USMLE Forum Archives - USMLE Step 3 - IM: Cholelithiasis
IM: Cholelithiasis
meduploader - 05-23-09 14:48
A 58-year-old female complained of intermittent right upper quadrant pain. Upper abdominal ultrasound revealed calcified gallbladder stones. Her history includes remote perforated duodenal ulcer that required multiple surgeries at the time and occasional residual dyspepsia since that time despite H2-blocker therapy. What is the modality of choice to treat cholelithiasis in this patient?
meduploader - 05-23-09 14:48
A 58-year-old female complained of intermittent right upper quadrant pain. Upper abdominal ultrasound revealed calcified gallbladder stones. Her history includes remote perforated duodenal ulcer that required multiple surgeries at the time and occasional residual dyspepsia since that time despite H2-blocker therapy. What is the modality of choice to treat cholelithiasis in this patient?
The correct answer and explanation will be available after you answer.
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#24
Re: IM: Cholelithiasis ysemak - 11-13-09 09:10 Ok, I'd like to see how u r gonna get into periton. cavity by laparoscop after MULTIPLE SURGERIES!!!!
#29
Re: IM: Cholelithiasis conym5 - 04-08-10 20:40 Contraindications for laparoscopic cholecystectomy include the following: High risk for general anesthesia Morbid obesity Signs of gallbladder perforation such as abscess, peritonitis, or fistula Giant gallstones or suspected malignancy End-stage liver disease with portal hypertension and severe coagulopathy
#32
Re: IM: Cholelithiasis bobby - 08-14-10 21:55 Well theoretically sounds perfect. The pt had perforated viscus and multiple surgeries and theres 100% chance of adhesions forming in the peritoneal cavity and entry and visualization of the abdominal organs then becomes not only difficult but also a dangerous proposition thus many such 'highly ambitious laparoscopic surgeries" have to be converted to open surgery.
#33
Re: IM: Cholelithiasis babbu5508 - 08-31-10 05:13 My answer is: d.
cholecystectomy via open subcostal incision..open surgery preferred over lap because the patient likely has adhesions by previous operations..
#42
Re: IM: Cholelithiasis surgeonbari - 11-22-11 12:56 My answer is: d.
as there will be adhesions to lap cholecystectomy, these stones cannot be dissolved
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