Cholecystectomy Health Dictionary

Examination of the interior of the abdomen using a laparoscope, which is a type of endoscope. Laparoscopy is widely used in gynaecology. Surgical procedures such as appendicectomy and cholecystectomy are now often performed laparoscopically (see minimally invasive surgery).... laparoscopy

Surgery using a rigid endoscope passed into the body through a small incision. Further small openings are made for surgical instruments so that the operation can be performed without a long surgical incision. Minimally invasive surgery may be used for many operations in the abdomen (see laparoscopy), including appendicectomy, cholecystectomy, hernia repair, and many gynaecological procedures. Knee operations (see arthroscopy) are also often performed by minimally invasive surgery.... minimally invasive surgery

Acute or chronic inflammation of the gallbladder, causing severe abdominal pain. Acute cholecystitis is usually caused by a gallstone obstructing the outlet from the gallbladder. The trapped bile causes irritation of the gallbladder walls and may become infected by bacteria. The main symptom is severe constant pain in the right side of the abdomen under the ribs, accompanied by fever and, occasionally, jaundice. Treatment is usually with analgesic drugs, antibiotic drugs, and an intravenous infusion of nutrients and fluids. In some cases, complications develop, which may include peritonitis, if the gallbladder bursts, and empyema. Both require urgent surgical treatment.

Repeated mild attacks of acute cholecystitis can lead to a chronic form, in which the gallbladder shrinks, its walls thicken, and it ceases to store bile.

Symptoms (indigestion, pains in the upper abdomen, nausea, and belching) may be aggravated by eating fatty food.

Cholecystectomy is the usual treatment.... cholecystitis

The removal of gall-stones from the gallbladder or bile ducts (see GALL-BLADDER, DISEASES OF), when CHOLECYSTECTOMY or LITHOTRIPSY are inappropriate or not possible. It involves a cholecystomy, an operation to open the gall-bladder.... cholelithotomy

The gall-bladder rests on the underside of the LIVER and joins the common hepatic duct via the cystic duct to form the common BILE DUCT. The gall-bladder acts as a reservoir and concentrator of BILE, alterations in the composition of which may result in the formation of gallstones, the most common disease of the gallbladder.

Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.

Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.

Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of

An instrument consisting, essentially, of a rigid or ?exible cylinder, an eyepiece and a light source, which is inserted through a small incision into the abdominal cavity (which has already been distended with carbon dioxode gas). The laparoscope allows the contents of the abdominal cavity to be examined without performing a LAPAROTOMY. Some operations may be performed using the laparoscope to guide the manipulation of instruments inserted through another small incision – for example, STERILISATION; CHOLECYSTECTOMY. (See also ENDOSCOPE; MINIMALLY INVASIVE SURGERY (MIS).)... laparoscope

A preparation used in the treatment of cholesterol gall-stones when laparoscopic CHOLECYSTECTOMY and endoscopic biliary procedures cannot be used (see GALL-BLADDER, DISEASES OF).... ursodeoxycholic acid

A severe pain in the upper right quadrant of the abdomen that is usually caused by the gallbladder’s attempts to expel gallstones or by the movement of a stone in the bile ducts. The pain may be felt in the right shoulder (see referred pain) or may penetrate to the centre of the back. Episodes of biliary colic often last for several hours and may recur, particularly after meals.

Injections of an analgesic drug and an antispasmodic drug may be given to relieve the colic.

Tests such as cholecystography or ultrasound scanning can confirm the presence of gallstones, in which case cholecystectomy (surgical removal of the gallbladder) is possible.... biliary colic

An imaging technique performed to check that there are no gallstones left in the bile duct after a cholecystectomy.

A T-shaped rubber tube is inserted into the bile duct during the surgery.

A week or so later, contrast medium is inserted into the tube and X-rays are taken.... t-tube cholangiography

Lumps of solid matter found in the gallbladder, or in the bile ducts. Gallstones are composed mainly of cholesterol and bile pigments from the breakdown of red blood cells. They develop when there is a disturbance in the chemical composition of bile.

