Dear Heathwise 200 expert medical advisory team.

We are an advocacy group for patient care and informed consent for the treatment of Gallstones
We would like to use your patient handout information used by many heath care providers as an example of informed consent obtained by deception. Link example found here:

https://www.cigna.com/healthwellness/hw/medical-topics/laparoscopic-gallbladder-surgery-for-gallstones-hw106860

https://highlakeshealthcare.com/patient-education/healthwise/?DOCHWID=hw106860

 https://osmc.net/services-specialties/hw-view.php?DOCHWID=hw106860

Heathwise may want to consider the following as being true and honest disclose of long term outcome risk . And consider the law, your risk of liability for risk not disclosed . And consider medical ethics under Nurburgring trials code of ethics.

Heathwise appear to be producing 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

ETHICAL

The concept of consent arises from the ethical principle of patient autonomy[1] and basic human rights.[2] Patient’s has all the freedom to decide what should or should not happen to his/her body and to gather information before undergoing a test/procedure/surgery. No one else has the right to coerce the patient to act in a particular way.

LEGAL

No one has the right to even touch, let alone treat another person. Any such act, done without permission (as a result of making informed consent), is classified as “battery”[3] – physical assault and is punishable.

The issue:  Non disclosure for the following risks post removal of gallbladder and function.  False information putting patient safety at risk

Noted also your information on Postcholecystectomy Syndrome is misleading and incomplete

Sincerely

LWNGB

Not disclosed to Patients, specialist medical opinion and studies list the following expected risks, side effects, diseases, syndromes and conditions after the removal of the gallbladder and its function (Cholecystectomy). The majority of these problems are not accepted by surgeons, heath service providers, public or private hospitals, as a risks to disclose and are blocked from the informed consent process, nor advised during post-operative follow-ups.

They are but not exclusive to: Achalasia, Adhesions, Adrenal cancer, Aerophagia, Anxiety, Arthritis, Bacteria overgrowth in the stomach, Barrett’s oesophagus, Benign tumours, Bezoars, Bile Gastritis, Bile Reflux, Bloating, Celiac Disease, Cholangitis, Choledocholithiasis, Chronic idiopathic jaundice, Cirrhosis, Colon Cancer, Constipation, Coronary angina, Cramps, Cyst, Decrease in bile secretion, Depression, Diabetes, Diaphragmatic hernia, Diarrhoea, Dilation without obstruction, Dubin-Johnson syndrome, Dumping of bile, Duodenal diverticulitis, Dyskinesia, Oesophageal cancer, Fatty infiltration of liver, Fistula, Gas, Gastric cancer, Gastroparesis, GERD Reflux, Gilbert disease, Heartburn, Hepatitis, Hepatolithiasis, Hiatal hernia, Hydronephrosis, Hypertension or nonspecific dilation, Incisional hernia, Intercostal neuralgia, Intestinal angina, Irritable bowel disease, Irritable Bowel Syndrome, Malignancy and cholangiocarcinoma, Malnutrition, Nerve damage, Nausea, Neuroma, Neurosis, Obstruction, Pain – right upper abdomen, Pain – shoulders and abdomen, Pancreatic Cancer, Pancreatic Cysts, Pancreatic stone, Pancreatitis, Papilloma, Peptic ulcer disease, Psychic tension, Residual or reformed gallbladder, Sclerosing cholangitis, Sphincter of Oddi Dysfunction, Spasms or hypertrophy, Spinal nerve lesions, Strictures, Stump cholelithiasis, Sympathetic imbalance, Thyrotoxicosis, Trauma, Vomiting, Weight gain, Weight loss

Wikipedia
“Postcholecystectomy Syndrome (PCS) describes the presence of abdominal symptoms after surgical removal of the gallbladder (cholecystectomy). Symptoms of Postcholecystectomy Syndrome may include: Upset stomach, nausea, and vomiting, gas, bloating, and diarrhoea. Persistent pain in the upper right abdomen. Symptoms occur in about 5 to 40 percent of patients who undergo cholecystectomy, and can be transient, persistent or lifelong”

“Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome Dr. Jacob L. Turumin (Iakov L. Tyuryumin), MD, PhD, DMSci”
“The absence of the gallbladder leads to functional biliary hypertension and increased hepatic and common bile duct . 3-5 years after cholecystectomy increases right and left hepatic ducts equity.
Functional hypertension in the common bile duct contributes to the appearance of functional and hypertension in Wirsung’s pancreatic duct with the development of the phenomena of chronic pancreatitis . At the same time period in some patients this is accompanied by the progression of chronic pancreatitis, sphincter of Oddi dysfunction and duodenogastric (Biliary / bile ) reflux.
Duodenogastric reflux of mixture of bile with pancreatic juice promotes atrophic gastritis in the antral part of stomach.
From 40% to 60% of patients after cholecystectomy dyspeptic suffering from various disorders, from 20% to 40% of pains of different localization .

  • Up to 70% of patients after cholecystectomy have chronic effects of “bland” cholestasis, chronic cholestatic hepatitis and chronic compensatory bile acid-dependent apoptosis of hepatocytes.
  • Patients undergoing cholecystectomy had an increased prevalence of metabolic risk factors for cardiovascular disease, including type 2 diabetes mellitus, high blood pressure, and high cholesterol levels.
  • Part of patients after cholecystectomy with increased concentration of hydrophobic hepatotoxic co-carcinogenic deoxicholic bile acid in serum and/or feces with increased risk of colon cancer”

Postcholecystectomy syndrome (PCS), S. Mohandas, L.M. Almond, Department of General Surgery, Worcestershire Royal Hospital, Worcester, UK
“The incidence of postcholecystectomy syndrome has been reported to be as high as 40% in one study, and the onset of symptoms may range from 2 days to 25 years. There may also be gender-specific risk factors for developing symptoms after cholecystectomy. In one study, the incidence of recurrent symptoms among female patients was 43%, compared to 28% of male patients.”
“cholecystectomy is associated with several physiological changes in the upper gastrointestinal tract which may account for the persistence of symptoms or the development of new symptoms after gallbladder removal. The cholecyst sphincter of Oddi reflex, cholecyst-antral reflex, and cholecyst-oesophagal reflexes are all disrupted and some local upper gastrointestinal hormonal changes also occur after cholecystectomy. Thus, there is an increased incidence of gastritis, alkaline duodene gastric reflux and gastro-oesophageal reflux after cholecystectomy, all of which may be the basis for postcholecystectomy symptoms.”

The postcholecystectomy syndrome: A review, Khalid R Murshid, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
Instance of Post Cholecystectomy Syndrome sustainably increased when patients followed for 5-9 years vs. only two years’ follow-up
Cholecystectomy and Clinical Presentations of Gastroparesis, the NIDDK Gastroparesis Clinical Research Consortium (GpCRC)*
Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization and had a worse quality of life.

Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079, Russia
The basic role of the gallbladder in a human is a protective. The gallbladder decreases the formation of the secondary hydrophobic toxic bile acids (deoxycholic and lithocholic acids) by accumulating the primary bile acids (cholic and chenodeoxycholate acids) in the gallbladder, thus reducing their concentration in gallbladder-independent enterohepatic circulation and protecting the liver, the mucosa of the stomach, the gallbladder, and the colon from their effect

Curr Med Chem. 2017 May 17. doi: 10.2174/0929867324666170518100053. [Epub ahead of print] Altomare DF1, Rotelli MT1, Palasciano N1.

Patients with gallstones are often affected by alimentary disorders contributing to the onset of gallstones disease. Cholecystectomy can have nutritional and metabolic consequences in the short-term (diarrhea, abdominal pain and bloating) and in the long-term (increased Body Mass Index with metabolic syndrome, gastritis, liposoluble vitamin deficiency). Pathogenic mechanisms behind these disturbances are reviewed and the need for an early post-operative nutritional intervention based on low-lipid, high-fibers diet, is highlighted.

