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How is a gall bladder disorder treated? – Part 2

Acute pain from gallstones and gallbladder disease is usually treated in the hospital, where diagnostic procedures are performed.

Approaches to Gallstone Treatment:
– Expectant management (“wait and see”)
– Nonsurgical removal of the stones
– Surgical removal of the gallbladder

Treatment for Acute Cholecystitis (Gallbladder Inflammation)
The first step if there are signs of acute cholecystitis is to “rest” the gallbladder in order to reduce inflammation. This involves the following treatments:

– Fasting.
– Intravenous fluids and oxygen therapy.
– Strong painkillers, such as meperidine (Demerol). Potent NSAIDs, such as ketorolac, may be useful.
– Some doctors believe morphine should be avoided for gallbladder disease.
– Intravenous antibiotics.
– These are administered if the patient shows signs of infection, including fever or an elevated white blood cell count, or in patients without such signs who do not improve after 12 – 24 hours.
– People with acute cholecystitis almost always need surgery to remove the gallbladder.
– The most common procedure now is laparoscopy.
– This is a less invasive technique than open cholecystectomy.
– Surgery may be done within hours to weeks after the acute episode.

Treatment for Gallstone-Associated Pancreatitis:
– Patients who have developed gallstone-associated pancreatitis almost always have a cholecystectomy.
– For gallstone pancreatitis, immediate surgery may be better than waiting up to 2 weeks after discharge.
– Patients who delay surgery experience a high rate of recurrent attacks before their surgery.

Treatment for Common Duct Stones:
– If noninvasive diagnostic tests reveal obstruction from common duct stones then the doctor will perform endoscopic retrograde cholangiopancreatography (ERCP).
– This technique is used along with antibiotics if infection is present in the common duct (cholangitis).
– In most cases, common duct stones are discovered during or after gallbladder removal.

Management of Common Bile Duct Stones
– In the past, when common bile duct stones were suspected, the approach was open surgery (open cholecystectomy) and surgical exploration of the common bile duct.
– This required a wide abdominal incision.
– Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is now the most frequently used procedure for detecting and managing common bile duct stones.
– The procedure involves the use of an endoscope (a flexible telescope containing a miniature camera and other instruments), which is passed down the throat to the bile duct entrance.
– Laparoscopic cholecystectomy also is increasingly being used for the detection and removal of common bile duct stones.
– This is an approach through the abdomen.
– It uses small incisions instead of one large incision.
– It is used in combination with ultrasound or a cholangiogram (an imaging technique in which a dye is injected into the bile duct and moving x-rays are used to view any stones).

Dissolution Therapies
– Oral drugs used to dissolve gallstones and lithotripsy (alone or in combination with other drugs) gained popularity in the 1990s.
– Oral medications have lost favor with the increased use of laparoscopy.

Oral Dissolution Therapy
– Oral dissolution therapy uses bile acids in pill form to dissolve gallstones.
– These may be used in conjunction with lithotripsy.
– Ursodiol (ursodeoxycholic acid, Actigal, UDCAl) and chenodiol (Chenix) are the standard oral bile acid dissolution drugs.
– Most doctors prefer ursodeoxycholic acid.
– This one is considered to be one of the safest common drugs.
– Long-term treatment appears to notably reduce the risk of biliary pain and acute cholecystitis.
– The treatment is only moderately effective.
– Patients most likely to benefit from oral dissolution therapy are those who have small stones.

Contact Dissolution Therapy:
– Contact dissolution therapy requires the injection of the organic solvent methyl tert-butyl ether (MTBE) into the gallbladder to dissolve gallstones.
– This is a technically difficult and hazardous procedure.
– It should be performed only by experienced doctors in hospitals.
– MTBE rapidly dissolves stones — the ether remains liquid at body temperature and dissolves gallstones within 5 – 12 hours.
– Serious side effects include severe burning pain.

The Liver and Gallbladder Miracle Cleanse Healthy Digestion the Natural Way 3B Scientific VE315 Liver with Gall Bladder, Pancreas and Duodenum Model

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