Gallstones are rare in childhood and become increasingly common with age. Women are affected more than men. Risk factors include a high-fat diet and being overweight.

Most gallstones cause no symptoms. When symptoms do occur, they often begin when a stone gets stuck in the duct leading from the gallbladder, causing biliary colic and nausea. Gallstones may cause indigestion and flatulence. Possible complications are cholecystitis and bile duct obstruction.Diagnosis is by ultrasound scanning, X-ray oral cholecystography, or cholangiography.

Stones that are not causing symptoms are usually left alone.

In other cases, the gallbladder and stones may be removed by cholecystectomy.

Ultrasonic shock waves (see lithotripsy) are sometimes used to shatter stones; the fragments pass into the bowel and cause no further problems.

Drugs such as chenodeoxycholic acid or ursodeoxycholic acid can dissolve some stones if given over a period of months.... gallstones

n. imaging of the bile ducts in order to demonstrate congenital anatomical abnormalities (such as biliary atresia), biliary diseases, and the presence of gallstones or strictures. It may be combined with imaging of the pancreatic duct (cholangiopancreatography), as in endoscopic retrograde cholangiopancreatography (see ERCP). Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive *magnetic resonance imaging technique that has largely superseded ERCP for diagnostic purposes. ERCP following MRCP is used for therapeutic intervention. In operative (or on-table) cholangiography, a radiopaque *contrast medium is injected into the bile ducts during *cholecystectomy, to ensure that there are no remaining gallstones in the ducts. Percutaneous transhepatic cholangiography (PTC) is an invasive technique in which a catheter is manipulated under direct fluoroscopic guidance through the anterior abdominal wall, across the liver, and into a bile duct; contrast solution is injected to outline the bile ducts. Using a *Seldinger technique, drains or stents can be placed to treat infection or malignant strictures. T-tube cholangiography involves the postoperative injection of radiopaque contrast material via a drain (T-tube) left in the main bile duct after cholecystectomy.... cholangiography

(cholecystotomy) n. an intervention in which a catheter is placed in an infected gall bladder to drain the pus. This is the preferred technique for patients who are unfit to undergo emergency removal of the gall bladder (*cholecystectomy).... cholecystostomy

n. gallstones within the common bile duct. Gallstones usually form in the gall bladder and pass through the cystic duct into the common bile duct. However, they may develop within the common bile duct itself, despite *cholecystectomy.... choledocholithiasis

n. a highly specialized endoscopic instrument used to visualize the common bile duct. This can aid removal of stones from the common bile duct during a laparoscopic *cholecystectomy.... choledochoscope

n. a surgical operation in which the common bile duct is opened in order to search for or to remove stones within it. It may be performed at the same time as *cholecystectomy or if gallstones form in the bile duct after cholecystectomy.... choledochotomy

an oblique *incision made in the right upper quadrant of the abdomen just below and parallel to the costal margin. It is classically used for open *cholecystectomy. [E. T. Kocher]... kocher’s incision

n. a hard mass composed of bile pigments, cholesterol, and calcium salts, in varying proportions, that can form in the gall bladder. The formation of gallstones (cholelithiasis) occurs when the physical characteristics of bile alter so that cholesterol is less soluble or there is an excess of bile pigments. Diminished contractility of the gall bladder may also be a contributory factor, leading to biliary stasis. Gallstones may exist for many years without causing symptoms. However, they may cause severe pain (see biliary colic) or they may pass into the common bile duct and cause obstructive *jaundice or *cholangitis. Gallstones are usually diagnosed by ultrasonography, but those containing calcium may be seen on a plain X-ray (opaque stones). Symptomatic cholelithiasis is usually treated by surgical removal of the gall bladder (see cholecystectomy). Nonsurgical treatments, such as gallstone-dissolving drugs or lithotripsy, have proved less successful and are not in widespread use.... gallstone