Gallbladders - Perils of waiting - Mr Marcus Reddy - Parkside Hospital
Gallbladders - Perils of waiting - Mr Marcus Reddy - Parkside Hospital
Gallbladders - Perils of waiting - Mr Marcus Reddy - Parkside Hospital
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Elective• Pain• Jaundice• Dyspepsia
• RecognitionBarriers to ElectiveCholecystectomy• Scanning/ OGD• Referral• Surgery
Methods to increase service• Elective• Dedicated clinic slots• Utilisation <strong>of</strong> Day surgery• Specialisation <strong>of</strong> surgeons• Emergency• Role specialist service• Radiology and surgeons• Emergency theatre lists
Conclusion• Treatment is early cholecystectomy• Elective – early diagnosis andreferral with a streamline service• Emergency – referral to a fast trackhot service
Diagnostic Criteria forFunctional GallbladderDisorders• Must include episodes <strong>of</strong> pain locatedin the epigastrium and/or right upperquadrant and all <strong>of</strong> the following:• 1. Episodes lasting 30 minutes or longer• 2. Recurrent symptoms occurring at different intervals (notdaily)• 3. The pain builds up to a steady level
Diagnostic Criteria for FunctionalGallbladder Disorders• . The pain is moderate to severe enoughto interrupt the patient’s daily activities orlead to an emergency department visit• 5. The pain is not relieved by bowelmovements• 6. The pain is not relieved by posturalchange• 7. The pain is not relieved by antacids• 8. Exclusion <strong>of</strong> other structural diseasethat would explain the symptoms
Diagnostic Criteria for FunctionalGallbladder Disorders• Supportive criteria•• The pain may present with 1 or more <strong>of</strong>the following:• 1. Pain is associated with nausea andvomiting• 2. Pain radiates to the back and/or rightinfrasubscapular region• 3. Pain awakens from sleep in the middle<strong>of</strong> the night
ConclusionFunctional disorders <strong>of</strong> the gallbladderare not identified by gallstones onultrasoundDiagnosis made by symptomcharacteristics and 85% confirmedon provocation ultrasound scans