Essay On Laparoscopic Cholecystectomy

ABDOMEN: The lung basis appeared unremarkable. The liver, spleen, gallbladder, adrenals, kidneys and pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seen constant with acute appendicitis. Osseous structures of the abdomen appeared unremarkable. No free air was seen.

When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam or CT Scan, the most sensitive and specific test for gallstones. Other exams that may be performed are a Cholescintigraphy a.k.a. HIDA (hepatobiliary iminodiactec acid) Scan, ERCP (endoscopic retrograde cholangiopancreatography), and blood tests.

Abdomen: The lipases appeared unremarkable. The liver, spleen, gallbladder adrenals, kidneys, pancreas and abdominal aorta appeared unremarkable. The bowels seen on the study appeared thickened. Dilated appendix seemed consistent with acute appendicitis. All the structures of the abdomen appeared unremarkable. No free air was seen.

There seem to be an increasing application of Roen-en-Y gastric bypass today by some surgeons. This is a restrictive procedure that has minimal mal-absorption issues and it makes part of an array of bariatric surgeries. However, the most commonly used procedure is biliopancreatic diversion or Scopinaro, which have been used for more than two decades and are popular in with many surgeons more so in the developing countries. This process is intended to inhibit absorption of fat in a bid to trigger massive weight loss in patients who are morbidly obese. It restricts gastric thereby diverting bile and pancreatic fluids to the distal ileum (Consensus Development Conference Panel, 1991). This procedure therefore exposes a limited area of small bowel for the absorption of nutrients that need biliary and pancreatic fluids. The procedure and its variations are still common as indicated above including; biliopancreatic diversion with duodenal switch, which also result in malabsorption. It is however noted that most patients who undergo this procedure also experience severe protein and fat related malabsorption problems.

I knew the severe symptoms that I had were not characteristic of gallbladder disease. Particularly not in the beginning, when there was only a very small amount of gallbladder sludge. The very elevated liver enzymes I had were also a mystery because they also do not occur when there is gallbladder sludge alone. They can occur when there is sludge blocking a duct, but there never appeared to be any obstructed ducts in either of the ultrasounds I had during that

c) While palpating the liver ask the pt to take a deep breath. Sharp abdominal pain occurs in pt’s with cholecystitis. (in the RUQ)

Obstetric Cholestasis (OC) or Intraheptic Cholestasis of pregnancy is a disorder that is unique to pregnancy (Kelly and Nelson-Piercy, 2000).OC classically presents in the third trimester (Royal College of Obstetricians and Gynaecologists [RCOG], 2006), With maternal pruritus and raised bile acids (Geenes and Williamson, 2009).It is one of the few disorders of pregnancy that can affect both maternal well being and fetal outcome. OC usually resolves forty eight hours after delivery (Mays, 2010).

Other symptoms of gall stone formation in your body are decreased appetite, severe pain by your left side, vomiting, low grade fever, abdominal distention, flatulence, elevated cholesterol level and taking deep breaths causes you pain.

Mr. Johnson’s reason for driving himself to the emergency room and the symptoms he is experiencing in conjunction with test, and lab results led me to this conclusion. Johnson noticed pain from his epigastric region, radiating to the right shoulder and scapular region. During his emergency room physical exam the physician noted, palpation of the epigastric region demonstrated tenderness with guarding, an above normal body temperature, increased blood pressure, as well as an increased heart rate. The increase in body temperature can be linked to a gallbladder infection. The pain Mr. Johnson is feeling radiating to the

The ultrasound will look for the presence of gallstones, inflammation of the liver, blockage of the bile duct, thickened gallbladder walls or an oversized bile duct tract. An ultrasound can detect gallstones that are two millimeters or larger in size.

Gallstones are described as digestive fluid that has hardened which can be very painful. They form in the gallbladder which is a pear shaped organ that is located on the right side of of the abdomen right underneath the liver. Gallstones can be many sizes which varies how much the pain is. They can be as small as a crumb to a size of a golf ball! Ouch! Also, some people have more than one, while other people may just have one. More than likely, you will have symptoms if you have gallstones and if you do have symptoms, most people have to get gallstone removal surgery. These symptoms may include, sudden pain in your upper right side of the abdomen or under the breast, back pain between shoulder blades, right shoulder pain, nausea, or vomiting.

The initial plan started with ordering a CBC, CMP, amylase and lipase STAT. These are all standard labs that help to rule out gallbladder pathology as well as our other differential diagnoses. Her vital signs were stable and the physical exam revealed only moderate TTP of the RUQ and epigastric region. The lab results revealed no leukocytosis, no elevation of liver enzymes, bilirubin, amylase, lipase, alk phos or any other signs of cholecystitis, cholangitis, pancreatitis or other potential signs of infection. The plan of care began with keeping the patient NPO. This is recommended as this keeps the patient from further pain secondary to food stimulating gallbladder contraction.5 It also allows the patient to be prepared for surgery if urgent cholecystectomy is required. The next step was beginning IV normal saline to keep her well hydrated. After this we began to give her medication through the IV including Zofran for her nausea. Zofran is an effective anti-emetic and there were no contraindications for use in this patient. We also gave her Morphine 2 mg IV for pain control. Opioids are an effective option for a patient with significant biliary colic.6 Although NSAIDS are another option for pain control, PUD was part of the differential diagnosis so NSAIDS were not an appropriate therapy. We ordered an abdominal ultrasound as this is the diagnostic test of choice for cholelithiasis. The ultrasound revealed multiple gallstones in the gallbladder, some mild gallbladder thickening, and some dilatation of the common bile duct. At this point we consulted GI who scheduled the patient for MRCP in the morning in order rule out choledocholithiaisis. We also consulted the surgery team who admitted the patient. The stated they would likely plan for laparoscopic

I. Introduction: It is estimated that approxiamately 10 to 20 percent of the population in the United States and Western Europe are currently being affected by Gallbladder attacks.

Treatment: Treatment for cholecystitis is mainly bowel rest, pain management, antiemetics, IV antibiotics, IV fluids for hydration and correction of electrolyte abnormalities. Surgical management includes laparoscopic cholecystectomy, ERCP, endoscopic ultrasound-guided transmural cholecystostomy, and endoscopic gall bladder drainage (Bloom, 2016).

Although many adults may present with any of these abdominal symptoms, acute (sudden severe inflammation of the gallbladder), lactose intolerance, and hepatitis there are differences in presentation and predominance of disease process between 20 year old and fifty year old middle age adult (Lange, 2012). Symptoms are difficult to indicate for many young adults they present with vague symptoms. Often it may be