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Reflection on cholecystitis
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The earliest known gallstone dates back to the twenty-first Egyptian Dynasty sometime between 1085-945 B.C., that was discovered in the mummy of a priestess of Amen. This ancient specimen was destroyed, unfortunately, in the bombing of England during World War Two. Gallstones or cholelithiasis were first described and further researched in the fifth century by the Greek physician named Alexander Trallianus. Trallianus wrote about stones within the bile ducts. Trallianus wrote about stones in the bile duct. Although, Trallianus discovered gallstones, he did not know there are different stages in the formation of gallstones. However, Carl Langenbuch of Berlin was credited to have performed the first cholecystectomy or surgical removal of the …show more content…
The gallbladder is not a vital organ. Gallstones range in size from as small as a grain of sand to as big as a golf ball, range from a few millimeters to several centimeters in diameter. Gallstones may also be soft, smooth, or even jagged, due to the development of cholesterol and pigments in bile that sometimes form hard particles (Balentine). Bile is a fluid produced by the liver, stored in the gallbladder, it passes through the common bile duct into the duodenum where it helps digest fat. Bile is made of cholesterol, bile salts, and the pigment bilirubin. Gallstone disease is the most common gastrointestinal disorder of adult life (Heuman "Gallstones (Cholelithiasis) "). There are two types of gallstones that can form in the gallbladder: Cholesterol and Pigment Gallstones. Cholesterol Gallstones are the commonly developed stones, they usually appear to have a yellowish color, this is because of the undissolved cholesterol. Pigment Gallstones have a dark brown or black color, these stones only appear when you have too much bilirubin in your …show more content…
Certain chemicals such as, ursodiol or chenodiol, have been shown to dissolve some gallstones, they can be found in oral bile acid pills. If these medicines work on the patient they will thin the bile, which will allow the gallstones to dissolve. This medical treatment can be very effective and tolerated if limited to people whose gallstones are small and made of cholesterol (WebMD). However, Doctors believe if you do not have symptoms, the patient should “wait and see,” because the risks outweigh the benefits for both medical and surgical treatments. If you have gallbladder symptoms, surgical treatments are preferred unless you are at high risk, and then drug treatments may be utilized. Surgical removal for gallstones range from different prices however, most health insurances typically pay for the procedure. For patients without health insurance, gallbladder surgery typically costs $10,000-$20,000. For example, at Wright Medical Center in Iowa, open gallbladder surgery costs about $9,700, including a doctor fee of about $2,500, while laparoscopic gallbladder surgery costs about $12,600, including a doctor fee of about $3,200
...h a type of surgery called Cholecystectomy. The Non-Surgical approaches are used only in specific situations such as when a patient’s condition prevents using an anesthetic. In such cases, Oral dissolution therapy is used.
Strasberg SM (2008). "Acute Calculous Cholecystitis". New England Journal of Medicine 358 (26): 2804–2811. doi: 10.1056/NEJMcp0800929. PMID 18579815
One or more gallstones erode into the gastrointestinal tract, creating a cholecystenteric fistula, most commonly between the gallbladder and the duodenum. Gallstones less than 2 to 2.5 cm generally pass into the intestine without causing obstruction while stones 5 cm or larger are more likely to impact usually at the distal ileum, the narrowest part of the small bowel. Other reported sites of impaction include proximal ileum, jejunem, colon, and rarely the duodenum or stomach (bouveret’s syndrome). [11] In our case, a large, approximately 5 cm, gallstone was found impacted at the jejunum while a smaller stone was found impacted at a Meckel’s
However, patient needs to have gallbladder removed. Patient with cholecystitis requires hospital admission for complete bowel rest and other treatment. NG tube insertion and gastric decompression is other non-pharmacological way to prevent further gall bladder stimulation. Surgical treatment of cholecystitis includes laparoscopic choleycystectomy, percutaneous cholecystectomy and open cholecystectomy .The treatment of choice for symptomatic cholecystitis is laparoscopic choleycystectomy. Approximately 90% of gallbladder removal is done laparoscopically because it is considered as gold standard treatment. This procedure is performed by using four small incisions and gallbladder is removed by using one of them. Likewise, Percutaneous cholecystectomy is other treatment option for diagnosis and treatment of acute cholecystitis for patients who are at risk for any surgical procedure or general anesthesia. Open cholecystectomy is performed when the inflammation is severe. In this procedure gallbladder is surgically opened and the purulent drainage, bile and stones are removed. Cochrane reviews suggest that there is no difference in complication rate, mortality or operative time in comparison to laparoscopic and open cholecystectomy (Graham, 2008). However, because of less surgical risk, less hospital stay and short recovery period current usual treatment option is
The laparoscope was inserted and the remaining ports were placed visualizing their placement with a laparoscope. An 11 mm port was placed in the subxiphoid location, and two 5 mm ports were placed laterally under the right subcostal (rib) margin. The gallbladder was identified. It was edematous, acutely inflamed. It was grasped with the fundus and retracted in a (cephalad) direction. There were no omental adhesions adherent to the gallbladder that were taken down sharply. The neck was then grasped along the lateral most ports and retracted in a lateral direction. The cone bile duct was identified and care taken to avoid injury to this structure. The cystic artery and cystic duct were identified, mobilized, doubly ligated with endoclips and then divided. The gallbladder was dissected free from the liver with the electrocautery. The specimen was placed in an (Endo Catch) (sac), and was removed through the umbilical incision with no difficulty. The Hassan trocar was reinserted into the abdomen, reinflated the suprahepatic lymphatic space was irrigated copiously with normal saline. Adequate hemostasis was obtained in the gallbladder fossa with the electrocautery. The 360 degree
These expertly-crafted watches, created by world-renowned watchmakers such as Chopard, Breguet and Patek Phillippe, are some of the most valuable timepieces in the world. The intricacy of the design, the level of detail and the inclusion of diamonds and precious stones means that these watches each cost a couple of million dollars.
