Oral medical dissolution of gallstones in patients with gallstone disease

Being the main treatment for cholelithiasis, laparoscopic cholecystectomy does not always solve the problem. It often entails postcholecystectomy syndrome (PCS). Oral medication to dissolve gallstones with bile acids is alternative therapy for some patients. However, lack of efficacy and limited medical indications make it necessary to apply combination treatment tactics. This study was conducted to investigate the dissolution of gallstones during the combined effects of ursodeoxycholic acid (UDCA) and rosuvastatin as well as to assess the results of eradication therapy in the presence of H. pylory as a measure to prevent cholelithiasis in the course of treatment.

Intervenciones de enfermería en la atención del adulto con colelitiasis y colecistitis crónica agudizada / Interventions Nursing Care Adult Chronic cholecystitis with cholelithiasis erxacerbated

Introducción. Los trastornos de la vía biliar afectan una proporción importante de la población mundial; más del 95% son atribuibles a la colecistitis aguda. La principal manifestación es el dolor agudo abdominal por lo que el 50% de los pacientes han tenido este síntoma al menos 48 horas antes de su ingreso.Método. Se realizaron cuatro búsquedas sistematizadas de información donde arrojo meta análisis, ensayos clínicos aleatorizados y/o estudios de cohorte publicados que dieron respuesta a las preguntas planteadas, de los cuales se seleccionaran las fuentes con mayor puntaje obtenido, en la evaluación de su metodología, las de mayor nivel en cuanto a gradación de evidencias y recomendaciones.Resultado. El signo de Murphy positivo en la colecistitis presenta una sensibilidad del 97%; el 95% de la colecistitis se asocia con la colelitiasis y aumenta riesgo de complicaciones, la Escala Visual Análoga (EVA) permite establecer una base de control y alivio del dolor y del 1 al 3% de las mujeres embarazadas presentan litios vesiculares.Conclusión. La colecistitis aguda ocurre entre los 30 y 80 años, siendo más frecuente en mujeres, es de importancia la valoración de los signos y síntomas, además de identificar complicaciones secundarias con la finalidad que el personal de enfermería elabore un plan de cuidados especifico ante los problemas reales del paciente, contemplando intervenciones en la ministración de medicamentos, preparación quirúrgica garantizando la seguridad del paciente y cuidados postquirúrgicos para minimizar factores de riesgo de infección y las recomendaciones del autocuidado para su egreso.

Introduction. The biliary disorders affect a significant proportion of the world population; more than 95% are attributable to acute cholecystitis. The main manifestation is abdominal pain so sharp 50% of patients have this symptom at least 48 hours before admission.Method. Four systematized information searches were performed which threw meta-analysis, randomized clinical trials and / or studies published cohort that provided answers to the questions, of which the sources were selected with the highest score obtained in the evaluation methodology ,the highest level as to grading evidence and recommendations.Result. The positive sign of cholecystitis Murphy has a sensitivity of 97%; 95% of cholecystitis and cholelithiasis associated with increased risk of complications, the Visual Analogue Scale (VAS) allows us to set a base control and pain relief and 1 to 3% of pregnant women have vesicular lithiums.Conclusion. Acute cholecystitis occurs between 30 and 80 years, being more common in women, it is important the assessment of signs and symptoms, and identify secondary complications in order that nurses develop a specific plan of care to actual problems of the patient, contemplating interventions in the ministration of medicines, surgical preparation ensuring patient safety and postoperative care to minimize infection risk factors and recommendations for self discharge.

Introdução. Os distúrbios biliares afetar uma proporção significativa da população mundial; mais de 95% são atribuíveis a colecistite aguda. A principal manifestação é a dor abdominal tão acentuada de 50% dos pacientes apresentam este síntoma pelo menos 48 horas antes da admissão.Método. quatro informações sistematizadas pesquisas onde eu jogo meta-análise, ensaios clínicos randomizados e / ou estudos publicados coorte que forneceram respostas para as perguntas, das quais as fontes foram selecionados com a maior pontuação obtida na metodologia de avaliação foram feitas, maior nível de evidências e recomendações de classificação.Resultado. O sinal positivo de colecistite Murphy tem uma sensibilidade de 97%; 95% de colecistite e colelitíase associada ao aumento do risco de complicações, a Escala Analógica Visual (VAS) permite que você defina um controle base e alívio da dor e 1 a 3% das mulheres grávidas têm lithiums vesiculares.Conclusão. colecistite aguda ocorre entre 30 e 80 anos, sendo mais comum em mulheres, é importante a avaliação de sinais e sintomas, e identificar complicações secundárias com as enfermeiras objectivo q desenvolver um plano específico de atendimento a problemas paciente real, contemplando intervenções no ministério de medicamentos, preparo cirúrgico, garantindo a segurança do paciente e cuidados pós-operatórios para minimizar os fatores de risco de infecção e recomendações para a auto descarga.

effect of moderate alcohol intake on gallbladder motility A milk ultrasonographic study

To assess the effect of periodic and moderate alcohol intake on gallbladder motility. The Ultrasonographic ellipsoid method was used in 21 healthy male subjects: 12 non-alcohol and 9 alcohol drinkers. The stimulus for gallbladder contraction was 165 ml of half cream milk. Gallbladder dynamics were studied for 20 minutes following the ingestion of the milk. The mean percentage change in gallbladder volume after 10 and 20 minutes gave indications of gallbladder motility. Moderate and periodic alcohol intake did not stimulate rapid postprandial gallbladder emptying. The protective effect of alcohol against biliary cholesterol cholelithiasis could not be due to stimulation of gallbladder emptying

