Aymptomatic Gallstones Flashcards
What percentage of patients with gallstones develop symptoms at 5 years, 10 years, and 15 years?
10% at 5 years, 15% at 10 years, 18% at 15 years (Gracie and Ransohoff)
What is the reported conversion rate for laparoscopic to open cholecystectomy?
1.6% conversion rate with 5% morbidity
What are proposed criteria for prophylactic cholecystectomy?
Life expectancy > 20 yrs; calculi >2cm; calculi >3mm + patent cystic duct; radiopaque calculi; polyp >15mm; nonfunctioning/calcified gallbladder; women <60yrs; pts in ares with high prevalence of gallbladder cancer
Which immunosuppressive agents increase incidence of cholelithiasis?
cyclosporine and tacrolimus
How do these immunosuppressive agents cause cholelithiasis?
decrased bile salt export-pump function
Prophylactic posttransplantation cholecystectomy is recommended after which transplants?
Heart transplant and Heart-lung transplant
T/F. Elective cholecystectomy should be considered in sickle cell anemia patients with symptomatic gallstones and in those with gallstone-related symptomatology that cannot be differentiated from sickle cell hepatic crisis.
TRUE
What operation should be offered to a patient with hereditary spherocytosis, under age 39 years, mild hemolysis, and asymptomatic gallstones?
combined splenectomy and cholecystectomy
What percentage of patients on long-term TPN develop gallstones?
35% incidence of gallstone formation in long-term TPN patients
What agent can be used as prophylaxis for patients post bariatric surgery who develop gallstones?
ursodeoxycholic acid
Incidental cholecystectomy is most appropriate in which patient population?
Patients undergoing abdominal or alimentary tract surgery older than 70 years, and undergoing AAA repair, provided the graft is covered with peritoneum before proceeding with cholecystectomy
