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Biliary Colic Prevention and Treatment

Preventive measures are addressed to patients with gallstones, those who have had this issue or who show biliary dyspeptic manifestation.

gallbladderThe goal is to improve biliary dyskinesia, address the causes (biliary stasis, biliary infections, obesity, constipation, use of oral contraceptives) that favour lithogenesis (formation of gallstones) and the neuro-vegetative factors (stress, emotions, and conflicting states).

Diet: the recommendations are orientative only, each patient requiring an individualized regimen based on their specific tolerance.

Recommended:

  • split meals (4-5 per day) in moderation quantities;
  • lying idle (half hour) after meals;
  • food not too hot and well chewed;
  • reduction or quitting smoking.

Prohibited foods:

  • fat milk, sour cream, cream, cheese products;
  • fat soups, pulses (beans, peas, lentils);
  • fat pork, goose, duck, smoked cured meats, sausages, bacon, ham fat, organs (brain, kidney, liver), fatty fish (carp, catfish);
  • eggs or omelette with bacon;
  • food with sauce, goulash, paprika, spices (pepper, mustard, olives);
  • fruit: walnuts, hazelnuts, peanuts, almonds;
  • many cakes made with eggs, cream, fatty creams, ice cream;
  • black coffee, chocolate, cocoa, alcoholic beverages (beer, brandy, liqueur).

Foods without fat are generally allowed, salty foods with moderation, pasta, green vegetables cooked with butter or oil (sautéing or purées), buttermilk, yogurt, skim milk, cottage cheese fresh poultry poor (boiled or barbecue) without sauces, veal, lamb, little snacks, salted eggs, cheese or apple pie, raw fruits or baked, stewed – are allowed.

Besides the presented diet, it may also be recommended medication according to the needs, choleretic and kinetic (metoclopramide), spasmolytic (lizadon, Scobutil) and sedatives (hydroxyzine, Extraveral).

Treatment of biliary colic: aims to relieve pain, nausea, vomiting and anxiety.

Bed rest is recommended during the painful phase.

  1. Medical treatment is addressed to uncomplicated biliary colic. It consists of analgesic and antispasmodic medication (Algocalmin, Scobutil, Papaverine). Analgesics and antispasmodic preparations may be associated, their effects empowering each other. If pain does not respond to antispasmodics further investigations are required depending on the instructions of the doctor, possibly hospitalization.

Antiemetic medication: Emetiral, Torecan, sedative medication: hydroxyzine, napoton, meprobamate.

Generally, uncomplicated biliary colic is resolved by this treatment. Investigating the causes that caused it and the frequency, the severity, the presence of another disease, allows establishing whether surgical treatment is indicated.

  1. When is surgical treatment indicated?

Surgical treatment of biliary colic aims to solve the problem of complicated biliary colic:

  • gallbladder hydrops (mechanical obstruction of the bile duct – the cystic duct);
  • acute cholecystitis (inflammation + hydrops of the gallbladder wall);
  • piocolecist (suppurative inflammation of the gallbladder + hydrops);
  • gangrenous cholecystitis (gallbladder microabscesses in the walls);
  • biliary peritonitis (gallbladder perforation cavity peritoneal);
  • biliary fistulas (perforated in a neighbouring organ);
  • bile duct stones (migrating calculi from the gallbladder bile => jaundice, fever);

These complications may be life-threatening and emergency surgical intervention is indicated regardless of the age or the associated disorders that cause increased operational risk.

Because of the risk of unpredictable complications, surgical treatment is recommended for all patients with symptomatic gallstones.

Of those, the most vulnerable to develop complications are:

  • patients who have experienced more than 2 episodes in the last 3 months;
  • patients who have a history of complicated colic (hydrops, acute cholecystitis, bile duct stones) that were resolved by conservative treatment;
  • patients who presented with acute pancreatitis with complicated biliary colic.
  • patients presenting other diseased which are aggravated by the biliary colic and stones (diabetes, ischemic heart disease, chronic pancreatitis, chronic hepatitis).

In these cases, surgical indication will be individualized taking into account the increased risk of developing complications. Surgery may be indicated for prophylaxis even in patients with few or no symptoms.

The surgery consists of cholecystectomy (surgical removal of the gallbladder). This can be done in the conservatory method or laparoscopic method.

Classic cholecystectomy is performed under general anaesthesia, with subhepatic or median approach. It provides increased surgical comfort, any other complications can be resolved (peritonitis, bile duct stones, fistulas). The patient needs 8-10 days of hospitalization.

Laparoscopic cholecystectomy is the modern alternative. It is aimed especially to the uncomplicated cases. Advantages: the recovery is much faster (1-2 days of hospitalization) and for cosmetic reasons.




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