Gall Bladder and Biliary Tract Surgery

What is Gall bladder and biliary tract surgery?
Gall bladder stones are an extremely common disorder and are usually asymptomatic. Some patients experience biliary colic, an intermittent and often severe pain in the epigastrium or right upper quadrant, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone. If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder.

Signs and Symptoms:
The vast majority of patients with gallstones are asymptomatic. Symptomatic gallstones typically manifest with right upper quadrant abdominal pain, often accompanied by nausea and vomiting. The pain is often severe, may abate over several hours (biliary colic), or may progress to cholecystitis, with persistent pain and fever. On examination, there is pain to palpation in the right upper quadrant (Murphy's sign).

Diagnosis:
The imaging study of choice is a right upper quadrant ultrasound, which, in the presence of cholecystitis, typically shows the presence of gallstones, a thickened gallbladder wall, and pericholecystic fluid. In those patients with symptomatic gallstones and a negative ultrasound examination, endoscopic ultrasound may be helpful. 2 To confirm the suspicion of cholecystitis, a hydroxyiminodiacetic acid (HIDA) scan can be useful. The radionuclide material is concentrated in the liver and excreted into the bile but does not fill the gallbladder because of cystic duct obstruction.

Summary: Acute Cholecystitis:

• Right upper quadrant abdominal pain, nausea, and vomiting
• Ultrasound reveals
• Thickened gallbladder wall
• Pericholecystic fluid collection
• HIDA scan reveals non-visualized gallbladder

Treatment:
TThe primary treatment for symptomatic gallstone disease is cholecystectomy which require gall bladder surgery, Prophylactic cholecystectomy for silent gallstones is not warranted. Most cholecystectomies in the World are done laparoscopically. A patient with an acute episode that resolves should see a surgeon within a few weeks and elective cholecystectomy should be considered. Patients who have persistent right upper quadrant tenderness and develop fever or an elevated white blood cell count should be seen more urgently.

Common bile duct stones can accompany acute cholecystitis in up to 10% of cases. These stones can be removed endoscopically before or after cholecystectomy, or surgically at the time of laparoscopic or open cholecystectomy.

Most good-risk patients who undergo elective laparoscopic cholecystectomy are sent home within 24 hours. Patients who undergo open cholecystectomy may require hospitalization for several days. It is estimated that 95% of patients experience relief of pain after cholecystectomy. The remaining patients probably had symptoms not related to gallbladder disease before surgery.

The primary treatment for symptomatic gallstone disease is cholecystectomy. Prophylactic cholecystectomy for silent gallstones is not warranted. 3 Most cholecystectomies in the world are done laparoscopically. A patient with an acute episode that resolves should see a surgeon within a few weeks and elective cholecystectomy should be considered. Patients who have persistent right upper quadrant tenderness and develop fever or an elevated white blood cell count should be seen more urgently