Sunday, January 1, 2012

surgery to remove the gallbladder

In the surgical removal of the gallbladder, a surgeon makes an incision (cut) in your belly to open and view the area. The surgeon then removes your gallbladder by reaching in through the incision and gently lifting.

The surgery is done while you are under general anesthesia (unconscious and unable to feel pain).

The surgeon makes an incision of 5 to 7 inches in the upper right abdomen, just below the ribs, and cut the bile duct and blood vessels leading to the gallbladder. Then he removed the gallbladder.

During surgery, you will use special x-ray called a cholangiogram. This involves squirting some dye into your common bile duct. This duct will be left in after gallbladder removed. The dye helps locate other stones that may be outside of the gallbladder. If any are found, the surgeon can remove these other stones with a special medical instrument.

The open surgical removal of the gallbladder takes about an hour.

Why is the procedure:

The doctor may recommend surgery to remove the gallbladder if you have gallstones or your gallbladder is not functioning normally (biliary dyskinesia).

You may have some or all of these symptoms:

Pain after eating, usually in the upper right or middle abdomen (epigastric pain)
Nausea and vomiting
Infection (cholecystitis)
The most common way is to remove the gallbladder using a medical instrument called a laparoscope. See also: laparoscopic removal of the gallbladder

Other reasons for this surgery include:

You have had many surgeries in this part of your belly in the past
Respiratory problems
Severe liver problems
Bleeding problems
You are in their third trimester of pregnancy

Saturday, December 31, 2011

Gallstones is one more death

The housewife Suely Sena da Silva, 43, died last Saturday at around 13h, the Municipal Hospital Oriximiná victim of dengue hemorrhagic fever. She leaves her husband and five children.

According to the family, Suely began to show symptoms on the morning of last Wednesday. In the evening, was taken by her husband John Araujo da Silva to the hospital where she was treated with one tablet of dipyrone and released.

But the next day, the picture has worsened and she was taken to hospital, this time by daughter, Nilma da Silva. "She arrived at the hospital with bleeding," said Nilma. In the HM, it was attended by GP Rosângela Warrior Milk, which underwent a series of tests. The result confirmed dengue hemorrhagic fever, and gallstones. Suely still remained in the emergency room, where he received the first drugs to be subsequently hospitalized.

On Saturday, before the severity of the disease, the board decided to forward the HM Suely to Santarem, but the plane that would never even take off: 13h, the housewife could not resist bleeding and died.

The family, very shaken, not wanted to record an interview. The report tried to talk to health officials, but no one was found to give explanations. The funeral took place yesterday at Our Lady of Sorrows Cemetery.


The patient admitted to the Emergency Hospital and Emergency Dr. Augusto Rodrigues Chaves, last Saturday, with suspected dengue hemorrhagic fever in Marituba was transferred early yesterday morning to the Divine Providence Hospital.

The state of her health was not disclosed. The patient's name, 46, is also kept secret. The clinical director Avelar Feitosa only confirmed by telephone that a woman suspected of the disease was admitted to Providence moved from Augusto Chaves. Even today, the hospital will issue a technical note indicating the state of her health.

In the first hospital where the woman was hospitalized, no one wanted to talk about it. A nurse who declined to be identified said the hospital had not reported any cases of dengue hemorrhagic fever, dengue fever only. "That's the only thing I can say for sure," he said.

While waiting for an answer on the case, the team caught a DAILY pit with the cover broken with weeds around. The patients said that the problem is very old and uncomfortable. "We have asked that action on pit. I think it has even become a focus of dengue, "said the housewife Cilene Silva. At the hospital, no one wanted to comment.

Awareness Icoaraci

A dragnet against dengue to the rhythm of Carnival. That was the way that the passage Oscarina Darco residents in the district of Icoaraci found to avoid proliferation of mosquitoes at the site.

