Transcripts
DR. TARR:
The treatment for liver injuries
is actually to encourage oral feeds that will
help the stagnant gall bladder start to contract.
If it seems to persist and the child seems to
be symptomatic in that part of the abdomen we
would consider a trial of ursodiol, which is a
choleretic, it's a bile salt that tends to help.
It also tends to stimulate bile flow and perhaps
that sludge will go downstream.
But there do seem to be a
subset of children, 10 percent in the 1993
outbreak, somewhat lower since, where the sludge
actually coalesces into gall stones. The sludge,
presumably, has a large part of its components
being the pigmented red blood cells breaking up.
There is a massive pigment load
in HUS and presumably these sludge collections
precipitate and turn into gall stones and
actually become symptomatic.
Cholecystectomy these days is
considerably easier than it was 10 or 15 years
ago in pediatrics, with most of the cases being
performed via laparoscope. The average stay in
our hospital following laparoscopic cholecystectomy
is about 30 hours.
The operation takes a couple
hours, a bit longer than the old fashioned
cholecystectomy, and children are back in school
within five to seven days.
So when we discover gall stones
secondary to the abdominal pain, we are
encouraging the removal of the gall bladder.
