Another example of informed consent documentation written with out complete information

Outsourcing to VeriMed Healthcare Network this time. Paid to make fake informed consent patient handouts through Selective referencing – by excluding relevant information needed by a patient to make an informed consent decision on treatment options

ie strategical missing key info needed for a patient to make an informed consent decision for treatment options. Surgeons and hospitals will avoid advising patients alternative treatment option due to personal revenue income steam. This is informed consent fraud. Fundamental breach of human rights and the law.

Treatment options :Sleisenger & Fordtran’s Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management actulay states the following

During the 1990s, there was a 29% increase in the number of cholecystectomies performed,with over a 100% increase in cholecystectomy for acute acalculous cholecystitis and 300% increase for biliary dyskinesia. Although nonsurgical methods of gallstone removal, including pharmacologic dissolution, shock wave lithotripsy, and endoscopic laser ablation, were once considered alternatives to the traditional open surgical approach, widespread use of laparoscopic cholecystectomy with its increased patient acceptance, has generally lead to the limination of these treatments as alternatives.

Therapy of gallstone disease: What it was, what it is, what it will be.

Portincasa P1, Ciaula AD, Bonfrate L, Wang DQ.


Cholesterol gallstone disease is a common clinical condition influenced by genetic factors, increasing age, female gender, and metabolic factors. Although laparoscopic cholecystectomy is currently considered the gold standard in treating patients with symptomatic gallstones, new perspectives regarding medical therapy of cholelithiasis are currently under discussion, also taking into account the pathogenesis of gallstones, the natural history of the disease and the analysis of the overall costs of therapy. A careful selection of patients may lead to successful non-surgical therapy in symptomatic subjects with a functioning gallbladder harboring small radiolucent stones. The classical oral litholysis by ursodeoxycholic acid has been recently paralleled by new experimental observations, suggesting that cholesterol-lowering agents which inhibit cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe), or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis, might be proposed as additional approaches for treating cholesterol gallstones. In this review we discuss old, recent and future perspectives on medical treatment of cholesterol cholelithiasis.


Bile; Bile acids; Cholecystectomy; Dissolution therapy; Ezetimibe; Gallbladder; Gallstones; Nuclear receptors; Statins

Note also missing root cause of Gallstone 

Poetincasa P, DiCiaula A, Bonfrate L, Wang DQH. Therapy of gallstone disease. World J Gastrointest Pharmacol Ther. 2012;3(2):7-20.

Risk factors for gallbladder disease or stones include the following: female, especially if pregnant, on hormone therapy or using birth control pills, or over the age of 60 years; people with a history of rapid or significant weight loss using very-low-kilocalorie diets; increased fat and sugar intake in the food history; and a sedentary lifestyle.1 Being either Hispanic or Native American also predisposes an individual to gallbladder disease. In addition, the prevalence of gallstones is associated with a number of diseases: type 2 diabetes, dyslipidemia, and hyperinsulinemia.2


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Acute cholecystitis


Gallstones, cholangiogram
Gallbladder removal - series


Acute cholecystitis is sudden swelling and irritation of the gallbladder. It causes severe belly pain.

Alternative Names

Cholecystitis – acute


The gallbladder is an organ that sits below the liver. It stores bile, which your body uses to digest fats in the small intestine.

Acute cholecystitis occurs when bile becomes trapped in the gallbladder. This often happens because a gallstone blocks the cystic duct, the tube through which bile travels into and out of the gallbladder. When a stone blocks this duct, bile builds up, causing irritation and pressure in the gallbladder. This can lead to swelling and infection.

Other causes include:

  • Serious illnesses, such as HIV or diabetes
  • Tumors of the gallbladder (rare)

Some people are more at risk for gallstones. Risk factors include:

  • Being female
  • Pregnancy
  • Hormone therapy
  • Older age
  • Being Native American or Hispanic
  • Obesity
  • Losing or gaining weight rapidly
  • Diabetes

Sometimes the bile duct becomes blocked temporarily. When this occurs repeatedly, it can lead to chronic cholecystitis. This is swelling and irritation that continues over time. Eventually, the gallbladder becomes thick and hard. It does not store and release bile as well as it did.


The main symptom is pain in the upper right side or upper middle of your belly that usually lasts at least 30 minutes. You may feel:

  • Sharp, cramping, or dull pain
  • Steady pain
  • Pain that spreads to your back or below your right shoulder blade

Other symptoms that may occur include:

  • Clay-colored stools
  • Fever
  • Nausea and vomiting
  • Yellowing of skin and whites of the eyes (jaundice)

Exams and Tests

Your health care provider will perform a physical exam and ask about your symptoms. During the physical exam, you will likely have pain when the provider touches your belly.

Your provider may order the following blood tests:

  • Amylase and lipase
  • Bilirubin
  • Complete blood count (CBC)
  • Liver function tests

Imaging tests can show gallstones or inflammation. You may have one of these tests:

  • Abdominal ultrasound
  • Abdominal CT scan
  • Abdominal x-ray
  • Oral cholecystogram
  • Gallbladder radionuclide scan


If you have severe belly pain, seek medical attention right away.

In the emergency room, you’ll be given fluids through a vein. You also may be given antibiotics to fight infection.

Cholecystitis may clear up on its own. However, if you have gallstones, you will probably need surgery to remove your gallbladder.

Nonsurgical treatment includes:

  • Antibiotics you take at home to fight infection
  • Low-fat diet (if you are able to eat)
  • Pain medicines

You may need emergency surgery if you have complications such as:

  • Gangrene (tissue death)
  • Perforation (a hole that forms in the wall of the gallbladder)
  • Pancreatitis (inflamed pancreas)
  • Persistent bile duct blockage
  • Inflammation of the common bile duct

If you are very ill, a tube may be placed through your belly into your gallbladder to drain it. Once you feel better, you may have surgery.

Outlook (Prognosis)

Most people who have surgery to remove their gallbladder recover completely.

Possible Complications

Untreated, cholecystitis may lead to any of the following health problems:

  • Empyema (pus in the gallbladder)
  • Gangrene
  • Injury to the bile ducts draining the liver (may occur after gallbladder surgery)
  • Pancreatitis
  • Perforation
  • Peritonitis (inflammation of the lining of the abdomen)

When to Contact a Medical Professional

Call your health care provider if:

  • Severe belly pain does not go away
  • Symptoms of cholecystitis return


Removing the gallbladder and gallstones will prevent further attacks.


Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 66.

Jackson P, Evans S. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap. 55.

Wang DQH, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease:Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 65.

Review Date: 8/20/2015
Reviewed By: Subodh K. Lal, MD, Gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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