Gallbladder disorders
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Gallstones are the most common--but not the only---disease of the gallbladder. Others include:
beneficial because it blood levels of cholesterol. Try to get 30 minutes of aerobic exercise--jogging, swimming, cycling, playing tennis, brisk walking--at least three to five times a week.
Medications
If you have intense pain in your upper abdomen, call your doctor right away or go to an emergency room. You'll probably be put on intravenous (IV) medications, which may include a painkiller such as morphine, drugs to stop your vomiting and if you have signs of an infection, antibiotics. You'll get electrolytes and fluids by IV. If your pain clears up and blood test don't reveal any complications, you're likely to be sent home with oral painkillers, and perhaps antibiotics. However, expect to have a conversation with your doctor regarding surgery.
Medication to dissolve gallstones, ursodeoxycholic acid or ursodiol, is successful only in cholesterol gallstones. If there's too much bile pigment relative to cholesterol in the stone, ursodial can't dissolve it. This oral treatment is often combined with extracorporeal shockwave lithotripsy (see Procedures, below) to reduce the size of the stone. It is usually reserved for small number of cases who have uncomplicated but symptomatic gallstones and who are not candidates for surgery.
>Why is my doctor going to take out my whole gallbladder rather than just my gallstones?
Removing your gallbladder is the only to keep gallstones from coming back. If you have gallstones, you're likely to continue to form them even if your existing ones are removed. A gallstone attack is painful and debilitating, and while some people experience one only every few years, others have them with great frequency. This is why most people when told that after surgery they'll never pass another gallstone, say, 'where do I sign?'.
>Don't I need my gallbladder to digest food?
Contrary to what you might think, removing your gallbladder doesn't interfere with digestion. Instead, bile will simply pass from your liver right into your small intestine. You may experience some gas and bloating, but you can remedy these symptoms by sticking to a low-fat diet. Some people also report that bowel movements are looser and more frequent after surgery, but this typically improves with time.
HEREDIT Y CAN PLAY A REAL ROLE in determining your risk for developing gallstones. Among the Pima Indians of Arizona, for example, nearly 70% of women develop gallstones by the time they reach 30 years of age.
Procedures
For gallstones that cause problems, the most common treatment is surgery to remove the source of the problem--your gallbladder. This procedure is called a cholecystectomy. Until 1990, this was done via a long abdominal incision, in an operation called an open cholecystectomy. Today, some 90 percent of gallbladder removals are performed with a less invasive tehcnique called a laparoscopic cholecystectomy, known as a 'lap chole' (see illustration below). Four small incisions are made in the abdomen, and the gallbladder is removed using a tiny video camera and flexible surgical instruments. If any problems occur, the surgeon can revert to a conventional open cholecystectomy.
With a lap chole, you'll need to stay in the hospital for only a day (and sometimes even less if it's done as outpatient sugery), versus five days after open surgery. Your recovery time should be short, too; many people are back at their regualar activities within a week. (Traditional surgery has a four to six week recovery period.) Under most circumstances surgery is elective, meaning you can decide when you want it done. But if you're hospitalised and tests indicate that you have a serious complication, such as an abscess or gallbladder perforation, you'll need to have surgery immediately.
If your doctor suspects that you have a gallstone stuck in a bile duct but no infection, he may recommend an endoscopic retrograde cholangiopancreatography (ERCP). To do this, a flexible viewing tube with surgical attachments is passed through your mouth, oesophagus and stomach to your small intestine and into the tiny opening where the bile duct enters. your doctor can actually see the stone directly, grasp it with surgical instruments and remove it from the duct. Exploration of the common bile duct is frequently carried out, as 15 to 20 percent of patients with stones in the gallbladder will also have stones in this duct.
A small number of people may be able to treat their gallstones with procedures less invasive than surgery. One involves ultrasound waves (extracorporeal shockwave lithotripsy) that pulverise gallstones, so they're small enough to pass through bile ducts or be dissolved with medication. To be a candidate, you must have only one small stone and a healthy gallbladder. However, doctors recommend this only in rare cases because the treatment is slow, variable and costly, and is associated with high recurrence rates.
In this surgery, an instrument with a tiny camera (laparoscope) is inserted at the navel. Forceps inserted on either side hold the gallbladder while it is detached from the liver. The gallbladder (with its stones inside) is then teased out through the tiny navel incision.
PROMISING DEVELOPMENTS
What's the advantage?
With the robot, there are no extra hand movements or shaky instruments. Robot 'wrists' are also highly flexible, letting them reach areas that surgeons can't through the small incisions used for a laparoscopy. And the use of the
computer allows for a three-dimensional image, which gives a better view than the two-dimensional image used in a conventional laparoscopy.
So far, robotic surgery is done at only a small number of major medical centres, but its use is likely to spread in the future. Eventually, it may even allow specialists to perform surgery on patients hundreds of kilometres away.
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Gallstones are the most common--but not the only---disease of the gallbladder. Others include:
- Polyps in the gallbladder. New ultrasound techniques can help determine when a polyp is benign, requiring no action, and when it's malignant, needing removal.
