Cholecystectomy

Cholecystectomy means the excision of the gallbladder.

Cholecyctectomy is the treatment of choice for cholecystitis. Even though some physicians would like to manage the patient conservatively, many think it is appropriate to do the surgery as early as possible to reduce the risk of recurrence. 

If the disease recurs, the symptoms may become worse and the patient may deteriorate fast. Therefore, the surgery is usually done within first 48 hours. 

Now with advancement of the laparoscopic surgeries, the first choice of removal of gallbladder is by a laparoscopic cholecystectomy. It was earlier done by laperotomy and it is still being used when laparoscopic surgery is unavailable and when any complication arise during laparoscopic cholecystitis. 

Complications of cholecystectomy

·         Bile duct injury

·         Bleeding

·         Wound infection

·         Hypertrophic scar

·         Keloid

·         Burst abdomen

·         Incisional hernia

·         Deep vein thrombosis

·         Post cholecystectomy syndrome

This is said when the symptoms persist even after the surgery. It is mainly due to wrong diagnosis.

References:

Kumar and Clark's clinical Medicine Seventh Edition

Bailey and Love's Short Practice of Surgery 25th Edition

Abdominal Pain? Is it gallstones? What are the signs & Symptoms?

If you have abdominal pain, it could be due to gallstones, but there are docents of other diseases which may cause abdominal pain. Therefore, a thorough analysis of your symptoms should be done followed by examinations and investigations to establish the diagnosis of gallstones.

Gallstones can be found in following places. The symptoms vary according to the place where the gallstones are. 

·         Gallbladder

Gallbladder is the organ which acts as a reservoir of bile secreted by the liver. It also concentrates bile by active absorption of water.  

Majority of patients who have stones in the gall bladder do not show any symptoms. The diagnosis is usually incidental in such cases.

They start showing symptoms once they develop any of the following conditions.

o   Acute cholecystitis

The gallstones in the gallbladder can migrate in to the cystic duct and thereby obstruct the bile outflow from the gallbladder. In such situations the gallbladder wall contracts forcefully to overcome the obstruction.

So the patient experiences billiary colic. So you may experience pain over the upper right side of the abdomen. It starts recently, and the pain is very high. The pain is persistent and may radiate to the tip of the right shoulder and to the right infrascapular region.

Usually the pain is relieved by pain killers. You may also have vomiting, and low grade fever.

The right upper abdomen is painful to touch.

o   Empyema of gallbladder

o   Emphysematous cholecystitis

o   Perforation and billiary peritonitis

o   Chronic cholecystitis

o   Mucocele of the gallbladder

o   Carcinoma of the gallbladder

It is not necessary that each and every patient may finally develop any of the above conditions. Some people may live with no symptom or complication even they have gallstones.

·         Common bile duct

You may have acute onset, persistent sever epigastric pain radiating to the right upper abdomen, tip of the shoulder and right infrascapular region. You may also experience vomiting. The pain is relieved with pethidine.

Your eyes will become deeply yellowish. You may have fever with chills and rigors.

·         Pancreatic duct and terminal Ileum are other places where gallstones could be present.

More : Cholecystectomy

References:

Bailey and Love’s Short Practice of Surgery 25^th Edition

Kumar and Clark’s Clinical Medicine 7^th Edition