Gallstones and Gallbladder Disease - Treatment

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Gallstones and Presence of Pain (Biliary Colic) but No Infection. Patients with pain and tests that indicate gallstones but who do not show signs of inflammation or infection have the following options:

• Intravenous pain killers are administered for severe pain. Such drugs include meperidine (Demerol) or the potent NSAID ketorolac (Acular, Toradol). Ketorolac should not be used for patients who are likely to need surgery. They can cause nausea, vomiting, and drowsiness. Opioids, such as morphine, may have fewer adverse effects, but some doctors avoid them for gallbladder disease.
• They may electively choose to have the gallbladder removed (called cholecystectomy) at their convenience.
• A minority of such patients may be candidates for a stone-breaking technique called lithotripsy (the treatment works best on solitary stones that are less than 2 cm in diameter.)
• Drug therapy for gallstones is available for some patients who are unwilling to undergo surgery or who have serious medical problems that increase the risks of surgery. Recurrence rates are high with nonsurgical options. The introduction of laparoscopic cholecystectomy has greatly reduced the use of nonsurgical therapies. Note: Drugs treatments are generally inappropriate for patients who have acute gallbladder inflammation or common bile duct stones since delaying or avoiding surgery could be very hazardous in these cases.

Acute Cholecystitis (Gallbladder Inflammation). The first step if there are signs of acute cholecystitis is to "rest" the gallbladder in order to reduce inflammation. This involves the following treatments:

• Fasting.
• Intravenous fluids and oxygen therapy.
• Intravenous painkillers, usually meperidine (Demerol). Potent NSAIDs, usually indomethacin, may be particularly useful. Indomethacin, for example, can reduce pain and inflammation and improve emptying actions of the gallbladder. (Some doctors believe morphine should be avoided for gallbladder disease.)
• Intravenous antibiotics. These are administered if the patient shows signs of infection, including fever or an elevated white blood cell count, or in patients without such signs who do not improve after 12 to 24 hours.