Accompanied by a samba school drum Independent Youth Village Smile, residents went out walking the streets in the district advising and guiding on the evils of disease. "The city has been here, has advised. But we need to reinforce it with everyone. Let's knock on the door and show that we have to engage in the fight against this disease that kills and causes so much suffering, "said Regiane Farias, one of the directors of the Friends of Icoaraci.

During the walk, residents handed out flyers to neighbors about the disease. Plastic bottles, poorly packaged junk and anything that might serve to focus dengue was collected during the trawl.

She said the idea came from cases that have begun to increase on-site. "Dengue is here already becoming well known. Everyone knows someone who has had the disease. We need to change this reality, "said Regiane.

Another concern of residents is that Icoaraci was the first place in Pará to register a case of dengue type 4, which did not circulate for more than 20 years in the country. "We were scared. Now, home care has increased greatly. I am very afraid of getting this disease, "said the shopkeeper Nilza Smith

Friday, December 30, 2011

learn all smallest detail about gallstones

In the past ...
When her surgeon recommended a gallbladder operation, you remember a friend or relative who did the same surgery a few years ago. They had a huge scar and told they had intense pain after surgery. They stayed in hospital for a week, unable to return to normal activities in less than 6 weeks. So you were worried about going through the same things. How do I get off work almost two months?
Today ... There is a new surgical technique to great advantage
The gallbladder removal surgery is one of the most practiced and most is already done laparoscopically. The medical term for this procedure is laparoscopic cholecystectomy.
Instead of incisions 20 to 30 cm long, the operation is performed through four small holes of 0.5 cm in the abdomen.
The postoperative pain is much smaller than that of conventional surgery.
Usually the patient is admitted to the hospital one day and return to normal activities within 10 to 15 days.
It is a pear-shaped organ located under the right lobe of the liver.
Its main function is to collect the bile produced by the liver and concentrate it. When the person eats, the gallbladder contracts releasing the bile, which passes through a channel called bile until it reaches the gut and find food.
The removal of the gallbladder is not associated with any digestive dysfunction in most people.
WHAT CAUSES gallbladder problems?
The main problem of the gallbladder is associated with the presence of gallstones. They are stones of varying size and number, usually formed from cholesterol and / or bile salts contained in bile.
It is still uncertain why some people form stones.
There's no way to prevent stones from forming.
These stones can block the flow of the gallbladder, blocking the natural flow of bile, causing increased pressure within the bladder, leading to swelling (edema) and therefore the infection. This state is known as acute cholecystitis. The person has a cramping pain below the right rib, with vomiting and fever later.
If a small stone can pass into the bile duct the person may become yellow and have severe complications.
As these problems are detected and treated?
An ultrasound or abdominal ultrasound is the method of choice for diagnosis.
In some more complex cases, other radiological investigations are needed.
Calculi (stones) of gall bladder does not disappear with time. Any attempt another surgery that did not have any success. Temporary improvement may occur but may return with complications.
The removal of the gallbladder is the fastest and safest treatment for cholelithiasis. (Medical term to describe the presence of stones in the gallbladder)
The night the day before surgery from midnight I must remain absolute fasting.
Taking a bath in the evening or morning before surgery.
If you have constipation problems chronic tell your surgeon.
If you do use daily doses of medications, talk with your surgeon to find the best solution. If you make use of anti-coagulants or aspirin be sure to alert your doctor.
The patient is operated under general anesthesia.
Made a small incision in the navel where a needle is inserted to fill the abdominal cavity of a special gas. The intention is to create a space for the surgery can be performed.

It is then inserted a metal tube called a trocar is placed where the laparoscope (like a telescope). Through this shows all the abdominal cavity.

Held over three small cuts where the clamps are placed which will be used during surgery.

