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Cholecystectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
It is possible to have gallbladder disease without gallstones though this should only be considered after appropriate investigations. Two situations are worthy of note. Biliary dyskinesia, though controversial, is being increasingly recognized as a cause of epigastric or right upper quadrant abdominal pain, nausea, and/or vomiting. If a radioisotope gallbladder-emptying scan can show an abnormal ejection fraction of <35% (or better still <10%), then cholecystectomy may be considered. Still, up to 40% of those patients will not benefit from surgery.Acalculous cholecystitis in children arises in association with and is caused by severe sepsis, trauma, or burns. Ultrasound may show evidence of the inflammatory process, with mural edema and thickening, gallbladder distention, and occasionally sludge. It should be treated conservatively in the first instance though acute decompression with a cholecystostomy may be considered.
Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The principles of abdominal surgery include taking a proper history, proper examination, appropriate explanation and consent, appropriate surgical procedures, and careful follow-up. The introduction of endoscopic techniques, laparoscopic techniques, and minimally invasive procedures for the treatment of many conditions has changed the practice of abdominal surgery. The introduction of medication for the treatment of peptic ulcers is one example of how a whole section of abdominal surgery has disappeared. The introduction of drugs to treat gallstones could affect the treatment of gallbladder disease in the future, although removal of the gallbladder and the treatment of stones remains the most effective form of treatment. Medicine, like many other ‘high-tech’ subjects, changes rapidly. Educating surgeons and the public remains an important function. Patients must have realistic expectations and should fully understand the principles of the surgical procedure and the expected outcome. Complications can occur even when the most experienced surgeons are operating and they do not by themselves represent negligence. All surgeons experience complications but it is the recognition of the complication and the appropriate management of that complication which differentiates the negligent surgeon from the surgeon who is carrying out his practice in accordance with standard clinical practice.
The Liver and the Biliary System
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Early presenting signs and symptoms of gallbladder cancer are similar to any gallbladder disease. Therefore, in most cases, the diagnosis of gallbladder cancer is not made clinically. Even at surgery, the diagnosis may be missed until the pathologist reports it. Radiological studies also do not differentiate between benign and malignant gallbladder disease. They only reveal a nonfunctioning gallbladder. If other anomalies are detected, it is due to the more advanced stages of the disease rather than accurate early diagnosis of the case. Sonography can detect some but again cannot differentiate between the carcinoma and a benign papillary lesion in the gallbladder. CT scanning will detect advanced cases but cannot differentiate between a thickened wall of the gallbladder due to tumor or due to a benign condition such as the inflammatory cases which are more common.
Erector Spinae Plane Block Enhances Multimodal Analgesia for Laparoscopic Cholecystectomy
Published in Journal of Investigative Surgery, 2022
Hao Tan, Hui-Fang Huang, I-Cheng Lu
Laparoscopic cholecystectomy has become the gold standard for the treatment of gallbladder disease, with the advantages being minimal invasiveness, less postoperative pain, and faster recovery. The enhanced recovery after surgery (ERAS) protocols for laparoscopic gastrointestinal surgery have shown beneficial outcomes, not only in terms of reducing opioid consumption, but also in reducing the number of adverse events and achieving a shorter hospital stay [2,3]. To our best knowledge, there are no reports of ERAS guidelines for minor abdominal procedures, such as laparoscopic cholecystectomy. We were thus interested to see how the authors used multimodal analgesia, which is one of the core elements of ERAS protocols, in their comparative study of EPS and STAP blocks [1]. The authors report using a routine multimodal analgesia regimen including a preoperative ESP or STAP block, intraoperative paracetamol and tenoxicam, postoperative intravenous paracetamol, and patient-controlled fentanyl analgesia. Our major concern with this study is that we found it partially against ERAS guidelines to use patient-controlled fentanyl analgesia and meperidine as a rescue in laparoscopic surgery. The purpose of multimodal analgesia is to reduce opioid consumption and associated adverse events for enhanced recovery after abdominal surgery [4].
The relationship between UGT1A1 gene & various diseases and prevention strategies
Published in Drug Metabolism Reviews, 2022
Dan Liu, Qi Yu, Qing Ning, Zhongqiu Liu, Jie Song
The liver is the main drug-metabolizing organ that maintains the normal function of the living system. However, high-intensity liver burdens, such as alcoholism, medication, and infection, may impair the liver’s detoxification function, and other organ cells may also be negatively affected. Liver cells secrete bile every day. The gallbladder is the digestive organ in the human body. Its main function is to store and concentrate bile. Therefore, there is an old saying in Traditional Chinese medicine theory that liver and gallbladder assist each other, and are interconnected. Cholestasis or the formation of secondary stones is symptoms of gallbladder disease. Herein, we summarize the hepatobiliary diseases associated with UGT1A1, shown in Figure 2. And the corresponding treatment strategies reported in the literature are summarized, as shown in Table 1.
The influences of cholecystectomy on the circadian rhythms of bile acids as well as the enterohepatic transporters and enzymes systems in mice
Published in Chronobiology International, 2018
Fan Zhang, Yingting Duan, Lili Xi, Mengmeng Wei, Axi Shi, Yan Zhou, Yuhui Wei, Xinan Wu
Cholecystectomy, the best and most effective treatment for gallbladder diseases, is one of the most frequently performed abdominal surgeries worldwide. Under physiological conditions, the gallbladder handles up to 80% or more of the bile secreted by the liver, and it is well known that the circadian cycle of gallbladder filling and emptying controls the flow of bile into the intestine and the enterohepatic circulation of BA, which plays a pivotal role in regulating the physiological homeostasis (Housset et al. 2016). It has been demonstrated that long-term medical consequences of cholecystectomy would increase the risk of non-alcoholic fatty liver disease, diarrhea and colon cancer (Siddiqui et al. 2009; Nervi and Arrese 2013; Ruhl and Everhart 2013; Housset et al. 2016; Ridlon et al. 2016). Thereby, it is also plausible to postulate that the resection of gallbladder has a crucial effect on the circadian rhythms of BAs and could even cause the alternation on the circadian clock of BAs’ relevant transporters and enzymes; these more probably would be the key contributors leading to the relevant disorders and the chronopharmacology alternation of drugs in vivo after cholecystectomy (Housset et al. 2016; Ridlon et al. 2016).