1. Gallbladder Removal Among Obese Pediatric Patients PAS 646 March 24, 2006 Advisor: Gilbert Boissonneault PhD, PA-C

2. Review: 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

3. Cholelithiasis: Stone Formation Conditions: 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

4. Cont.. Cholelithiasis: Stone Formation Types of Stones: Calcium bilirubinate (25%) Cholesterol (75%)

5. Cholelithiasis and the Symptomatic Patient Common Sx: Severe pain in upper abdomen Pain starts suddenly and may last from 30 minutes to hours Pain under right shoulder of in right shoulder blade Nausea or vomiting or both Nocturnal pain Indigestion after eating high fat foods *Most common presenting Sx for pediatric patients is abdominal pain*

6. Treatment Options for Cholelithiasis Among Adult Patients Laparoscopic cholecystectomy: #1 treatment option for cholelithiasis 4 incisions in the abdomen to view and remove the gallbladder Symptomatic treatment w/o surgery

7. Treatment Options for Cholelithiasis Among Pediatric Patients Laparoscopic cholecystectomy: #1 tx option 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

8. Study #1 128 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.

9. Study #2 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

10. Why is it Important to Recognize and Address Pediatric Obesity? 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

11. Caregiver Education for Pediatric Patients 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

12. Recommended Weight Reduction/Maintenance Programs (patients under age seven) Patients under age 7 and absent of other health complications: weight maintenance Patients under age 7 who are in the 95 th percentile or above for their BMI and with coinciding health complications: weight loss programs

13. Recommended Weight Reduction/Maintenance Programs (patients seven and older) Patients 7 and older who are in the 85 th to 95 th percentile for their BMI w/o other coinciding health conditions: weight maintenance program Patients 7 and older who are in the the 95 th percentile or above: weight loss program Patients who are 7 and older and in the 85 th percentile or above and have a coinciding health condition: weight loss program

14. Caregiver Education for Pediatric Patients 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…

15. Conclusion: 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??????

16. References