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Gallbladder Removal Among Obese Pediatric Patients PAS 646 March 24, 2006

Gallbladder Removal Among Obese Pediatric Patients PAS 646 March 24, 2006. Advisor: Gilbert Boissonneault PhD, PA-C. Review:. Functions of the Gallbladder: *store bile *secretes bile when fat is ingested in the diet Types of Gallbladder disease: *cholelithiasis*

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Gallbladder Removal Among Obese Pediatric Patients PAS 646 March 24, 2006

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  1. Gallbladder Removal Among Obese Pediatric PatientsPAS 646March 24, 2006 Advisor: Gilbert Boissonneault PhD, PA-C

  2. Review: • Functions of the Gallbladder: *store bile *secretes bile when fat is ingested in the diet • Types of Gallbladder disease: *cholelithiasis* *chronic and acute cholecystitis *choledocholithiasis and acute cholangitis *biliary tree dysfunctions

  3. Cholelithiasis: Stone Formation • Conditions: • Bile contains more cholesterol than it can dissolve • Too much protein of other molecules that can increase the chance of bile to form hard crystals • Gallbladder does not contract or empty properly

  4. Cont.. Cholelithiasis: Stone Formation • Types of Stones: • Calcium bilirubinate (25%) • Cholesterol (75%)

  5. Cholelithiasis and the Symptomatic Patient • Common Sx: • Severe pain in upper abdomen • Pain starts suddenly and may last from 30 minutes to hours • Pain under right shoulder of in right shoulder blade • Nausea or vomiting or both • Nocturnal pain • Indigestion after eating high fat foods • *Most common presenting Sx for pediatric patients is abdominal pain*

  6. Treatment Options for Cholelithiasis Among Adult Patients • Laparoscopic cholecystectomy: #1 treatment option for cholelithiasis • 4 incisions in the abdomen to view and remove the gallbladder • Symptomatic treatment w/o surgery

  7. Treatment Options for Cholelithiasis Among Pediatric Patients • Laparoscopic cholecystectomy: #1 tx option • Ports are more caudal and lateral to prevent overcrowding in abdomen • Ports are smaller to decrease recovery time and better cosmetic results • Symptomatic treatment w/o surgery

  8. Study #1 • 128 pediatric patients 18 yo and under, who underwent surgery for cholelithiasis, cholecystitis, and choledocholithiasis at Texas Children’s Hospital between 1980-1996 • 6% of these patients had cholecystectomies done because of morbid obesity • Significant because the rise in cholecystectomies among the obese pediatric patients is directly related to lifestyle changes among American society.

  9. Study #2 • Looked at pediatric patients regarding health consequences of obese patients • Showed cholelithiasis occurred most frequently among obese patients • Also, reported that patients who showed signs of cholecystitis, 50% of these cases were directly related to obesity and weight reduction programs

  10. Why is it Important to Recognize and Address Pediatric Obesity? • Obesity is the most significant nutritional disease of children and adolescents in the United States • 1 in 5 children are affected by obesity in the united States • Long-term effects of Obesity

  11. Caregiver Education for Pediatric Patients • Eat meals together as a family • Eat at the table and not in front of a television • Do not use food as a reward or punishment • Involve children in meal planning and grocery shopping • Keep healthy snacks on hand

  12. Recommended Weight Reduction/Maintenance Programs (patients under age seven) • Patients under age 7 and absent of other health complications: weight maintenance • Patients under age 7 who are in the 95th percentile or above for their BMI and with coinciding health complications: weight loss programs

  13. Recommended Weight Reduction/Maintenance Programs (patients seven and older) • Patients 7 and older who are in the 85th to 95th percentile for their BMI w/o other coinciding health conditions: weight maintenance program • Patients 7 and older who are in the the 95th percentile or above: weight loss program • Patients who are 7 and older and in the 85th percentile or above and have a coinciding health condition: weight loss program

  14. Caregiver Education for Pediatric Patients • Reduce inactivity • Limit television watching to 1 to 2 hours per day • Incorporate activity into usual daily routines • Simply add vigorous activity into everyday lifestyles such as kickball, basketball, etc…

  15. Conclusion: • Pediatric obesity and cholecystectomy is on the rise • Important to recognize and treat • Important to educate caregivers and patients • Important to know the recommended weight reduction/maintenance programs for pediatric patients • Further Research??????

  16. References

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