Source references:

1. http://emedicine.medscape.com/article/192761-overview#showall
2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891205
3. http://en.wikipedia.org/wiki/Postcholecystectomy_syndrome
4. Murshid KR. The postcholecystectomy syndrome: A review. Saudi J Gastroenterol [serial online] 1996 [cited 2014 Nov 5];2:124-37. Available fromhttp://www.saudijgastro.com/text.asp?1996/2/3/124/34017
5. http://www.nhs.uk/conditions/Irritable-bowel-syndrome/Pages/Introduction.aspx
6. Mayoclinic Diseases Conditions Bile Refluxhttp://www.mayoclinic.org/diseases-conditions/bile-reflux/basics/definition/con-20025548
7. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatographyhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3473449/
8. Role of the Gallbladder in a Human. Jacob L. Turumin, Victor A. Shanturov, Helena E. Turumina. Irkutsk Institute of Surgery, Irkutsk Regional Hospital, Irkutsk 664079,http://www.sciencedirect.com/science/article/pii/S0375090613000323
9. Biliary Diseases Laparoscopic Cholecystectomy. Postcholecystectomy Syndrome. Treatment: Celecoxib and Ursodeoxycholic acidhttp://www.drturumin.com/en/index.html#sthash.Y35Uey8C.dpuf
10. Postcholecystectomy syndrome (PCS), S.S. Jaunoo, S. Mohandas, L.M. Almond, Department of General Surgery, Worcestershire Royal Hospital, Worcester, UK http://www.journal-surgery.net/article/S1743-9191(09)00153-8/fulltext
11. Weight gain after cholecystectomy.P W Houghton, L A Donaldson, L R Jenkinson, and M K Crumplinhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1443570/pdf/bmjcred00528-0026a.pdf
12. Martin W. RECENT CONTROVERSIAL QUESTIONS IN GALL-BLADDER SURGERY. Annals of Surgery. 1924;79(3):424-443.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1399518/pdf/annsurg00690-0104.pdf
13. American Journal of Gastroenterology, August 2005http://www.medicineonline.com/news/12/1569/Gallbladder-Removal-Raises-Colon-Cancer-Risk.html
14. http://www.sciencedirect.com/science/article/pii/S1743919109001538
Issues – complete non disclosure of heath risk. False information putting patient safety and heath at risk

Ie non disclosure for the following risks post removal of gallbladder and function. We will be advising , patients to sue their heath care provider for damages

FAKE PATIENT HANDOUTS

Strategically 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. https://www.ncbi.nlm.nih.gov/pubmed/22577615?dopt=Abstract

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.

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

 

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

Note also missing root cause of Gallstone

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. 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.

 

 

 

LAPAROSCOPIC GALLBLADDER SURGERY FOR GALLSTONES[EN ESPAÑOL]

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Surgery Overview

Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small cuts (incisions) in the abdomen. The surgeon inflates your abdomen with air or carbon dioxide in order to see clearly.

The surgeon inserts a lighted scope attached to a video camera (laparoscope) into one incision near the belly button. The surgeon then uses a video monitor as a guide while inserting surgical instruments into the other incisions to remove your gallbladder.

Before the surgeon removes the gallbladder, you may have a special X-ray procedure called intraoperative cholangiography , which shows the anatomy of the bile ducts.

You will need general anesthesia for this surgery, which usually lasts 2 hours or less.

After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. In most people, this has little or no effect on digestion.

In 5 to 10 out of 100 laparoscopic gallbladder surgeries in the United States, the surgeon needs to switch to an open surgical method that requires a larger incision. footnoteExamples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, and bleeding.

What To Expect After Surgery

You may have gallbladder surgery as an outpatient, or you may stay 1 or 2 days in the hospital.

