Ouch! I Think My Gall Bladder Hurts! Jody C. DiGiacomo, M.D., FACS Department of Surgery CentraState Medical Center.

Ouch!I Think My Gall Bladder Hurts!

Jody C. DiGiacomo, M.D., FACSDepartment of Surgery

CentraState Medical Center

What Is The Gall Bladder?

A Bag Shaped Organ Under the Liver That

Holds, Concentrates and Stores Bile

Biliary System

Bile is Made by the Liver

Flows Into Small Channels

Converge Into Large Ducts

Stored in Gall Bladder

Moves Into Intestine When Needed

What Is Bile?Dark Green and Bitter Tasting

Functions:

Aid Digestion of Fats

Help Neutralize Stomach Acid

Excretion of Complex Wastes

Composition:

85% Water

10% Bile Salts

3% Pigments

1% Inorganic Salts & Cholesterol

What Are Gall Stones?

Result of An Imbalance Between the Components of Bile

Age

Ethnicity

Diet

Medical Conditions

What Is Biliary Colic?

Right Upper Quadrant Pain

Epigastric Pain

May Be Severe

Nausea, Vomiting

Lasts > 1 Hour and < 24 Hours

Anatomy

Anatomy

Anatomy

Symptomatic Cholelithiasis

67% of Patients With Gall Stones Remain Asymptomatic

70% Will Have Recurrent Episodes

6-8% Will Need Surgery Each Year

Diagnosis

History and Clinical Exam

Abdominal X-Rays

Ultrasound

CT Scan

HIDA Scan

Treatment Options

CholecystectomyThe Surgical Removal of the Gall Bladder

Stone Removal Does Not Cure Condition

Laparoscopic Cholecystectomy

Under General Anesthesia Tubes Placed Thru the Abdominal Wall

The Abdomen Is Filled With Air

Long Instruments Are Used To Remove the Gall Bladder From the Liver

Removed From The Abdomen Via the Umbilicus

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy

If The Gall Bladder Can Not Be Safely Removed

Laparoscopically, The Abdomen Must Be Opened

In The Traditional Manner

Open Cholecystectomy

Open Cholecystectomy

Open Cholecystectomy

Open Cholecystectomy

Laparoscopic Vs Open

Less Post Operative Pain

Faster Recovery

Faster Return to Life

Less Pain Medications

Biliary Pain After Surgery

Abdominal Pain and Other Symptoms

May Persist or Recur In up to 20%

Diet After Surgery

No Specific Restrictions

Individualized Intolerences

Gall Stones

A Common Finding In Many

Symptomatic in Few

Surgery Warranted for Symptoms

Laparoscopic Cholecystectomy

Few Contra-Indications

Same Day Surgery or Overnight

General Anesthesia

1-2% Require Conversion To Open

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