30/11/2019
Pigment stone / Bilirubin stone
Types of gall stones • Cholesterol stones • Pigment stones / Biliribin stones • Mixed stones • Stones with calcium content 15% of gall stones in the general public is pigmented whereas majority of gall stones in SCD patients are pigmented. (Vasavda et, al., 2007)
• By-product of haemolysis • Causes extrahepatic obstruction • Causes cholecystitis • Affects 50% of adult patients with HbS • Cholecystectomy indicated if patient is symptomatic.
(Schnall & Benz, 2002)
7
8
Cholecystitis
Surgical Management
Symptoms • Abdominal pain localising in the right upper quadrant sometimes radiating towards right shoulder. • Persistent pain • Fever • Nausea and vomiting • Sweating • Loss of appetite • Jaundice • Bulge in the abdomen
Investigations
Laparoscopy is an approach to abdominal surgery for minimal access into the abdomen to achieve the same surgical result as open laparotomy. It is also referred to as minimally invasive surgery where surgery is performed with instruments manipulated from outside the patient’s body.
• Blood tests; Hb, U&E, Liver function tests • Abdominal ultrasound screening • ERCP • Sometimes MRCP
(Rothrock, 2011)
9
10
Laparoscopic cholecystectomy • Preferred technique as it posses less risk to the patient • Gold standard for treatment • Elective procedure for symptomatic cholelithaisis (gallstones) • Minimally invasive • Less scaring • Reduced rate of infection • Reduced length of hospital stay • Day case procedure
Laparoscopic cholecystectomy
Benefits for patient • Minimal blood loss
Benefits for surgeon • Enhanced imaging resolution • Image/video recording option • All team members see the same image • Abundant light and magnification
• Reduced risk of infection • Rapid return of GI function • Less small bowel obstruction • Reduced risk of incisional hernia with small incision • Less post op pain and reduced analgesia use
(Rothrock, 2011).
(Rothrock, 2011)
11
12
2
Powered by FlippingBook