incidentally at laparotomy. In this situation, the patient’s history and physical exam must be reviewed to determine whether the gallstones were truly asymptomatic.
Symptomatic gallstones (biliary colic)-
Diagnosis largely depends on correlating symptoms with imaging. Differential diagnoses includes acute cholecystitis, peptic ulcer disease, renal colic, gastroesophageal reflux, irritable bowel syndrome, and diseases based in the chest, including inferior wall myocardial ischemia/infarct or right lower lobe pneumonia. Appropriate auxiliary testing is dictated by clinical suspicion of these entities.
Symptoms. Biliary colic is the main symptom and is initiated by impaction of a gallstone in the outlet of the gallbladder. Typical pain is characterized by the following four attributes:
- Periodicity. The pain comes in distinct attacks lasting 30 minutes to several hours, between which the patient is well.
- Location. The pain occurs in the epigastrium or right upper quadrant.Severity. The pain is steady and intense and may cause the patient to cry or restrict breathing. Frequently it is so severe that it prompts the patient to seek professional care immediately, and parenteral narcotics may be necessary for control.
- Timing. The pain occurs within hours of eating a meal; often, it awakens the patient from sleep for gall bladder stone treatment in Bangalore.
- Other related symptoms include back pain, left upper quadrant pain, nausea, and vomiting, but it is important to understand that these usually occur in addition to rather than in place of the pain as described. Although the pain may be atypical (varying in one or more of the four attributes), the less typical the pain, the more another cause should be suspected.
Physical signs include– mild right upper quadrant tenderness, although there may be few abdominal findings during an attack of biliary colic. Jaundice is not typical.
Diagnostic Tests.
Ultrasound diagnosis is based on the presence of echogenic structures in conjunction with posterior acoustic shadows. There is usually little or no associated gallbladder wall thickening or other evidence of cholecystitis. The biliary ducts must be assessed for evidence of dilatation or choledocholithiasis (gallstones in the common bile duct) for gall bladder stone treatment in Bangalore.
Pathology. Note that chronic cholecystitis is a pathological term and not a clinical diagnosis. Patients with symptomatic gallstones have chronic cholecystitis (chronic inflammatory cells, fibrosis) in the wall of the gallbladder.
Laparoscopic cholecystectomy is the appropriate treatment for the vast majority of patients with symptomatic gallstones (see Section I.F.1.).
Complications of Gall bladder stone
- Acute calculous cholecystitis is an inflammatory complication of cholelithiasis that involves the gallbladder to a variable degree. As in biliary colic, acute cholecystitis is initiated by obstruction of the cystic duct by an impacted gallstone. Persistance of stone impaction leads to inflammation, by incompletely understood mechanisms, but supersaturated bile seems important. Although the onset and character of the resulting pain resemble those of biliary colic, the pain is unremitting and may persist for days. In a limited number of cases, one of the complications of acute cholecystitis may develop, including empyema, gangrene, or contained or free perforation of the gallbladder with abscess formation for gall bladder stone treatment in Bangalore.
- Diagnosis of cholecystitis depends on the constellation of symptoms and signs and the demonstration of characteristic findings with diagnostic imaging.
The symptoms of acute cholecystitis are similar to but more severe than those of biliary colic. - Unlike in the case of biliary colic, the right upper quadrant pain is persistent. As the inflammatory process progresses to the parietal peritoneum, patients develop tenderness in the right upper quadrant or even more diffusely and are reluctant to move.
- Systemic complaints such as anorexia, nausea, and vomiting are common. Rigors may occur but are uncommon. Fever may or may not be present. Murphy’s sign (inspiratory arrest during deep palpation of the right upper quadrant) is characteristic of acute cholecystitis and is most informative when the acute inflammation has subsided and direct tenderness is absent for gall bladder stone treatment in Bangalore. Mild jaundice may be present, but severe jaundice is rare and suggests the presence of common bile duct stones, cholangitis, or obstruction of the common hepatic duct. Biliary obstruction may occur as a result of external compression of the common bile duct by a large stone impacted in the Hartmann pouch and the associated intense pericholecystic inflammatory process; this is termed Mirizzi syndrome for gall bladder stone treatment in Bangalore.
Laboratory abnormalities may include leukocytosis although often the white blood cell count is normal. - Complications of cholecystitis, such as gangrene, perforation, or cholangitis, are suggested by an extremely high white blood cell count, . Liver function tests, including serum bilirubin, alkaline phosphatase, and serum amylase tests, also may be abnormal. However, patients with acute cholecystitis often present with persistent right upper quadrant pain even in the absence of fever or leukocytosis for gall bladder stone treatment in Bangalore.
Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous gall bladder stone patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
For Appointments Call Now ! –+91-9972446882 .
Diagnostic Tests for complications of Gall bladder stone.
- Ultrasonography is the best test for diagnosing acute cholecystitis. Findings indicative of acute cholecystitis include gallbladder wall thickening, pericholecystic fluid, and a sonographic Murphy sign (tenderness over the gallbladder when directly compressed by the ultrasound probe). In one meta-analysis, the sensitivity and specificity of ultrasonography for evaluating patients with suspected gallstones were 0.84 and 0.99, respectively. For the diagnosis of acute cholecystitis, the sensitivity was 0.88 and specificity 0.80 (Arch Int Med 1994;154:2573).
- Radionuclide cholescintigraphy occasionally is useful when the diagnosis is still unclear after ultrasonography. Scintigraphic scanning with derivatives of iminodiacetic acid such as hepatic 2,6-dimethyliminodiacetic acid (HIDA) enables visualization of the biliary system. The radionuclide is concentrated and secreted by the liver, allowing visualization of the bile ducts and the gallbladder normally within 30 minutes for gall bladder stone treatment in Bangalore. Because the test depends on hepatic excretion of bile, it may not be useful in jaundiced patients. Nonfilling of the gallbladder after 4 hours in the appropriate clinical setting is good evidence of acute cholecystitis. Administration of morphine may increase the sensitivity and specificity of the test by encouraging spasm of the sphincter of Oddi and thereby enhancing gallbladder filling for gall bladder stone treatment in Bangalore.
- Computed tomographic (CT) scanning occasionally is performed to evaluate the patient with abdominal pain and acute illness. CT scan can demonstrate gallstones, although it is less sensitive for these than is ultrasonography. Other signs of acute cholecystitis on CT scan may include gallbladder wall thickening, pericholecystic fluid and edema, and emphysematous cholecystitis (air in the gallbladder or gallbladder wall) for gall bladder stone treatment in Bangalore.
Gall bladder stone treatment in bangalore
- Initial management for patients with acute cholecystitis includes hospitalization, intravenous fluid resuscitation, and parenteral antibiotics appropriate for the Gram-negative rods and anaerobes that are typical of bowel flora.
- Acute cholecystitis often resolves with nonsurgical initial management. However, the patient must be reassessed frequently with respect to fever curve, symptoms, physical signs of inflammation, and laboratory values. If the patient is deteriorating or not improving, alterations in management must be made. These include changing the antibiotic regimen, percutaneous cholecystostomy, or operative cholecystectomy or cholecystostomy.
- Patients with acute cholecystitis should have cholecystectomy as definitive treatment . Controversy surrounds the timing of operation.
- Early cholecystectomy has the advantage of resolving the illness more quickly than delayed cholecystectomy for gall bladder stone treatment in Bangalore.
- The operation is best performed within 48 hours after the onset of symptoms for gall bladder stone treatment in Bangalore, when there is less inflammation around the base of the gallbladder. When cholecystectomy is performed during an episode of acute cholecystitis (as compared with symptomatic cholelithiasis), the rate of conversion from laparoscopic to open surgery increases from <1% to approximately 5% .
- Prospective, randomized trials comparing early versus delayed (6 weeks) laparoscopic cholecystectomy for acute cholecystitis suggest no significant differences in the conversion rate to open cholecystectomy between the two types. This suggests that for most patients with acute cholecystitis, early laparoscopic cholecystectomy should be attempted, with conversion to an open procedure if necessary.
- Tube cholecystostomy should be performed in patients who have acute cholecystitis and who are failing systemic therapy but are not candidates for cholecystectomy because of severity of illness or concomitant medical problems. Although cholecystostomy can be performed operatively, these patients usually benefit from the less invasive percutaneous approach.
- Drainage and decompression of the gallbladder almost uniformly resolves the episode of acute cholecystitis. After resolution of the acute episode, the patient can eventually undergo either cholecystectomy or percutaneous stone extraction and removal of the cholecystostomy tube. Such nonoperative stone removal as definitive treatment is reasonable in very elderly or debilitated patients who cannot have a general anesthetic for gall bladder stone treatment in Bangalore.
Dr Adarsh M Patil mbbs ms Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.
He has experience of treating numerous gall bladder stone patients in Bangalore .
He believes in that Patient safety comes first and strives to provide exceptional service to patients.
For Appointments Call Now ! –+91-9972446882 .