In some special situations, RX is performed bile duct during surgery to detect stones in the bile duct. If any are detected, or should be removed during surgery or after a procedimente performed with endoscopy. (Endoscopic sphincterotomy)

At surgery the cuts are closed with one or two points on the skin.
In a small number of patients, the method can not be done. This is usually due to local anatomical difficulties inherent in the patient or the degree of inflammation that occurs at the site due to gallbladder disease. When the surgeon decides to convert a surgery for the safety of the patient, does not consider it as a trial but as a complication of surgery (wisdom). Factors that could cause the conversion of closed to open surgery include excessive obesity, history of previous abdominal surgery, bleeding and other containment difficult.
The vast majority of patients undergoing laparoscopic cholecystectomy is not more than 24 hours in hospital. In some cases the patient is operated in the early morning, and may be released on the same night.
When will I get back to work?
On average you can return to full activities within 7 days. Of course it depends on what you do. If you have a job that requires great effort or medium, is to return to usual activities within 3 to 4 weeks.
IT IS SAFE TO PERFORM laparoscopic surgery?
The risks of laparoscopic surgery is identical to conventional surgery. Since the conventional method runs a greater risk of hernia formation at the site of the cut.
THERE IS RISK IN laparoscopic surgery?
Although surgery is considered safe, complications can occur as with any surgery.
The gallbladder surgery is an abdominal surgery and therefore a little postoperative pain you should have. Nausea and vomiting may occur within 12 hours.
Once the liquid diet is well tolerated and no vomiting, the patient can be discharged the next day.
Getting out of bed already in the postoperative period is allowed and encouraged. The next morning the bandages can be removed and the patient bathing.
In general, recovery is gradual and progressive. You should always be better the next day.
Should return in a week to remove the stitches.
Constant fever (above 38oC)Starting to get the yellow skin or eyesYou have nausea and vomitingThe wound bled continuouslyIncreased abdominal pain or swelling in the abdomen.You have chillsPersistent cough or shortness of breathDifficulty swallowing liquids or solids after the normal period of recoveryShow secretion through the wound.

Acute Pancreatitis, terrible consequence ...

Acute pancreatitis is a condition resulting from inflammation of the pancreas. The main function of the pancreas is to produce digestive enzymes, insulin and glucagon that regulate blood sugar levels.

In pancreatitis, pancreatic enzymes that are normally released in the small intestines to aid digestion are activated inside the pancreas and start to damage it. If the crisis is severe or prolonged, or if outbreaks of acute pancreatitis occur repeatedly, permanent damage to the pancreas can occur and lead to a condition called chronic pancreatitis.

The two most common causes of pancreatitis are gallstones and bile alcoholism (alcohol abuse). As the pancreatic duct, which carries digestive enzymes from the pancreas into the small intestine is the common bile duct, which comes from the gallbladder and liver, gallstones that clog the channel prevent pancreatic enzymes from reaching the intestines, being accumulated inside the liver and it is activated by eroding the body inside. Although most people who drink alcohol do not develop pancreatitis, drinking large amounts of alcohol can activate pancreatitis.

Other factors that sometimes can cause pancreatitis include:

Abdominal trauma (traumatic pancreatitis)
Abdominal surgery, drugs, including certain antibiotics (metronidazole, tetracycline and sulfa drugs), thiazide diuretics and estrogen, calcium or High levels of triglycerides in the blood, some infections such as mumps or viral hepatitis,
Endoscopic procedures involving the bile duct and pancreatic
Idiopathic (no cause is found).


Symptoms of acute pancreatitis include:

the upper abdominal pain that may be tolerable to the stabbing, in a band at the time of the stomach, both right and left;

Projection of the pain to the back, chest, flank or down

Worsening of the pain with food, especially fatty

nausea and vomiting,

o Loss of appetite,

the abdominal distention (swelling),

The Fever,

o Lack of air,


Hypotension and the shock (very low pressure, disabling the functioning of organs).


The patient's history will reveal the abuse of alcohol which, when absent, especially in women, is strongly suggestive of gallbladder calculi, confirmed by ultrasound examination.

Blood tests reveal elevated levels of pancreatic enzymes, amylase and lipase confirm the diagnosis of pancreatitis. The decrease of calcium in the blood is a sign of worsening, as well as the increase of leukocytes, glucose, urea and creatinine.

