Website resources for gallstones

Dr Keith Barnard recommends websites relating to this week's Clinical Review.

Website of the Week

I have long been an admirer of the ABC series of reviews published in the BMJ, and this one shows why. Here is as excellent an overview of gall bladder disease as you could wish to see, right from the first summary box to the rarities at the end.

In between is all the expected information about epidemiology, mechanisms, diagnosis and management.

There is also information relating to complications in gall bladder disease, acalculous biliary pain and gall bladder cancer.

However, what makes this article so outstanding is the liberal supply of images of gallstones, gross anatomical specimens, cholangiograms and colourful schematics. One in particular is a beautiful illustration that shows percutaneous cholecystectomy for acute cholecystitis.

And you don't just have to look at low-resolution screen versions - all the images can be viewed in larger high-resolution format or can be downloaded as PowerPoint slides.

Why go there: as good as you'll get.
Downside: none.
Information from: BMJ.
Address: www.bmj.com/cgi/content/full/323/7322/1170

Patient Information
This patient leaflet is so good it actually made me smile with pleasure. It's a downloadable PDF presented in colour and in an excellent readable style.

Helpful headings abound, there are lots of good quality diagrams, and likely questions are answered.

It comes from a charity called CORE, which represents itself with a whole apple and a weird squiggly circle. CORE is the working name of the Digestive Disorders Foundation. Why it isn't simply called this is beyond me, but that does not detract from what is one of the best patient information leaflets I've seen.

Why go there: this is the best site I have come across for gallstones.
Downside: not a single thing
Information from: CORE
Address: www.digestivedisorders.org.uk/content/pdfs/Gallstones.pdf

Biliary colic
Finding a single page that lists current thinking on the treatment of biliary colic was a near-impossible task.

The next best thing is to go to this account of the whole biliary colic scenario.

However, there really is no need to read it all - just go to section six. You will find that little has changed - pethidine (dosages and frequency are given) is still the drug of choice, morphine is to be avoided because it may aggravate biliary spasm, and diclofenac is a good non-opiate choice.

Why go there: reassure yourself you are using appropriate drugs.
Downside: you have to find it in a long article.
Information from: e-Medicine.
Address: www.emedicine.com/med/topic224.htm

Acute pancreatitis
If you've ever dealt with acute pancreatitis, whether secondary to gall bladder disease or some other cause, it is likely to have made an impression on you as a potentially serious, even fatal, debilitating disease.

It is a diagnosis none of us wants to miss. Reading this will help make sure you don't. It is clearly written with bullet points, boxes and summaries.

There is an excellent full-colour drawing.

There are also several CT scans showing diagnostic features that help you understand just what is going on.

Why go there: covers the field.
Downside: longer than it needs to be.
Information from: American Academy of Family Physicians.
Address: www.aafp.org/afp/20000701/164.html

Gall bladder removal
Laparoscopic cholecystectomy is a procedure only the adventurous of us are likely to perform any time soon, but who knows what lies around the corner in the world of subspecialisation and super-GPSIs.

As this is such a commonly performed procedure, it behoves us to know what is going on at the end of those tubes and cameras, if only so that we can empathise with and explain to a patient who is about to undergo this operation. The images come from Argentina, and are colourful and clear.

Why go there: see what goes on inside.
Downside: does not go through to the end.
Information from: laparoscopy.com
Address: www.laparoscopy.com/pictures/ernest.html

Dr Barnard is a former GP in Fareham, Hampshire.

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