| Discussion in 'All Categories' started by Brajesh - Dec 6th, 2024 8:54 am. | |
Brajesh
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My mother is 85 year old they have cbd problem with 10mm stone.please suggest right treatment. |
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re: CBD Stone
by Dr. B. S. Bhalla -
Dec 6th, 2024
9:01 am
#1
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Dr. B. S. Bhalla
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The appropriate treatment for a common bile duct (CBD) stone, especially in elderly patients, depends on various factors, including the stone's size (10mm in this case), symptoms, overall health, and potential complications. Here are the typical steps and treatments recommended for managing CBD stones: 1. Confirm Diagnosis Ensure the diagnosis is confirmed through imaging studies such as: Ultrasound MRCP (Magnetic Resonance Cholangiopancreatography) CT scan Endoscopic Ultrasound (EUS) 2. Initial Management If symptoms like jaundice, abdominal pain, fever, or infection (cholangitis) are present, immediate medical attention is required. Supportive Care: Intravenous fluids Pain relief Antibiotics (if infection is suspected) 3. Treatment Options The standard treatments for a 10mm CBD stone include: a. Endoscopic Retrograde Cholangiopancreatography (ERCP) ERCP is the first-line treatment for CBD stones in elderly patients. Procedure: A specialized endoscope is used to access the bile duct through the gastrointestinal tract. The stone is either removed using a basket or fragmented for easier passage. Advantages: Minimally invasive Can address both diagnostic and therapeutic needs in one procedure. b. Sphincterotomy Often done during ERCP to widen the bile duct opening and facilitate stone removal. c. Lith-otripsy (Optional) If the stone is too large, it can be broken into smaller fragments using techniques like laser or mechanical lith-otripsy. d. Surgery Reserved for cases where ERCP is not feasible or unsuccessful. Procedures: Laparoscopic Cholecystectomy with CBD Exploration: If the gallbladder also has stones and surgery is suitable. Open Surgery: Rarely needed unless complications are severe. 4. Post-Treatment Care Regular follow-up with imaging to ensure no residual stones. Monitoring liver function tests (LFTs) to check for normalization. Dietary changes: Avoid fatty and greasy foods to reduce bile duct stress. 5. Special Considerations for Elderly Patients A thorough evaluation of the patient's overall health is necessary to determine if they can tolerate procedures like ERCP or surgery. In high-risk patients, a temporary biliary stent may be placed during ERCP to relieve obstruction without removing the stone immediately. Recommendations: Consult a gastroenterologist or hepatobiliary surgeon for a tailored treatment plan. If there are signs of infection (fever, chills, jaundice), seek emergency medical attention. |
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