In some cases of pancreatitis, blood amylase may be normal as it rises rapidly at first and then decreases, does not mean improvement.

In some cases, computed tomography is suspected when swelling of the pancreas and the presence of fluid in the abdomen. CT scans also can reveal pancreatic pseudocysts are well containing pancreatic enzymes that develop in some cases of severe pancreatitis in chronic pancreatitis. Serious complications can occur when the cysts burst and enzymes come in contact the surface of the abdomen (peritonitis).


Avoid the abuse of alcohol if the person never had pancreatitis,

Never drink the more, if the person has had one episode of alcohol-induced pancreatitis,

It is believed that to maintain a normal weight and avoiding rapid weight loss can prevent the development of gallstones,

Avoid the indiscriminate use of antibiotics and oral contraceptives the basis of estrogen.


· General:

Rest in hospital

Fasting to "rest" the pancreas,

the replacement fluid intravenously

the passage of a nasal tube into the stomach to control the vomiting, the parenteral nutrition (through a vein thick) may be required in severe cases,· Medications to protect stomach stress ulcers. Include H2 blockers (ranitidine hydrochloride) and proton pump inhibitors (omeprazole, pantoprazole, esomeprazole, etc.)

· Antibiotics are only indicated in severe cases and when the cause is gallstones by the frequent presence of infection of the gallbladder - cholecystitis.

• The Surgery is indicated in the following situations:

The definitive treatment of gallstones (cholecystectomy)

Infection with the documented pancreatic abscess (collection of pus)

the necrosis (deterioration) of the pancreas extensive,

the major bleeding,

Shock that does not improve

the failure of multiple organs.

What Is It?

The patient with severe abdominal pain, does not improve with the portion sizes, or is accompanied by intense nausea or vomiting, you should seek a surgeon general or treated at an emergency room.


Pancreatitis often improves slightly in the first week, without complications and without any further problem, but severe cases can last several weeks. Chronic pancreatitis may develop if there is a significant injury to the pancreas or if the patient had several attacks over time.

Nearly 10 percent of patients develop complications such as abscesses and necrosis of the pancreas that may require surgical treatment.

The pancreatitis caused by alcohol in crises occur from time to time, if the patient insists on drinking. Approximately 10 percent of patients with acute pancreatitis develop alcohol-related chronic pancreatitis.

