hello doctors .. dis case is of my father's sister so plz help me n suggest me d management a female age 68 yrs having d c/o bloating of stomach ; weakness ,no appetite, hyperglycemic patient ... reports r uploaded... doctor had advised for operate... patient does not will to operate plzz do needful



Cholelithiasis with multiple calculi 3- 4 mm in size. There is no option except for laparoscopic cholecystectomy. Convince her that there is definitive medical treatment. This is a high risk case of Gall stones induced acute pancreatitis as calculi of 3- 4 mm can slip in CBD and can cause obstructive jaundice or can cause acute pancreatitis. Medical treatment if any is Ursodeoxycholic acid 300 mg B.D for prolonged period of 6- 9 months along with sorbiline

Described symptoms can be due to diabetic autonomic neuropathy causing delayed gastric emptying seen in prolonged uncontrolled diabetes, than due to biliary colic. Presently if gall stones asymptomatic or uncomplicated evaluating further based on clinical biochemical and imaging, refer to physician for optimisation of medical conditions. May be an UGI endoscopy at some point before taking for Lap cholecystectomy which is Gold standard for treating gall bladder diseases due to stones in elective setting.

Dear Doc. With cholelithìasis with multiple calculi though small on size .aThere is no option particularly ven in old age Lparaspy cholecstetomy is the only answer .Diabetid shown on the report is not a proleb at all. These small stones will be a high risk than lap. Operation .pl.convince her that at I am noa in favour for medical treatment. These small stoes may induce acute pancreatitis and can slip in CBD

@Dr. Gajanan Chavan

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Abdominal pain with background of Diabetes and GB calculi is the indication for surgery basically... Its for better sake in terms of further cholecystitis, CBD stones, Pancreatitis, GB cancer.... Other option is to start on T. UDILIV 300mg TDS, that will prevent formation of stones but already formed stones will remain yhe same..

Calculus cholelithiasis with diabetes May proceed to perf gall bladder Glycaemic control followed by lap cholecystectomy should be helpful Till then treat with PPI(RABEPRAZOLE WITH DOMPERIDONE) TWICE DAILY AND UDCA 300 MG DAILY IN TWO DIVIDED DOSES COUNSEL THE PATIENT.

As pt is symptomatic for cholelithiasis so better to convince her and in safe first ercp with stenting followed by interval lap chole

Control the Diabetes part, what is the need for Operation , what Operation ?

After controlling bs and anaemia go for cholecystectomy

Surgery required...but till for blating stomach give her light food. Give good quality vegitable i.e fiber diet. Avoid excess pulse. 10 to 15 min walk after dinner.. its better to take dinner as early as poasible i.e 7 o 7.30 pm. Dont sleep immediate after dinner..for sleep left lateral position is good

Laparoscopic Cholecystectomy after BS control required for Cholelithiasis with DM

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