Gallstones (Asymptomatic Gallstones (asymptomatic --> prophylactic…
asymptomatic --> prophylactic cholecystectomy NOT
biliary colic--> elective cholecystectomy.
episode of biliary colic: parenteral analgesics, observation.
After cholelithiasis confirmed
may add intraoperative cholangiogram; if shows common duct calculi
duct should be explored or
referred subsequently for ERCP and sphincterotomy to extract stones.
comorbid conditions precluding safe cholecystectomy and in refusing surgery: oral dissolution therapy
Initial: withhold oral; IV fluid; AB; analgesics; if vomiting--> NG
cholecystectomy (open if bleeding / obscure anatomy)
most: early (within few d)
major med problem to be addressed--> delayed
suspect perforation or abscess--> earlier
Acute emphysematous cholecystitis: broad-spectrum AB, emergency cholecystectomy
Acute gangrenous cholecystitis: stabilization, broad-spectrum AB, and emergency cholecystostomy/ectomy
too ill for ectomy--> ostomy (percut under US)--> decompression of gallbladder
Choledocholithiasis and Acute Cholangitis