Subtleties in the Emergency Care of Elderly Patients with Biliary Disease

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作者：Harold H. Bach IV ; Anthony J. Baldea ; Joseph M. Galante
关键词：Elderly ; Biliary disease ; Emergency surgery ; Frailty ; Cholecystostomy tube ; Non ; operative management ; Cholecystectomy ; ERCP
刊名：Current Translational Geriatrics and Experimental Gerontology Reports
出版年：2016
出版时间：March 2016
年：2016
卷：5
期：1
页码：44-48
全文大小：239 KB
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作者单位：Harold H. Bach IV (1)
Anthony J. Baldea (1)
Joseph M. Galante (2)

1. Loyola University Medical Center, 2160 S First Avenue, Maywood, IL, 60153, USA
2. University of California-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA, 95817, USA

刊物主题：Geriatrics/Gerontology; Medicine/Public Health, general; Psychopharmacology; Pain Medicine; Neurology; Rheumatology;

出版者：Springer US

ISSN：2162-4941

文摘

The management of acute biliary disease in the elderly population can be a challenging endeavor. Older patients often present with atypical symptoms or advanced disease, which can further complicate the treatment options. A treating physician must have a high index of suspicion for biliary disease as a cause of acute intra-abdominal emergencies in the elderly patient that presents with vague abdominal complaints. While the initial workup of these patients is similar to their younger counterparts, the utilization of advanced imaging modalities can often assist in clarifying the diagnosis. The successful treatment of an elderly patient with an acute biliary emergency must take many factors into account. Any decision to proceed with emergency surgery on an elderly patient should be predicated on thorough pre-operative cardiopulmonary risk stratification as well as the utilization of frailty scores. Candid discussions should be held with the patient and his/her family in order to highlight the benefits and risks of any invasive intervention and the associated increased mortality rate since not all patients will be a reasonable operative candidate. For patients deemed to have an appropriate mortality risk for surgical intervention, both laparoscopic and open approaches to cholecystectomy may be safely deployed in the elderly population. Elderly patients with acute biliary disease are often not suitable candidates for emergency surgery, due to the duration of their symptoms, delayed presentation, multiple underlying comorbidities, or acute physiological derangements. Thus, it is imperative that treating physicians understand the many non-operative management strategies that exist to take care of acute biliary disease in this specific patient population.