Patients With Large Common Bile Duct Stones

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.

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

The liver produces bile which contains conjugated bilirubin. It is then sent to the gallbladder, and it has to be excreted properly from there. However, the gallstones are blocking the way, which makes it hard for the bilirubin to get out, and results in a build-up. This leads to jaundice, which occurs when one has and excessive amount of bilirubin.

Review Ethics boards should be considerate of the patient’s they are using to conduct their research by first having them fill out an agreement to participate in the research. This idea is reinforced by a field researcher who had to get the patients to sign permission slips before interviewing them and the research wouldn’t reveal their identity. The field researcher found this was an effective way to make the patients whom the experiment is being conducted on comfortable and willing to participate. It allows the patients to have a say on whether they are willing to have specific research done on them whether related to psychological reasons such as asking questions or to have biological research

When a cystic duct is continuously obstructed inflammation occurs. Bile stasis triggers release of inflammatory enzymes and can be caused by fasting, obstruction, postsurgical/procedural irritation or ileus (total parenteral nutrition [TPN]), which can lead to bile inspissation that is directly toxic to the gallbladder epithelium. The damaged mucosa secretes more fluid into the gallbladder lumen than it absorbs. The resulting distention further releases inflammatory mediators (eg, prostaglandins), worsening mucosal damage and causing ischemia, all of which prolong inflammation and can cause a bacterial infection to occur later. The malicious circle of fluid secretion and inflammation leads to necrosis and perforation if it goes unchecked. If acute inflammation resolves then continues to recur, the gallbladder becomes fibrotic and contracted and does not concentrate bile or empty normally which is a feature of chronic cholecystitis. (Huffman, J. et al.,

In the case study regarding Mr. and Mrs. G, there were many questionable areas of concern regarding ethical practices and obtainment of an informed consent. As the nurse researcher, the duty to advocate for the patient is of primary concern. The first concern recognized through this case study is that of vague description of the study. As the nurse researcher, I would need to be made aware of the data collection process and the parameters upon which the research is based. Obtainment of data to be used in research must maintain patient confidentiality. Did the researchers use patient medical records, family member interviews, patient interviews or staff involvement in patient selection? Were there any HIPPA violations in the selection process? Were the subjects informed that they were being screened for participation? I would also need to assess the preliminary review of literature that is driving this particular study. What is the appropriate time to conduct a study such as this? Is the purpose of this study going to facilitate a change in patient outcomes? Awareness of the motivation for this study and the benefit that is expected to the future

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.

Cholelithiasis is the medical term for gallstones. The gallbladder is a small, pear-shaped organ situated in the upper part of the right abdomen below the liver. Gallstones are solid particles that build up in the gallbladder. The size of gallstones can range in size from that of sand grain to that of a golf ball. There may be a single large stone or several small and large stones of different sizes in the gallbladder. Approximately 10-15% of the adult population in the west is known to develop gall stones annually. Stones in the gallbladder form due to an imbalance in the chemical constituents of bile. Due to this, one or more components of bile get precipitated. The exact reason for this imbalance is not known. Patients suffering from this disease may experience a sudden pain ( called gall bladder attack, also called biliary colic)in the upper right abdomen. This pain occurs when the biliary ducts are blocked by the gallstones. Gallstones have been observed in people of all age groups. However, the risk increases with age. Obesity increases the risk of formation of gallstones. In females, oestrogen leads to secretion of more cholesterol, excess of which leads to formation of stones. Thus, the risk is higher in females. Genetic reasons also contribute to cholelithiasis. Other factors that increase risk of gallstones include

The current approaches to surgical management of gallstone ileus are: (1) enterolithotomy, cholecystectomy and fistula repair (single-stage surgery), (2) enterolithotomy with delayed cholecystectomy and fistula closure (two-stage surgery) and (3) simple enterolithotomy (most reported surgical procedure). Proponents of the single-stage procedure cite recurrence and increased risk of developing cholangitis or gallbladder carcinoma as reasons for performing concurrent cholecystectomy and fistula closure [18]. Those who support the two-stage procedure or simple enterolithotomy point to high mortality rates of single-stage procedures and low rates of recurrence and gallbladder carcinoma as reasons

Gall bladder ultrasound typically helps in establishing the diagnosis of Cholecystitis. A sonographic Murphy’s sign, (when the ultrasound probes the ultrasound patient will have pain) is a useful diagnostic

The gallbladder holds approximately 90ml of concentrated bile. Each day 700 to 1200 ml of bile is secreted and drained into the common bile duct and into the duodenum. (Kathryn L. McCance, 2014) As outlined earlier the blockage of the Sphincter of Oddi will cause all of this bile to be forced back up the common bile duct and into the gallbladder. The amount of fluid produced in a day far outweighs the capacity of the gallbladder causing it to become distended. This distention activates the pain fibers causing abdominal discomfort, especially during large meals. The same mechanism is found when the pancreas secretes pancreatic enzymes. The enzymes become stuck at the SO and are required to travel back up the main pancreatic duct into the pancreas; this causes pain and discomfort due to the distention of the

My diagnosis for Lars is that he has chronic cholecystitis, which is a type of constant inflammation of the gallbladder. According to research, the chronic cholecystitis is one of the “most common biliary diseases” (Sato et al., 2002). With Lars’ situation, his rapid weight loss which decreases the lipids can create an imbalance of bile composition which then increases the chances of having gallstones in the gallbladder.

Primary biliary cholangitis (PBC) is a rare, autoimmune cholestatic liver disease that puts patients at risk for life-threatening complications. PBC primarily affects women, afflicting approximately one in 1,000 women over the age of 40. If left untreated, or if a patient does not adequately respond to treatment, chronic inflammation and fibrosis can advance to

The gallbladder stores and concentrates bile. If the gallbladder was damaged or dysfunctional there would be softer and more frequent stools. (Audesirk, T., & Audesirk, G. (1999). Retrieved November 21, 2015 from Chapter 29: Nutrition and Digestion. In Biology: Life on Earth (5th ed., p. 585, 586). Upper Saddle River, N.J.: Prentice Hall.) (General Surgery- Gallstones (Cholelithiasis). (n.d.). Retrieved November 21, 2015, from

All these patients underwent a reconstructive surgery (5 cases urgently and 18 cases electively), in the form of Roux-en-Y HJ and choledocho-duodenostomy. Drainage of bile collections was initially established percutaneously (2 cases) or surgically (3 cases), to stabilize the patient's condition in cases with removed or slipped drain.