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Re: ERT & Cholelithiasis From: Hugo D. Ribot Jr. (hribot@mindspring.com) Sat Oct 5 10:57:29 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Mats Bergstrom: "Re: Jehowah witness medical care" Previous message: Don Shuwarger, M.D., F.A.C.O.G.: "Medical Uses of Newton PDA" Maybe in reply to: Harrison Sheld: "ERT & Cholelithiasis" Harrison Sheld wrote: > > 54 year old patient, She is asymptomatic as far as her GI history is concerned but > on diagnostic imaging studies has 18 small stones and sludge in her gall > bladder but no evidence of GB wall thickening. Would you use ERT after > getting informed consent etc? Benefits outweigh risks? I don't know how many of the 4 F's this pt has (fat, fertile, female,[>]forty), and I'm not going to pretend that I can cite any good ref's in the GI or general surgical literature re: the risk of currently asymptomatic cholelithiasis BUT... In my small anecdotal experience I've seen some hitherto very healthy and intact pts get extremely sick from pancreatitis. The risk of pancreatitis from flipping some of those tiny stones down the common duct, along with that sludge would make me reach for the phone so that my surgeon colleague can do an easy 45 minute lap chole, and then use ERT without reservation. We have a very high incidence of symptomatic gallstone disease in our very estrogen saturated (read fertile) population, and it stands to reason that adding estrogen to this pts situation may be asking for trouble. Now do you always do GB sonograms prior to postmenopausal ERT or was this pt not quite so asymptomatic as far as upper abdominal/postprandial symptoms? You also may have the managed care/HMO problem of requiring her to show some clinical evidence of lithiasis or pancreatitis before lap chole is allowed. I guess that's a little more than my $ 0.02 worth... Hugo -- Hugo D. Ribot Jr., M.D., FACOG Cartersville, GA Private practice Conscience is the inner voice which warns us that someone may be looking. H. L. Mencken (1880-1956), U.S. journalist. A Mencken Chrestomathy, "Sententiæ: The Mind of Men" (1914). Next message: Mats Bergstrom: "Re: Jehowah witness medical care" Previous message: Don Shuwarger, M.D., F.A.C.O.G.: "Medical Uses of Newton PDA" Maybe in reply to: Harrison Sheld: "ERT & Cholelithiasis"

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