What are gallstones? Gallstones usually form in the gallbladder when liquid stored hardens into pieces of stone like material. Also, gallstones can form anywhere in the intrahepatic, hepatic, common bile, or cystic ducts. The liquid, called bile is used to help the body digest fats. Bile is made in the liver, and then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a duct which carries it to the small intestine, where it helps with assimilation. Gallstones are yellow liquid made of fats and cholesterol that convert to stones when collect it in the gallbladder. Gallstones are hard, pebble-like deposits that form inside the gallbladder. Gallstones range in size from very small to as large as a golf ball. Also, gallstones can move from the gallbladder into the common duct or the cystic. However, knowledge about gallstones, and Occurrence, Symptoms, Diagnosis, Treatment, and Complications of Gallstones are very beneficial because you will be able to avoid it in the future.
There are two types of gallstones; Cholesterol stones and pigment stones. Cholesterol stones are the main types of stones that affect patients; it is created by too much cholesterol in the bile. Cholesterol stones are
The stones were discovered buried in close proximity to each other in a cave located in Namibia, Africa by German archeologists in 1969. When lead archeologist W.E. Wendt heard the Apollo 11 lunar mission was successful during the dig he dubbed his find The Apollo 11 Stones. These stones date back to the Paleolithic period, 25,500-25,300 B.C.E. making them some of the oldest discovered art in Africa, and perhaps the earliest known evidence of human artistic expression globally.
“Employees who believe that management is concerned about them as a whole person - not just an employee - are more productive, more satisfied, more fulfilled. Satisfied employees mean satisfied customers, which leads to profitability” (Mulcahy, n.d.). One Smooth Stone is a leader and front runner in their management styles. They are an exemplary example of an open system management company.
The main pharmaceutical drugs used to treat and manage asthma are Beta2-adrenergic agonist and inhaled corticosteroids (ICS). Beta2-adrenergic agonists are used for relief and acute symptoms, while corticosteroids are to be taken daily to control inflammation. Inhaled corticosteroids are used as the first-line maintenance therapy. ICS are the most effective anti-inflammatory drug used in the management of asthma. ICS must be used long-term, as symptoms are likely to recur if they are discontinued.
The Stone Ages were a time when hominids and early humans were alive. They lived in the three different epochs. The Paleolithic Era, Mesolithic Era, and the Neolithic Era. The initial humans were basic in the ages, but they eventually grew more advanced. The humans started growing more progressive in the Paleolithic Era.
Stone says, “Standing…is the authority of someone to initiate an action. The term in its narrower common use is probably limited to the right of nongovernmental parties to institute judicial review, which will be our principal focus” (35). Writing with an audience of environmentalists and environmental lawyers in mind, he argues to put Nature in the plaintiff’s seat and allow all of nature – animal, vegetable, and mineral – to have legal standing in order to claim rights on their own behalf. Historically, the judiciary accepted only complaints where human beings could stake claim to violation of rights, on their own behalf as well as for non-humans and other property either owned or affected (injured) by as a citizen. In the case of Nature and non-humans Stone says this is a mistake linked to the three elements necessary for establishing standing. Namely, that citizens and organizations cannot suffer injury-in-fact which thus means there can be no causal link to an injury nor any injury that requires redress.
Jade is an umbrella term to describe a variety of stones. Pure jade is compromised of either jadeite or nephrite. Jadeite is the rarer of the two, thus more valuable, and is made of sodium, aluminum, and silicate. Nephrite, made of calcium, magnesium, and iron silicate is used more often for carvings and jewelry as it’s a bit softer than it’s counterpart. Depending on which variety you want, locations vary on where to find it. Nephrite can be found on the South Island of New Zealand, Australia, Brazil, China, Canada, Zimbabwe, Russia, Taiwan, Alaska and Poland. Jadeite’s main source is in Burma, but it’s also found in Japan, Canada, Guatemala, Kazakhstan, Russia, Turkey, Cuba and the USA. Estimated to be over 500 million years old,
For this research paper I’ll be writing about one of the most famous monument in the world. Stonehenge is one of the world’s most famous monuments. Stonehenge is a unique prehistoric monument, lying at the center of an outstandingly rich archaeological landscape. An extraordinary source for the study of prehistory, it holds a pivotal place in the development of archaeology. It stands on Salisbury Plain, in Wiltshire, and its giant stones can be seen from miles around. Stonehenge was built over many hundreds of years. It was built in several stages: the first monument was an early henge monument, built about 5,000 years ago, and the unique stone circle was erected in the late Neolithic period about 2500 BC. Work began in the late Neolithic Age,