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Old 05-26-2013
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GIT Gastroenterology Q24

A 44-year-old woman is evaluated for complaints of abdominal pain. She describes the pain as a postprandial burning pain. It is worse with spicy or fatty foods and is relieved with antacids. She is diagnosed with a gastric ulcer and is treated appropriately for Helicobacter pylori. During the course of her evaluation for her abdominal pain, the patient had a right upper quadrant ultrasound that dem-onstrated the presence of gallstones. Following treatment of H. pylori, her symptoms have resolved. She is requesting your opinion regarding whether treatment is required for the finding of gallstone disease. Upon review of the ultra-sound report, there were numerous stones in the gallblad-der, including in the neck of the gallbladder. The largest stone measures 2.8 cm. What is your advice to the patient regarding the risk of complications and the need for defini-tive treatment?
A. Given the size and number of stones, prophylactic cholecystectomy is recommended.
B. No treatment is necessary unless the patient devel-ops symptoms of biliary colic frequently and severely enough to interfere with the patient’s life.
C. The only reason to proceed with cholecystectomy is the development of gallstone pancreatitis or cholangitis.
D. The risk of developing acute cholecystitis is about 5–10% per year.
E. Ursodeoxycholic acid should be given at a dose of 10–15 mg/kg daily for a minimum of 6 months to dissolve the stones.
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Old 05-26-2013
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I think the answer is B BUT i have seen surgeons do A (at the Mayo Clinic) so.. i wouldnt know.
there are numerous reasons to proceed with cholecystectomy.. including those exposed in option C + risk of gallbladder cancer.

I dont know anything about D and E is wrong because that acid doesnt dissolve stones.. it just prevents the formation of new gallstones.
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Old 05-26-2013
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Originally Posted by XpaezX View Post
I think the answer is B BUT i have seen surgeons do A (at the Mayo Clinic) so.. i wouldnt know.
there are numerous reasons to proceed with cholecystectomy.. including those exposed in option C + risk of gallbladder cancer.

I dont know anything about D and E is wrong because that acid doesnt dissolve stones.. it just prevents the formation of new gallstones.
Hey buddy, UDCA reduces cholestrol absorption and does dissolve cholestrol stones.....!!!!

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The drug reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones in patients who want an alternative to surgery. The drug is very expensive, however, and if the patient stops taking it, the gallstones tend to recur if the condition that gave rise to their formation does not change. For these reasons, it has not supplanted surgical treatment by cholecystectomy.
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Old 05-26-2013
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Hey buddy, UDCA reduces cholestrol absorption and does dissolve cholestrol stones.....!!!!

No buddy it does not.. UDCA might dissolve biliary sludge and very small stones but the stones this patient has the only way to remove them is via cholecystectomy... UDCA wont dissolve a 2.8 cm stone .. ask any surgeon or read any surgical book and you will find that
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Old 05-27-2013
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answer is B.

In the National Health and Nutrition Examination Survey, the prevalence of gallstone disease in the United States was 7.9% in men and 16.6% in women. While the disease is quite prevalent, not all patients with gallstone disease require cholecystectomy. It is estimated that 1–2% of patients with asymptomatic gallstone disease will develop complications that will require surgery yearly. Therefore, it is important to know which patients with asymptomatic gallstones require referral for surgery. The first factor to consider is whether the patient has symptoms that are caused by gallstones and whether they are frequent enough and severe enough to necessitate surgery. Commonly called biliary colic, the classic symptoms of gallstone disease are right upper quadrant pain and fullness that begins suddenly and can last as long as 5 hours. Nausea and vomiting can accompany the episode. Vague symptoms of epigastric fullness, dyspepsia, and bloating following meals should not be considered biliary colic. A second factor that would be con-sidered in recommending a patient for cholecystectomy is whether the patient has a prior history of complications of gallstone disease such as pancreatitis or acute cholecystitis. A final factor that would lead to the recommendation for cholecystectomy is the presence of anatomical factors that would increase the likelihood of complications such as a porcelain gallbladder or congenital abnormalities of the biliary tract. Individuals with very large stones (>3 cm) would also need to be considered carefully for cholecystectomy. Ursode-oxycholic acid can be used in some instances to dissolve gallstones. It acts to decrease the cholesterol saturation of bile and also allows the dispersion of cholesterol from stones by producing a lamellar crystalline phase. It is only effective, however, in individuals with radiolucent stones measuring less than 10 mm
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Old 06-02-2013
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cholecystectomy is recommended
thank you for your help
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