Page 267 - 2021 IDMT Digital
P. 267
CHOLELITHIASIS
Introduction:
• GDOOVWRQHV (hardened deposits of cholesterol or bilirubin)
• 0RUH FRPPRQ LQ ZRPHQ WKDQ PHQ KLJKHVW UDWHV ZLWK DJH ! DQG LQ 0H[LFDQ
$PHULFDQV
• $VVRFLDWHG ZLWK RYHUDOO LQFUHDVHG FDUGLRYDVFXODU DQG FDQFHU PRUWDOLW\
• 5LVNV REHVLW\ SUHJQDQF\ UDSLG ZHLJKW ORVV GLDEHWHV JOXFRVH LQWROHUDQFH LQVXOLQ
UHVLVWDQFH SURORQJHG IDVWLQJ ! GD\V K\SHUWULJO\FHULGHPLD FHUWDLQ PHGLFDWLRQV
FHIWULD[RQH KRUPRQH UHSODFHPHQW WKHUDS\
• &ODVVLILHG DFFRUGLQJ WR WKHLU SUHGRPLQDQW FKHPLFDO FRPSRVLWLRQ FKROHVWHURO RU FDOFLXP
ELOLUXELQDWH VWRQHV
Subjective:
• 6LJQV DQG 6\PSWRPV
o )UHTXHQWly DV\PSWRPDWLF DQG RQO\ GHWHFWHG ZLWK XOWUDVRQRJUDSK\
o &ODVVLF ELOLDU\ SDLQ RFFXUV LQ
,QIUHTXHQW HSLVRGHV RI VWHDG\ VHYHUH SDLQ in HSLJDVWULXP RU ULJKW
XSSHU TXDGUDQW ZLWK UDGLDWLRQ WR ULJKW VFDSXOD
• )RFXVHG +LVWRU\
o :HLJKW FRQFHUQV PHGLFDWLRQ XVDJH IDPLO\ RU SHUVRQDO KLVWRU\ RI JOXFRVH
LQWROHUDQFH RU GLDEHWHV
Objective:
• 3K\VLFDO ([DP
o $EGRPLQDO H[DP LV XVXDOO\ QRUPDO
o &DQ KDYH WHQGHUQHVV WR SDOSDWLRQ RYHU HSLJDVWULXP DQG 584
Assessment:
• 'LIIHUHQWLDO
o 38' EUHDN LQ JDVWULF RU GXRGHQDO PXFRVD HSLJDVWULF SDLQ LV KDOOPDUN
HQGRVFRS\ UHTXLUHG IRU GLDJQRVLV
o '\VSHSVLD SDLQ DQG disFRPIRUW FHQWHUHG LQ WKH XSSHU DEGRPHQ GRHV QRW LQYROYH
UHIOX[ V\PSWRPV
o *(5' UHIOX[ RI VWRPDFK FRQWHQWV FDXVLQJ KHDUWEXUQ V\PSWRPV
o *DVWULWLV LQIODPPDWLRQ RI WKH JDVWULF PXFRVD
o H Sylori LQIHFWLRQ PRUH OLNHO\ WR EH SUHVHQW LQ 38' OHDGV WR G\VSHSVLD
Plan:
• 16$,'V FDQ UHOLHYH ELOLDU\ SDLQ
• ,I V\PSWRPDWLF, SDWLHQWV PD\ QHHG UHIHUUDO WR VXUJHU\ IRU FKROHF\VWHFWRP\
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