Abnormal USG is carried out during evaluation for a possible abdominal aortic aneurysm. The presence of stones in the gall bladder is identified on this study. The patients only abdominal symptoms is a sense of fullness after eating. The appropriate first step is managing the gall stones is.
|D||Ursodeoxycholic acid therapy|
(Ref: Schwartz :Principles of surgery 8th edition page no.1400 )
a. Lap, cholecystectomy is the standard method today for dealing with most patients with symptomatic cholelithiasis.
b. In patient who has asymptomatic gall stones as an incidental finding, however, there are no data to suggest that any therapeutic intervention is justified.
c. Fewer than 25% of patients with asymptomatic cholelithiasis will develop symptoms that require intervention over a 5- years follow up period.
d. Liberal use of the ultrasonography has made possible the detection of asymptomatic stones.
e. Among the asymptomatic patients followed up only few developed serious complications if untreated.
f. So , patients are just observed and followed up.
g. Carcinoma of the gallbladder is to be given a serious thought as associations are found between the gallstones and gallbladder carcinoma.
h. Incidence of development of carcinoma in symptomatic stone is only 1 to 15%.
i. While incidence of development of carcinoma in asymptomatic gall stone is more than 65%.
j. Asymtomatic gallstone is rare.
k. Major components of gall stone are cholesterol,bile pigment, calcium.
l. It occurs in fertile , female of fourty age. (3Fs)
m. Stones in the common bile duct are called choledocholithiasis.
n. In choledocholithiasis, exploration of the duct is indicated .