Gallbladder Removal Among
Obese Pediatric Patients
PAS 646
March 24, 2006
Advisor: Gilbert Boissonneault PhD, PA-C
Review:
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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
Cholelithiasis: Stone Formation
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Conditions:
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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
Cont.. Cholelithiasis: Stone Formation
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Types of Stones:
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Calcium bilirubinate
(25%)
Cholesterol (75%)
Cholelithiasis and the Symptomatic
Patient
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Common Sx:
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Severe pain in upper
abdomen
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Pain starts suddenly and
may last from 30 minutes to
hours
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Pain under right shoulder of
in right shoulder blade
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Nausea or vomiting or both
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Nocturnal pain
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Indigestion after eating high
fat foods
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*Most common presenting
Sx for pediatric patients is
abdominal pain*
Treatment Options for Cholelithiasis
Among Adult Patients

Laparoscopic
cholecystectomy: #1
treatment option for
cholelithiasis
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4 incisions in the
abdomen to view
and remove the
gallbladder
Symptomatic
treatment w/o surgery
Treatment Options for Cholelithiasis
Among Pediatric Patients

Laparoscopic cholecystectomy: #1 tx
option
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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
Study #1
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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.
Study #2

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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
Why is it Important to Recognize
and Address Pediatric Obesity?
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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
Caregiver Education for
Pediatric Patients
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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
Recommended Weight
Reduction/Maintenance Programs
(patients under age seven)
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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
Recommended Weight
Reduction/Maintenance Programs
(patients seven and older)
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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
Caregiver Education for Pediatric
Patients
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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…
Conclusion:
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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??????
References