- Acalculous cholecystitis. This is a gallbladder inflammtion without stones. The acute version usually strikes people in a weakened condition ---from a serious illness, surgery, burns or a systematic infection. The chronic version stems from anatomical defects. Treatment is surgical removal of the gallbladder.
- Cancer of the gallbladder or bile ducts. Very rare, it is usually found in people over 70 years of age. If the cancer has not spread, your doctor will remove your gallbladder and bile ducts.
beneficial because it blood levels of cholesterol. Try to get 30 minutes of aerobic exercise--jogging, swimming, cycling, playing tennis, brisk walking--at least three to five times a week.
Medications
If you have intense pain in your upper abdomen, call your doctor right away or go to an emergency room. You'll probably be put on intravenous (IV) medications, which may include a painkiller such as morphine, drugs to stop your vomiting and if you have signs of an infection, antibiotics. You'll get electrolytes and fluids by IV. If your pain clears up and blood test don't reveal any complications, you're likely to be sent home with oral painkillers, and perhaps antibiotics. However, expect to have a conversation with your doctor regarding surgery.
Medication to dissolve gallstones, ursodeoxycholic acid or ursodiol, is successful only in cholesterol gallstones. If there's too much bile pigment relative to cholesterol in the stone, ursodial can't dissolve it. This oral treatment is often combined with extracorporeal shockwave lithotripsy (see Procedures, below) to reduce the size of the stone. It is usually reserved for small number of cases who have uncomplicated but symptomatic gallstones and who are not candidates for surgery.
>Why is my doctor going to take out my whole gallbladder rather than just my gallstones?
Removing your gallbladder is the only to keep gallstones from coming back. If you have gallstones, you're likely to continue to form them even if your existing ones are removed. A gallstone attack is painful and debilitating, and while some people experience one only every few years, others have them with great frequency. This is why most people when told that after surgery they'll never pass another gallstone, say, 'where do I sign?'.
>Don't I need my gallbladder to digest food?
Contrary to what you might think, removing your gallbladder doesn't interfere with digestion. Instead, bile will simply pass from your liver right into your small intestine. You may experience some gas and bloating, but you can remedy these symptoms by sticking to a low-fat diet. Some people also report that bowel movements are looser and more frequent after surgery, but this typically improves with time.
HEREDIT Y CAN PLAY A REAL ROLE in determining your risk for developing gallstones. Among the Pima Indians of Arizona, for example, nearly 70% of women develop gallstones by the time they reach 30 years of age.
Procedures
For gallstones that cause problems, the most common treatment is surgery to remove the source of the problem--your gallbladder. This procedure is called a cholecystectomy. Until 1990, this was done via a long abdominal incision, in an operation called an open cholecystectomy. Today, some 90 percent of gallbladder removals are performed with a less invasive tehcnique called a laparoscopic cholecystectomy, known as a 'lap chole' (see illustration below). Four small incisions are made in the abdomen, and the gallbladder is removed using a tiny video camera and flexible surgical instruments. If any problems occur, the surgeon can revert to a conventional open cholecystectomy.
With a lap chole, you'll need to stay in the hospital for only a day (and sometimes even less if it's done as outpatient sugery), versus five days after open surgery. Your recovery time should be short, too; many people are back at their regualar activities within a week. (Traditional surgery has a four to six week recovery period.) Under most circumstances surgery is elective, meaning you can decide when you want it done. But if you're hospitalised and tests indicate that you have a serious complication, such as an abscess or gallbladder perforation, you'll need to have surgery immediately.
If your doctor suspects that you have a gallstone stuck in a bile duct but no infection, he may recommend an endoscopic retrograde cholangiopancreatography (ERCP). To do this, a flexible viewing tube with surgical attachments is passed through your mouth, oesophagus and stomach to your small intestine and into the tiny opening where the bile duct enters. your doctor can actually see the stone directly, grasp it with surgical instruments and remove it from the duct. Exploration of the common bile duct is frequently carried out, as 15 to 20 percent of patients with stones in the gallbladder will also have stones in this duct.
A small number of people may be able to treat their gallstones with procedures less invasive than surgery. One involves ultrasound waves (extracorporeal shockwave lithotripsy) that pulverise gallstones, so they're small enough to pass through bile ducts or be dissolved with medication. To be a candidate, you must have only one small stone and a healthy gallbladder. However, doctors recommend this only in rare cases because the treatment is slow, variable and costly, and is associated with high recurrence rates.
In this surgery, an instrument with a tiny camera (laparoscope) is inserted at the navel. Forceps inserted on either side hold the gallbladder while it is detached from the liver. The gallbladder (with its stones inside) is then teased out through the tiny navel incision.
PROMISING DEVELOPMENTS
- It may seem like science fiction, but it's real: the US authorities have approved the first robotic surgical device for removing gallbladders and performing other abdominal operations.
What's the advantage?
With the robot, there are no extra hand movements or shaky instruments. Robot 'wrists' are also highly flexible, letting them reach areas that surgeons can't through the small incisions used for a laparoscopy. And the use of the
computer allows for a three-dimensional image, which gives a better view than the two-dimensional image used in a conventional laparoscopy.
So far, robotic surgery is done at only a small number of major medical centres, but its use is likely to spread in the future. Eventually, it may even allow specialists to perform surgery on patients hundreds of kilometres away.
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