Treatments for Gallstones
Treatments for Gallstones
The list of treatments mentioned in various sources
for Gallstones
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Gallstones: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Gallstones may include:
Hidden causes of Gallstones may be incorrectly diagnosed:
Latest treatments for Gallstones:
The following are some of the latest treatments for Gallstones:
Medical news summaries about treatments for Gallstones:
The following medical news items
are relevant to treatment of Gallstones:
Discussion of treatments for Gallstones:
Gallstones: NIDDK (Excerpt)
Surgery
Surgery to remove the gallbladder is the most common way to treat
symptomatic gallstones. (Asymptomatic gallstones usually do not need
treatment.) Each year more than 500,000 Americans have gallbladder
surgery. The surgery is called cholecystectomy.
The standard surgery is called laparoscopic cholecystectomy. For this
operation, the surgeon makes several tiny incisions in the abdomen and
inserts surgical instruments and a miniature video camera into the
abdomen. The camera sends a magnified image from inside the body to a
video monitor, giving the surgeon a closeup view of the organs and
tissues. While watching the monitor, the surgeon uses the instruments to
carefully separate the gallbladder from the liver, ducts, and other
structures. Then the cystic duct is cut and the gallbladder removed
through one of the small incisions.
Because the abdominal muscles are not cut during laparoscopic surgery,
patients have less pain and fewer complications than they would have had
after surgery using a large incision across the abdomen. Recovery usually
involves only one night in the hospital, followed by several days of
restricted activity at home.
If the surgeon discovers any obstacles to the laparoscopic procedure,
such as infection or scarring from other operations, the operating team
may have to switch to open surgery. In some cases the obstacles are known
before surgery, and an open surgery is planned. It is called "open"
surgery because the surgeon has to make a 5- to 8-inch incision in the
abdomen to remove the gallbladder. This is a major surgery and may require
about a 2- to 7-day stay in the hospital and several more weeks at home to
recover. Open surgery is required in about 5 percent of gallbladder
operations.
The most common complication in gallbladder surgery is injury to the
bile ducts. An injured common bile duct can leak bile and cause a painful
and potentially dangerous infection. Mild injuries can sometimes be
treated nonsurgically. Major injury, however, is more serious and requires
additional surgery.
If gallstones are in the bile ducts, the surgeon may use ERCP in
removing them before or during the gallbladder surgery. Once the endoscope
is in the small intestine, the surgeon locates the affected bile duct. An
instrument on the endoscope is used to cut the duct, and the stone is
captured in a tiny basket and removed with the endoscope. This two-step
procedure is called ERCP with endoscopic sphincterotomy.
Occasionally, a person who has had a cholecystectomy is diagnosed with
a gallstone in the bile ducts weeks, months, or even years after the
surgery. The two-step ERCP procedure is usually successful in removing the
stone.
Nonsurgical Treatment
Nonsurgical approaches are used only in special situations—such as when
a patient's condition prevents using an anesthetic—and only for
cholesterol stones. Stones recur after nonsurgical treatment about half
the time.
- Oral dissolution therapy. Drugs made from bile acid are used
to dissolve the stones. The drugs, ursodiol (Actigall) and chenodiol
(Chenix), work best for small cholesterol stones. Months or years of
treatment may be necessary before all the stones dissolve. Both drugs
cause mild diarrhea, and chenodiol may temporarily raise levels of blood
cholesterol and the liver enzyme transaminase.
- Contact dissolution therapy.This experimental procedure
involves injecting a drug directly into the gallbladder to dissolve
stones. The drug—methyl tert butyl—can dissolve some stones in 1 to 3
days, but it must be used very carefully because it is a flammable
anesthetic that can be toxic. The procedure is being tested in patients
with symptomatic, noncalcified cholesterol stones.
- Extracorporeal shockwave lithotripsy (ESWL).This treatment
uses shock waves to break up stones into tiny pieces that can pass
through the bile ducts without causing blockages. Attacks of biliary
colic (intense pain) are common after treatment, and ESWL's success rate
is not very high. Remaining stones can sometimes be dissolved with
medication.
(Source: excerpt from
Gallstones: NIDDK)
Dieting and Gallstones: NIDDK (Excerpt)
Silent gallstones are usually left alone and
occasionally disappear on their own. Usually only patients with
symptomatic gallstones are treated.
