Page 6 - 05- Cholelithiasis

– IOC helps delineate bile duct anatomy when dissection is difficult. Routine use of IOC is
controversial and may be associated with decreased incidence and severity of bile duct
injury.
Early LC (<24 hours after diagnosis of biliary colic) decreases hospital stay and operating time
(2)[A].
For patients with acute cholecystitis, early LC (<7 days of clinical presentation) is safe and
may shorten the total hospital stay versus delayed LC (>6 weeks after index admission with
acute cholecystitis) (3)[A]
Laparoscopic partial/subtotal cholecystectomy is a viable option in difficult operative
condition (such as severe cholecystitis).
Percutaneous cholecystostomy (PC) is used for high-risk patients with cholecystitis or
gallbladder empyema. Interval cholecystectomy is recommended.
Symptomatic patients who are not candidates for surgery or those who have small gallstones (5
mm or smaller) in a functioning gallbladder with a patent cystic duct are candidates for oral
dissolution therapy (ursodiol [Actigall]). The recurrence rate is >50% once medication is
discontinued.
Extracorporeal shock wave lithotripsy is a noninvasive therapeutic alternative for symptomatic
patients who are not candidates for surgery. It helps break down large bile duct stones before
ERCP. Complications include biliary pancreatitis, hepatic hematoma, incomplete ductal stone
clearance, and recurrence.

ADMISSION, INPATIENT, AND NURSING CONSIDERATIONS
For patients with symptomatic cholelithiasis, LC is typically an outpatient procedure. For
patients with complications (i.e., cholecystitis, cholangitis, pancreatitis), inpatient care is
necessary.
Acute phase: NPO, IV fluids, and antibiotics
Adequate pain control with narcotics and/or NSAIDs

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS
Patient Monitoring
Follow for signs of symptomatic cholelithiasis.
Follow patients on oral dissolution agents with serial liver enzymes, serum cholesterol, and
imaging.
DIET
A low-fat diet may help.

PATIENT EDUCATION
Change in lifestyle (e.g., regular exercise) and dietary modification (low-fat diet and reduction
of total caloric intake) reduce gallstone-related hospitalizations.
Patients with asymptomatic gallstones should be educated about the typical symptoms of
biliary colic and gallstone-related complications.

PROGNOSIS