Most people can return to their normal activities in 7 to 10 days. People who have laparoscopic gallbladder surgery are sore for about a week. But in 2 to 3 weeks they have much less discomfort than people who have open surgery. No special diets or other precautions are needed after surgery.

Why It Is Done

Laparoscopic gallbladder surgery is the best method of treating gallstones that cause symptoms, unless there is a reason that the surgery should not be done.

Laparoscopic surgery is used most commonly when no factors are present that may complicate the surgery.

How Well It Works

Laparoscopic gallbladder surgery is safe and effective. Surgery gets rid of gallstones located in the gallbladder. It does not remove stones in the common bile duct. Gallstones can form in the common bile duct years after the gallbladder is removed, although this is rare.

Risks

The overall risk of laparoscopic gallbladder surgery is very low. The most serious possible complications include:

  • Infection of an incision.
  • Internal bleeding.
  • Injury to the common bile duct .
  • Injury to the small intestine by one of the instruments used during surgery.
  • Risks of general anesthesia .

Other uncommon complications may include:

  • Gallstones that remain in the abdominal cavity.
  • Bile that leaks into the abdominal cavity.
  • Injury to abdominal blood vessels, such as the major blood vessel carrying blood from the heart to the liver (hepatic artery). This is rare.
  • A gallstone being pushed into the common bile duct.
  • The liver being cut.

More surgery may be needed to repair these complications.

After gallbladder surgery, some people have ongoing abdominal symptoms, such as pain, bloating, gas, and diarrhea ( postcholecystectomy syndrome ).

What To Think About

Recovery is much faster and less painful after laparoscopic surgery than after open surgery.

  • The hospital stay after laparoscopic surgery is shorter than after open surgery. People generally go home the same day or the next day, compared with 2 to 4 days or longer for open surgery.
  • Recovery is faster after laparoscopic surgery.
  • You will spend less time away from work and other activities after laparoscopic surgery (about 7 to 10 days compared with 4 to 6 weeks).

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Glasgow RE, Mulvihill SJ (2010). Treatment of gallstone disease. In M Feldman et al., eds., Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed., vol. 1, pp. 1121–1138. Philadelphia: Saunders.

Current as of: November 20, 2015

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Arvydas D. Vanagunas, MD – Gastroenterology

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . Learn how we develop our content .
This information is for educational purposes only and is unrelated to health plan benefits or coverage. Services addressed may not be covered under your health plan. If you have questions about your coverage, please refer to your benefit plan document or call the number on the back of your health plan membership ID card.

© 1995-2016 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

 

 

POSTCHOLECYSTECTOMY SYNDROME

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Topic Overview

Postcholecystectomy syndrome sometimes occurs when abdominal symptoms develop after surgery to remove the gallbladder (cholecystectomy). About 5% to 40% of people who have the gallbladder removed may experience symptoms. footnote1

Symptoms of postcholecystectomy syndrome may include:

  • Upset stomach, nausea, and vomiting.
  • Gas, bloating, and diarrhea.
  • Persistent pain in the upper right abdomen .

Your doctor may be able to give you medicine to help with some of these symptoms.

If pain continues, you may have a problem caused by something other than the gallbladder or a gallstone . Other possible causes of abdominal pain include irritable bowel syndrome , stomach (peptic) ulcers, or pancreatitis

More feed back to Healthwise. May want your expert medical advisers to also consider, removing the gallbladder function is the root cause of these issues / ongoing problems  NOT the other way round

Current as of: November 20, 2015

Author: Healthwise Staff

Medical Review: E. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Arvydas D. Vanagunas, MD – Gastroenterology

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . Learn how we develop our content .
This information is for educational purposes only and is unrelated to health plan benefits or coverage. Services addressed may not be covered under your health plan. If you have questions about your coverage, please refer to your benefit plan document or call the number on the back of your health plan membership ID card.

© 1995-2016 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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