The most common treatment for gallstones is surgery to remove the
gallbladder. This operation is called a cholecystectomy. In rare
cases, drugs are used to dissolve the gallstones. Other nonsurgical
methods are still considered experimental. (Source: excerpt from Dieting and Gallstones: NIDDK)
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Calcium imbalance:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment varies and requires correction of the acute imbalance, followed by maintenance therapy and correction of the underlying cause. Mild hypocalcemia may require nothing more than an adjustment in diet to allow adequate intake of calcium, vitamin D, and protein, possibly with oral calcium supplements. Acute hypocalcemia is an emergency that needs immediate correction by I.V. administration of calcium gluconate or calcium chloride. Chronic hypocalcemia also requires vitamin D supplements to facilitate GI absorption of calcium. To correct mild deficiency states, the amounts of vitamin D in most multivitamin preparations are adequate. For severe deficiency, vitamin D is used in four forms: ergocalciferol (vitamin D 2), cholecalciferol (vitamin D3), calcitriol, and dihydrotachysterol, a synthetic form of vitamin D2.
Treatment of hypercalcemia primarily eliminates excess serum calcium through hydration with normal saline solution, which promotes calcium excretion in the urine. Loop diuretics, such as ethacrynic acid and furosemide, also promote calcium excretion. (Thiazide diuretics are contraindicated in hypercalcemia because they inhibit calcium excretion.) Corticosteroids, such as prednisone and hydrocortisone, are helpful in treating sarcoidosis, hypervitaminosis D, and certain tumors. Plicamycin can also lower serum calcium levels and is especially effective against hypercalcemia secondary to certain tumors. Calcitonin may also be helpful in certain instances. Sodium phosphate solution administered orally or by retention enema promotes calcium deposition in bone and inhibits its absorption from the GI tract.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cholelithiasis and related disorders:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Surgery, usually elective, is the treatment of choice for gallbladder and bile duct diseases and may include open or laparoscopic cholecystectomy, cholecystectomy with operative cholangiography, and possibly exploration of the common bile duct. Electrohydraulic shock wave lithotripsy can be used to fragment gallstones if they’re few in number; it may be used with ursodeoxycholic acid to improve dissolution. Other treatments include a low-fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendencies due to vitamin K deficiency. Treatment during an acute attack may include insertion of a nasogastric tube and an I.V. line and, possibly, antibiotic administration.
A nonsurgical treatment for choledocholithiasis involves placement of a catheter through the percutaneous transhepatic cholangiographic route. Guided by fluoroscopy, the catheter is directed toward the stone. A basket is threaded through the catheter, opened, twirled to entrap the stone, closed, and withdrawn. This procedure can be performed endoscopically.
Chenodeoxycholic acid, which dissolves radiolucent stones, provides an alternative for patients who are poor surgical risks or who refuse surgery.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Calcium imbalance:
Treatment
(Handbook of Diseases)
An acute imbalance requires immediate correction, followed by maintenance therapy and correction of the underlying cause.
Hypocalcemia
A mild calcium deficit may require nothing more than an adjustment in diet to allow adequate intake of calcium, vitamin D, and protein, possibly with oral calcium supplements. Acute hypocalcemia is an emergency that needs immediate correction by I.V. administration of calcium gluconate or calcium chloride.
Chronic hypocalcemia also requires vitamin D supplements to facilitate GI absorption of calcium. Although the amount of vitamin D in most multivitamin preparations is adequate to correct a mild deficiency, different forms of vitamin D are used for severe deficiency, including ergocalciferol (vitamin D2), cholecalciferol (vitamin D3), calcitriol, and dihydrotachysterol, a synthetic form of vitamin D2.
Hypercalcemia
Treatment of hypercalcemia primarily eliminates excess serum calcium through hydration with normal saline solution, which promotes calcium excretion in urine. Loop diuretics, such as ethacrynic acid and furosemide, also promote calcium excretion. (Because thiazide diuretics inhibit calcium excretion, they’re contraindicated in hypercalcemic patients.)
Corticosteroids, such as prednisone and hydrocortisone, are helpful in treating sarcoidosis, hypervitaminosis D, and certain tumors. Plicamycin can lower the serum calcium level and is especially effective against hypercalcemia secondary to certain tumors. Calcitonin may also be helpful in certain instances.
Sodium phosphate solution administered by mouth or by retention enema promotes calcium deposits in bone and inhibits its absorption from the GI tract.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cholelithiasis, cholecystitis, and related disorders:
Treatment
(Handbook of Diseases)
Surgery, usually elective, is the treatment of choice for gallbladder and bile duct diseases. Surgery may include open or laparoscopic cholecystectomy, cholecystectomy with operative cholangiography and, possibly, exploration of the common bile duct.
Other treatment includes a low-fat diet to prevent attacks and vitamin K for itching, jaundice, and bleeding tendencies resulting from vitamin K deficiency. Treatment during an acute attack may include insertion of a nasogastric tube and an I.V. line and, possibly, administration of an antibiotic.
A nonsurgical treatment for choledocholithiasis involves insertion of a flexible catheter, formed around a biliary tube (T tube), through a sinus tract into the common bile duct. Guided by fluoroscopy, the catheter is directed toward the stone. A Dormia basket is threaded through the catheter, opened, twirled to entrap the stone, closed, and withdrawn.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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