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Botvinnik · Credits: 2706 My Scrapbook

In asymptomatic cholelithiasis,cholecystectomy should be done for?

a)stone size>1.5 cm
b)Diabetes mellitus
c)Cardiac transplant
d)Hemolytic anemia

drjanak · Credits: 3151 My Scrapbook

Schwartz's Surgery 8th Ed > Part II. Specific Considerations > Chapter 31. Gallbladder and the Extrahepatic Biliary System > Gallstone Disease> Natural History
Since few patients develop complications without previous biliary symptoms, prophylactic cholecystectomy in asymptomatic persons with gallstones is rarely indicated. For elderly patients with diabetes, for individuals who will be isolated from medical care for extended periods of time, and in populations with increased risk of gallbladder cancer, a prophylactic cholecystectomy may be advisable. Porcelain gallbladder, a rare premalignant condition in which the wall of the gallbladder becomes calcified, is an absolute indication for cholecystectomy.

Sabiston Textbook of Surgery, 18th ed. Ch 54- Biliary system> BENIGN PATHOPHYSIOLOGIC CONDITIONS Chronic Calculous Cholecystitis > Management
Diabetic patients should have a cholecystectomy promptly because they are at higher risk for acute cholecystitis or even gangrenous cholecystitis.

Botvinnik · Credits: 2706 My Scrapbook

Thanx Drjanak 4 the references.
This question was asked in IAMS june FTS.....answer given in the key was D.hemolytic anemia...no explanation was given though.....might be a mistake i guess...

drjanak · Credits: 3151 My Scrapbook

I cross checked regarding hemolytic anemia. this is what I found for various reasons for cholecystectomy.

Harrison's Internal Medicine > Chapter 305. Diseases of the Gallbladder and Bile Ducts >
Patients found to have gallstones at a young age are more likely to develop symptoms from cholelithiasis than are patients >60 years at the time of initial diagnosis. Although young age is a worrisome factor in asymptomatic gallstone patients, few authorities would now recommend routine cholecystectomy in all young patients with silent stones.
Patients with diabetes mellitus and gallstones may be somewhat more susceptible to septic complications, but the magnitude of risk of septic biliary complications in diabetic patients is incompletely defined. Patients with very large gallstones (>3 cm in diameter) and patients having gallstones in a congenitally anomalous gallbladder might also be considered for prophylactic cholecystectomy.

Harrison's Internal Medicine > 17th Ed> Chapter 101. Hemolytic Anemias and Anemia Due to Acute Blood Loss Hemolytic anemia
Thus, the essential pathophysiologic process common to all HAs is an increased red cell turnover. If the hemolytic event is transient, it does not usually cause any long-term consequences. However, if hemolysis is recurrent or persistent, the increased bilirubin production favors the formation of gallstones.
Hereditary Spherocytosis The main clinical findings are jaundice, an enlarged spleen, and often gallstones; frequently it is the finding of gallstones in a young person that triggers diagnostic investigations.
Treatment:
Avoid splenectomy in mild cases.
Delay splenectomy until at least 4 years of age, after the risk of severe sepsis has peaked.
Antipneumococcal vaccination before splenectomy is imperative, whereas penicillin prophylaxis postsplenectomy is controversial.
HS patients often may require cholecystectomy. It used to be considered mandatory to combine this procedure with splenectomy, but this may not be always necessary.

Conclusions that I have drawn based on above two Posts
Asymptomatic gall stones will need cholecystectomy in:
(On the basis of what is given in Shwartz surgery)
Elderly patients with diabetes
Populations with increased risk of gall bladder cancer
Porcelain gall bladder
(Sabiston TB of Surgery)
Diabetic patients
(Harrisson Medicine)
? Younger patients
? Diabetic patients
Patients with large gall stones > 3cms in diameter
Patients with congenitally anomalous gall bladder
Hereditary Spherocytosis wherein it maybe combined with splenectomy
This explains the answer given as hemolytic anemia being a reason for cholecystectomy but whether it is now a mandatory reason is open to question. None of the references categorically says that any patient with silent gallstones having one of the above problems should definitely have prophylactic cholecystectomy. Diabetes seems the common thread.

drjanak · Credits: 3151 My Scrapbook

Regarding the other option of cardiac surgery:
Love & Bailey mentions that Gall stones can occur in patients with mechanical destruction of RBC by prosthetic heart valves but makes no mention of Cholecystectomy in such patients.

Harrison's Internal Medicine > Chapter 305. Diseases of the Gallbladder and Bile Ducts >
As the paragraph on Natural History in Harrison concludes “The natural history of "silent," or asymptomatic, gallstones has occasioned much debate. A study of predominantly male silent gallstone patients suggests that the cumulative risk for the development of symptoms or complications is relatively low. Decision analysis has suggested that (1) the cumulative risk of death due to gallstone disease while on expectant management is small, and (2) prophylactic cholecystectomy is not warranted.”

Botvinnik · Credits: 2706 My Scrapbook

Thanx Drjanak 4 the references.....
So if the question is repeated with same options its better to go with Diabetes.

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