Wednesday, December 30, 2015

Gallstone Disease: Initial Management

  • Cholelithiasis = gallstone
  • Choledocholithiasis = presence of gallstones within the common bile duct
Managing gallbladder stones
  • Reassure people with asymptomatic gallbladder stones found in a normal gallbladder and normal biliary tree that they do not need treatment unless they develop symptoms.
  • Offer laparoscopic cholecystectomy to people diagnosed with symptomatic gallbladder stones.
  • Offer early laparoscopic cholecystectomy (to be carried out within 1 week of diagnosis) to people with acute cholecystitis.
  • Offer percutaneous cholecystostomy to manage gallbladder empyema when:
    • surgery is contraindicated at presentation and
    • conservative management is unsuccessful.
Managing common bile duct stones
  • Offer bile duct clearance and laparoscopic cholecystectomy to people with symptomatic or asymptomatic common bile duct stones.
  • Clear the bile duct:
    • surgically at the time of laparoscopic cholecystectomy or
    • with endoscopic retrograde cholangiopancreatography (ERCP) before or at the time of laparoscopic cholecystectomy.
  • If the bile duct cannot be cleared with ERCP, use biliary stenting to achieve biliary drainage only as a temporary measure until definitive endoscopic or surgical clearance.
  • Use the lowest‑cost option suitable for the clinical situation when choosing between day‑case and inpatient procedures for elective ERCP.
Bile Salt Therapy (ursodeoxycholic acid)
  • Suppress hepatic cholesterol secretion and inhibit intestinal absorption of cholesterol. It solubilizes cholesterol in micelles and acts by dispersing cholesterol in aqueous media
  • Medical management is more effective in patients with good gallbladder function who have small stones (< 1 cm) with a high cholesterol content. 
  • Bile salt therapy may be required for more than 6 months and has a success rate less than 50%.
Patient, family member and carer information
  • Advise people to avoid food and drink that triggers their symptoms until they have their gallbladder or gallstones removed.
  • Advise people that they should not need to avoid food and drink that triggered their symptoms after they have their gallbladder or gallstones removed.
References: 
  1. https://www.nice.org.uk/guidance/cg188/chapter/1-Recommendations
  2. http://emedicine.medscape.com/article/175667-treatment#d11

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.