Gallbladders - Perils of waiting - Mr Marcus Reddy - Parkside Hospital

Elective• Pain• Jaundice• Dyspepsia

• RecognitionBarriers to ElectiveCholecystectomy• Scanning/ OGD• Referral• Surgery

Methods to increase service• Elective• Dedicated clinic slots• Utilisation of Day surgery• Specialisation of surgeons• Emergency• Role specialist service• Radiology and surgeons• Emergency theatre lists

Conclusion• Treatment is early cholecystectomy• Elective – early diagnosis andreferral with a streamline service• Emergency – referral to a fast trackhot service

Diagnostic Criteria forFunctional GallbladderDisorders• Must include episodes of pain locatedin the epigastrium and/or right upperquadrant and all of the following:• 1. Episodes lasting 30 minutes or longer• 2. Recurrent symptoms occurring at different intervals (notdaily)• 3. The pain builds up to a steady level

Diagnostic Criteria for FunctionalGallbladder Disorders• . The pain is moderate to severe enoughto interrupt the patient’s daily activities orlead to an emergency department visit• 5. The pain is not relieved by bowelmovements• 6. The pain is not relieved by posturalchange• 7. The pain is not relieved by antacids• 8. Exclusion of other structural diseasethat would explain the symptoms

Diagnostic Criteria for FunctionalGallbladder Disorders• Supportive criteria•• The pain may present with 1 or more ofthe following:• 1. Pain is associated with nausea andvomiting• 2. Pain radiates to the back and/or rightinfrasubscapular region• 3. Pain awakens from sleep in the middleof the night

ConclusionFunctional disorders of the gallbladderare not identified by gallstones onultrasoundDiagnosis made by symptomcharacteristics and 85% confirmedon provocation ultrasound scans