GALLBLADDER STONE DISEASE IN ELDERLY CAN BE DANGEROUS.

For the past 7 to 10 days, I have had dull ache pain in my chest and dyspepsia.

I am diabetic and hypertensive, well-controlled on medications.

I came to DR ASHISH VASHISTHA, SENIOR DIRECTOR of HOD MAX HOSPITAL SAKET FOR EVALUATION AND MANAGEMENT.

He explained to me all about it.

GALLBLADDER STONE DISEASE IN THE ELDERLY CAN BE DANGEROUS.

GERIATRIC PATIENTS TEND TO HAVE SUBTLE PRESENTATIONS OF BILIARY DISORDERS AND IF UNTREATED CAN DECOMPENSATE ACUTELY.

GALLBLADDER STONES CAN CAUSE ACUTE CHOLECYSTITIS AND ARE SOMETIMES DIFFICULT TO MANAGE.

With the progression of age, the biliary tract undergoes anatomic and physiologic changes. Geriatric patients tend to have a subtle presentation of biliary disorders and can decompensate acutely if untreated. They have higher rates of complications and slower recovery because of delayed healing, comorbidities, and weaker immune systems. The management of gallstones must incorporate therapeutic goals ranging from improvement of quality of life to a disease-free body.

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about Asymptomatic Gallbladder stones.

Asymptomatic Gallbladder stones –

Elderly people can have a symptomatic gallbladder stone diagnosed on ultrasound / MRI etc.

Looking into their medical conditions, they should be offered its management.

Elective laparoscopic cholecystectomy is an ideal procedure to be done.

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains Acute cholecystitis.

Acute cholecystitis refers to acute inflammation of the gallbladder, which in most cases results from gallstones.

Acute calculous cholecystitis results from cystic duct obstruction and increased intraluminal pressure and congestion.

Symptoms –

• Acute pain in epigastric region 

• Nausea, vomiting

• Distention of abdomen

• Unable to pass gas/flatus

• Pain radiating to the back

• Acute pain is seen after fatty meals and early in the morning

On examination Murphy’s sign is positive. Sometimes in elderly patients due to neuropathy, less pain is felt and other symptoms like dizziness, weakness, ghabrahat, and a general feeling of unwell are felt.

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about Diagnosis.

Diagnosis –

• Ultrasound is extremely important to look for gallbladder stones, sludge, the thickness of the gallbladder wall, gas in the lumen of the gallbladder, cystic duct, bile duct caliber, wall thickness, and any presence of stones or sludge.

• HIDA scan can help if nothing significant is seen on the ultrasound

• MRI abdomen can also help

• A complete blood count will give us a clue about the association between pancreatitis and CBD stones.

• Clinical suspicion is also very important.

 

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about complications.

Complications–

• Gangrenous cholecystitis
• Emphysematous cholecystitis
• Gallbladder ileus
• Cholecystoenteric fistula
• Gallbladder perforation

Elderly people are prone to have complications so Gallbladder stones should be electively treated in them.

LAPAROSCOPIC CHOLECYSTECTOMY AFTER MEDICAL MANAGEMENT IS THE IDEAL TREATMENT FOR GALLSTONES IN THE ELDERLY.

IT SHOULD BE DONE IN TERTIARY HOSPITAL WITH HIGH-TECH INFRASTRUCTURE.

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about CHRONIC CHOLECYSTITIS.

CHRONIC CHOLECYSTITIS –

Long-standing gallstones or prior episodes of acute cholecystitis may cause indolent gallbladder inflammation, also called chronic cholecystitis.

On histology, gallbladder wall thickening, serosal adhesions, smooth muscle hypertrophy, and pathognomonic Rokitansky-Aschoff sinuses are observed.

The chronic inflammation may cause gallbladder calcification and porcelain gallbladder, the mechanism of which is unclear.

 TREATMENT FOR CHRONIC CHOLECYSTITIS IS ALSO MEDICAL MANAGEMENT AND LAPAROSCOPIC CHOLECYSTECTOMY