Parasites and Biliary stones

Treatment of calcular obstructive jaundice ٨٠
Treatment of calcular obstructive jaundice
Role of medical therapy:
Ursodeoxycholic acid (10 mg/kg) eliminated gallbladder
microlithiasis and reduced the episodes of further pancreatitis. Continuing
therapy with UDCA appeared to prevent recurrence of gallbladder
microlithiasis (Ros et al., 1991). Its benefit in patient who cannot
undergo surgery and may work best on solitary stones less than 2 cm in
diameter. These treatment are now considered adjuncts to surgery rather
than alternatives. Overall, results are poor compared with the
interventions described below (Kelly et al., 2000).
Patients with cholangitis or gallstone pancreatitis are acutely ill, and
they often require aggressive rehydration. Antibiotics are indicated if
infection is present, and complete bowel rest (nothing by mouth,
nasogastric intubation) may be necessary. The patient may require
correction of coagulopathy, especially when an intervention is planned
(Halpin and Soper, 2001).
ERCP (sphincterotomy or pneumatic dilatation):
Endoscopic biliary sphincterotomy (ES) at ERCP was first described
in 1974 and was initially advocated for elderly patients or patients with
other co-morbid illness excluding them from surgical management.
However, since this time, ES has become widespread in the practice for
the removal of choledocholithiasis. The use of ES, particularly in younger
patients, led to concern over the long term sequelae of a disrupted
sphincter of Oddi caused by chronic enteric-biliary reflux (Tham et al.,
1997).