Warung Bebas

Friday, 25 February 2011

Medical Treatment of Acute Cholecystitis

Treatment and Therapy
a.  Common actions
Bed rest, intravenous fluid administration, pain relief with petidin (demerol) and buscopa low-fat diet.  There are several factors that cause the occurrence of gallbladder disease, including obesity, high fat consumption, particularly the increasing trigleserida dyslipidemia associated with high intake of fat and sugar, weight loss quick reply.
Nutritional intervention needs to be done to prevent gallbladder disease: weight control, limiting fat intake to <30? Ri total calorie and fat intake no more than 30 grams / day, limiting the consumption of pure sugar (white sugar and other sweet food), avoid  weight reduction program drastically.  The principles of diet on gallbladder disease:

1.  Food for breakfast do not contain much fat, preferably in the form of cereals and fruits
2.  Using low-fat milk (fat level 1%) or skim milk to reduce fat consumption.  Vegetable milk such as soy milk is the best option.
3.  Using sugar substitutes such as aspartame as a sweetener in coffee, tea or cereal.
4.  Buying a low-fat snack foods such as fruit, low fat crackers
5.  Eating lots of vegetables that do not cause gas such as carrots, spinach, eggplant (cabbage, jackfruit, durian gas producer)
6.  Relaxing exercise such as walking or cycling.
7.  diet
- In a state of acute patients are usually fasted and get through the infusion of fluids and electrolytes.  After about 12-24 hours, clear liquid diet and then continued to offer low-fat diet.
- Low-fat diet, the consumption of fat 20-40 grams / day in patients with gallbladder
- Should be good and balanced diet to avoid deficiencies of calories, protein and micronutrient
- Diet may not contain foods that stimulate and contain gas
- Consumption of supplements of vitamins a, d, e, k
- Low-fat diet is recommended 4-6 weeks before the acute phase and surgery.
b.  Antibiotic
Given to treat peritonitis and septicemia and prevent empyema.  Microorganisms are often found was Escherichia coli, Streptococcus faecalis, Klebsiella, often in combination.  Anaerob germs can also be found as Bacteroides and Clostridia.
c.  Surgery
In acute cholecystitis should be performed immediately Cholycystectomy laparoscopic in one to two days of treatment.  Some surgeons prefer to wait and treat patients with hope for the better during treatment, and reserves the surgery when the patient's condition is almost completely recovered, with the rationale that the technical aspects of cholecystectomy would be easier if inflammation process has begun to heal.  The problem that approximately 25% of these patients fail to experience improvement or even deteriorate and require urgent surgery.  At this moment the tendency is to perform surgery immediately after diagnosis is certain and the patient's general condition is stable overall.
Compared with conventional cholecystectomy, the patient is out of the hospital within one to two days post-surgery and minimal scarring can re-move more quickly.  Approximately 10% of laparoscopic cholecystectomy should be changed to open surgery (conventional Cholecystectomy) in room of surgery because of extensive inflammation, adhesions or the presence of adhesion complications such as bile duct injury that requires repair.  In patients who require immediate treatment, but in a state of serious illness or very high risk for cholecystectomy, should be treated with the administration of medical fluids, antibiotics and analgesics, if this therapy fails to consider a percutaneous cholecystectomy.  Here the contents of the gall bladder removed and the lumen in the drainage with a catheter that was left.  In patients who experienced cholecystectomy and have recovered from an acute situation, cholecystectomy should be performed six to eight weeks later when conditions are good enough.

About 75% of patients treated with medical will experience a remission from acute symptoms within two to seven days of hospital care.  In 25% of cases, complications arise such as empyema and hydrops, gangrene and perforation, fistula formation, gallstone ileus.  In this case required surgery.
Than 75% of patients with symptoms of acute cholecystitis subsides, nearly a quarter will relapse within one year, and 60% at least will get a one-time relapse attack within six years.  Therefore it is best to early surgery.

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