[17:23, 2/3/2018]
CME held at Dewan hospital Ludhiana
Ludhiana: 3rd February 2018: (Punjab Screen Bureau)::
A CME was held at Dewan Hospital and Advanced Laparoscopic Surgery Center, Ludhiana on the topic of "Complications caused by delay in the surgery of Gall Stone Disease". Dr Narotam Dewan, consultant General and Laparoscopic Surgeon, Dewan Hospital and Advanced Laparoscopic Surgery Center said.
1. Surgery is not necessary if you come to know incidently that you are suffering from gallstones in your gallbladder.
2. When these stones start causing any problem the surgery becomes necessary. These problems may be mild pain, indigestion, vomiting, heaviness, fever or excessive gas formation due to gallstone disease. These problems can be considered as an alarm that now is the time to get gallstones out by submitting yourself to surgery.
3. Those patients who delay surgery when it is indicated can fall in the trap of some very serious and life-threatening disease.
4. One of the most dangerous complications of gall stones is "Cholangitis". This is the infection of and pus formation in the bile ducts. Due to obstruction by a gallstone the bacteria start growing in the bile duct and enter blood through veins of liver. The bacteria and their toxins spread throughout the body. The patient starts having very high fever with rigors and chills, jaundice, pain in abdomen and may become semiconcious. As the disease advances the kidnies fail and blood pressuer falls. The toxins of the bacteria push the person into septic shock and multiple organ failuer which may lead to death. Few decades back the prognosis of this disease was grim and it use to lead to 100% fatality. Even now a days if the disease is fulminating and paient has comorbidities the death rate inspite of best treatment is about 7%. Patient needs high antibiotics, lots of IV fluids and supportive care.
5. Secondly the patient who delay the treatment of gall stones can fall victim to dreaded disease named "Gall Stone Pancreatitis". A small stone slipping from gall bladder and passing to the intestine through bile ducts pushes bile in to the ducts of pancreas. This entering of bile in the pancreas activates highly potent digestive enzymes of pancreas within the pancreas and start autodigestion of pancreas. As the ducts and cells of pancreas get damaged more digestive enymes get leaked and some portion of pancreas may get inflamed or dead. At time bacteria invade this portion of pancreas leading to pus formation. This pus of pancrease is not easy to remove and multiple surgeries may be requiered with prolonged hosptialization over many months in intesive care units. At other timew these pancreatic enzymes enter the blood and damage lungs causing blockage in the exchange of oxygen and carbondiaoxide ( Acute Respiratory Distress Syndrom ) or may damage kidneys. These can also lead to clotting of blood with in the blood vessels. At times the pancreas start bleeding or there can be bleeding from other vessels digested by the digestive enzymes. Patient comes with very sever pain in the tummy and vomitting. The abdomen is found hard as a wooden board. The patient requires urgent fluids and supportive treatment. If the pancreatitis is sever the patient may go into shock and multiple organ failuer and die. There is about 4.5% mortality rate inspite of aggressive treatment in such cases.
6. Obstructive jaundice is another complication which is due to slipping of a gallbladder stone into bile ducts and leading to blockage. The patient devolopes jaundice, eyes and skin becomes yellow. The bile from liver enters the blood and is passed in urine so urine to becomes yellow. Since the bile no more goes to the intestine so the stools loose their colour and become light coloured. The patient has lot of itching of skin. Deficiency of Vit K developes and leads to decrease in clotting of blood.
7. Due to inflamation of gall bladder, the adjoining organs like intestine get stuck to the gall bladder and it forms a mass abdomen. If the mass is hard, it is dangerous to operate and the patient is admitted for antibiotics and IV fluids. Patient has to be on treatment for about two monts before the patient can be taken up for surgery.
8. A single large stone staying in the gall bladder is known to lead to the formation of cancer in the gall bladder. Due to proximity of gall bladder to the liver, this cancer invades liver at an early stage and so pushes the cancer to an advanced stager. This is potantially fatal cancer.
9. The delay is gall stone surgery often leads to formation of pus in the gallbladder. This pus can rupture in the abdomen. The gall bladder may rot and becomes gangreeous. Thses are serious complications increasing the risk of the disease and making the treatment and surgery difficult.
The discussion was heald among the present doctors and public and it was concluded that the patients need to be educated about when they can wait and when they must immidiatly submit themselves to the surgical treatmetn of gall stone disease to avoid life threatning, painfull, distressing and costly complications.
Dt. Neeta Dewan, Diet and Nutrition consultant welcomed the audience and introduced Dr Narotam Dewan.
Dr Narotam Dewan