Conveniencia de la colecistectomia laparoscópica en el paciente con litiasis asintomática / Suitability of laparoscopic cholecistectomy in the asymptomatic cholelithiasis patient

Cholelithiasis is a disease of high prevalence in the adult population. Prevalence increases with age; the incidence of complications, such as choledocolithiasis, acute pancreatitis, and cancer of galbladder, also increase with age. Cholecystectomy has been considered as the gold standard in the treatment of symptomatic or complicated cholethiasis. Laparoscopic cholecystectomy has become the new gold standard. Our Department of Surgery has adopeted a policy of advising laparoscopic cholecistectomy in all patiens with symptomatic cholelithiasis, but also subpopulation of high risk asymptomatic patients. This subgroup is made up by patients with long life expectancy, radioopaque stones, small calculus with patent cystic duct, nonfunctioning or calcified gall bladder, and patients with concomitant diabetes, cirrhosis, chronic hemolytic anemia, those are candidates for kidney or heart transplantation, and those with underling degenerative diseases that are more likely to develop severe complication of of choletihiasis. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia. He considers that cholecystectomy is indicated in asymptomatic patients as a "prophylactic" measure. Our group agrees that this is a valid indication in areas or populations groups where gallbladder cancer is of high prevalence.

Cholesterol gall stone dissolution using MTBE: study of efficacy, safety and prevention of recurrence

Twenty-three patients, 4 males and 19 females [mean age 38.6 years], with symptomatic noncomplicated cholesterol gall stone[s] were treated by percutaneous transhepatic direct contact MTBE dissolution. All patients were evaluated clinically and ultrasonographically before and after dissolution. Also, CT scan evaluation was done before dissolution to detect any calcification and to assure good gall bladder bed. Patients were classified into two groups: Group 1 [12 patients including 2 patients with residual stones], received ursodeoxycholic acid for three months after dissolution and group 2 [11 patients] did not receive ursodeoxycholic acid therapy. In 21 patients, first time gallbladder puncture was successful [91%], and in 2 obese patients second punctures [5 and 2 months later], were successful using stiffer catheter. Average dissolution time was 8.47 hours. Gall stone dissolution rate ranged from 0.98 to 3.4 cm/hour. The rate of dissolution was increased with the increase in stone number and stone burden. Complete stone dissolution was achieved in 21 patients [91.3%], residual gall bladder sediment not casting posterior shadow on ultrasound examination was detected in 3 patients [13.04%]. Residual stone fragments escaped dissolution in 2 patients [8.69%]. Side effects of the procedure were minimal and no major complications occurred. Results of 3 years follow up showed only one genuine recurrence [10%] out of 10 patients who received prophylactic post dissolution therapy in group 1, while 5 out of the 11 patients in group 2 showed recurrence [45.45%]. Direct contact MTBE cholesterol gall stone dissolution is safe and effective alternative for surgery. Post dissolution ursodeoxycholic acid therapy for 3 months is highly effective in preventing recurrence of stones

Diarréia pós-colecistectomia e vagotomia: estudo retrospectivo / Diarrhoea postcholecystectomy and vagotomy: a retrospective study

É demonstrada a elevada incidência de diarréia pós-colecistectomia e vagotomia, sejam estas cirurgias realizadas conjuntamente ou em ocasiöes diferentes. Faz-se um estudo comparativo com os casos em que a colecistectomia foi associada à vagotomia superseletiva, nos quais a diarréia é praticamente nula. A alta taxa de litíase biliar pós-vagotomia troncular é um elemento que obriga, sempre que possível, o uso da vagotomia superseletiva. Conclui-se que a utilizaçäo da vagotomia superseletiva se impöe na prevençäo da diarréia pós-vagotomia, que é muito mais grave quando se associa à colecistectomia

Valor de la colangioscopia transoperativa en la prevención de litiasis residual / To value of the transoperative cholangioscopy in the prevention of retaine stones

Cincuenta pacientes en los que se realizó exploración de vías biliares y colangioscopía rígida (Grupo II) se compararon con un grupo control de 50 enfermos en los que se realizó exploración de vías biliares (Grupo I). Cuarenta pacientes del Grupo I y 46 del Grupo II tuvieron coledocolitiasis. En 11 (26.2%) de 42 pacientes del grupo II se identificaron mediante la colangioscopia cálculos biliares que habían sido inadvertidos en la exploración instrumental (en siete de ellos se habían extraído cálculos en la exploración instrumental y en 4 nos se habían identificado). Todos los pacientes con colediocolitiasis en que se realizó colangioscopía tuvieron grado variables de coledocitis, uno tuvo un adenova y uno un adenocarcinoma. La colangiografía por sonda en T postoperatoria mostró litiasis residual en ocho (16%) de los 50 pacientes del grupo I y en uno (2.2%) del grupo II, con diferencia estadisticamente significativa (p <0.05) con la prueba de X2 pero no con la modificación de yates. Consideramos que la colangioscopia y la colangiografía transoperatória por sonda e T son métodos complementarios que deben realizarse rutinariamente en los pacientes en que se realiza exploración de vias biliares para disminuir el riesgo de litiasis residual