DO NOT OPERATE OR OPERATE? That is the question

Always working and silent, the gallbladder is where bile is stored, a greenish liquid, bitter and slimy, secreted by the liver and that, through its own system of channels, led to the duodenum, participating in important ways from digestion. But sometimes, a dysfunction, there is a change in the production of bile, precipitating the formation of crystals, which, little by little, get bigger and give rise to so-called gallstones. Most people who have no symptoms calculations. Although laparoscopic surgery is widespread, it is only indicated in certain cases. What is the development of asymptomatic gallstones? The frequency of symptoms and complications of gallstones discovered by chance is relatively small. In general, those who have gallstones never have symptoms or complications arising from calculations asymptomatic gallstones. Still, many researchers have been trying to establish which patients could biliary disease throughout his life. To our knowledge, there seems no relationship between symptoms and age, sex and number of calculations. So far, there is consensus that the evolution of the calculations without symptoms is benign and requires no intervention. What is the development of symptomatic gallstones? On the other hand, since the calculations cause typical symptoms of biliary disease, the risk of persistence of these problems is relatively high. Moreover, most of the complications of gallstone disease is preceded by an attack of biliary colic. Therefore, once the patient has presented biliary colic, the trend is that these episodes are repeated until they culminated in a complication, if nothing is done. Because biliary colic is expressed? The main complaint of patients with biliary colic symptoms is. Most clinicians agree that biliary colic - the most characteristic symptom of gallstones - is not an appropriate name because the pain is crampy. Rather, it is a very intense and continuous pain in upper abdomen, and during which alternate periods of worsening and improvement. This pain lasts from 15 minutes to hours and is commonly accompanied by nausea and vomiting. Evolves, often without precipitating factors. The interval between episodes can vary from days to months or even years, and, rarely, daily symptoms can be attributed to gallstones. The biliary colic must be differentiated from nonspecific symptoms that characterize functional dyspepsia. Gas, heartburn, abdominal discomfort, intolerance to fatty foods are frequent complaints in clinics. However, both occurring in patients with stones and in patients without gallstones. This differentiation is critical to successful treatment, since this is only indicated for biliary colic. In the episode of uncomplicated biliary colic are not detected changes in laboratory tests. The main test to confirm the diagnosis of gallstones is the abdominal ultrasound. What are the main complications of gallstones? When the frame persists for more than six hours, the suspicion of acute cholecystitis should be dismissed. Most patients with acute cholecystitis have previous episodes of biliary colic. The pain of acute cholecystitis is more prolonged, may be located precisely on the right side of the upper abdomen and is associated with fever. In the presence of acute cholecystitis, the gallbladder wall is thickened on ultrasound examination. Once the gallbladder becomes inflamed, signs of infection and elevated liver enzymes appear in blood tests. In some patients, the calculations can escape from the vesicle. If they are small, can go straight from the bile ducts into the intestine, leaving the faeces. If you are a little bigger, can become lodged in the bile ducts, causing complications such as jaundice, cholangitis or pancreatitis. The obstruction of the passage of bile results in jaundice (yellowing of the skin and whites of the eyes) and itching. Calculations in the main bile duct are often associated with infection, resulting in severe acute cholangitis framework, which is characterized by biliary colic, jaundice, fever and chills, requiring urgent treatment. Acute pancreatitis (inflamed pancreas) can also be caused by the passage of the bile duct calculations. Some experts recommend the removal of the gallbladder with calcified walls (also called porcelain gallbladder) the risk of developing gallbladder cancer. Although calculations large (greater than 3 cm) can be associated with gallbladder cancer, withdrawal prophylaxis is still controversial. What is the best treatment option? There is a consensus that asymptomatic calculations should not be treated. Only the calculations with symptomatic or complications and the calcified gallbladder should be treated. The options include surgery (cholecystectomy), dissolution or fragmentation of the calculations. Cholecystectomy is the only definitive treatment. It is a simple, safe, and suitable for most patients with stones. Currently, laparoscopic cholecystectomy facilitated the procedure with a shorter hospital stay, fewer complications and quicker return the patient to your routine. It is for this reason that cholecystectomy is now chosen by the majority of patients with gallstones. However, in about 5% of cases and in the presence of complications, conventional cholecystectomy may be a better option. The non-surgical treatment is reserved for patients who do not want to undergo surgery or have a very high surgical risk. Importantly, both dissolution and fragmentation of the calculations are not definitive procedures. Because the gallbladder is not removed, the calculations can, over time, reappear. The calculations present in the bile ducts can be removed through an endoscopic procedure called endoscopic retrograde cholangiopancreatography (ERCP). This test may be performed before, during or after cholecystectomy. Symptoms may persist after cholecystectomy? The persistence of symptoms after cholecystectomy should be observed and discussed with patients before subjecting them to surgery. Many doctors tend to indicate cholecystectomy before the occurrence of specific symptoms such as intolerance of fatty foods, gas, belching, heartburn, nausea. Although some patients may improve these symptoms after surgery, several studies have shown that these may be present in the presence or absence of gallstones, and therefore are not specific to biliary disease. Performing a cholecystectomy just to see if symptoms improve is not recommended. In addition, cholecystectomy is not an innocuous procedure and may lead to other symptoms such as diarrhea after cholecystectomy. The wide spectrum of clinical presentation, the possibility of improvement in some patients and the facility provided by the laparoscopic cholecystectomy, surgery could even occasionally be indicated in patients with such symptoms, provided that they are intolerable, have negative investigation for other causes, or the subject has been previously discussed with the patient and has even accepted the possibility that the symptoms are not relieved by surgery.