D98 Cholecystitis/cholelithiasis (ICD-10:K80, K81)

Introduction

Cholecystitis/cholelithiasis is a condition characterized by inflammation of the gallbladder (cholecystitis) and the presence of gallstones (cholelithiasis)^[1]. The gallbladder is a small organ located beneath the liver that stores bile, a substance produced by the liver to aid in digestion^[2]. When gallstones form in the gallbladder, they can cause blockages and lead to inflammation and infection^[3]. This guide aims to provide a comprehensive overview of the diagnosis and management of cholecystitis/cholelithiasis.

Codes

• ICPC-2 Code: D98 Cholecystitis/cholelithiasis^[4]
• ICD-10 Code: K80 Cholelithiasis, K81 Cholecystitis^[5]

Symptoms

• Abdominal pain: Typically located in the upper right quadrant of the abdomen and may radiate to the back or right shoulder. The pain may be ssevere and persistent^[6].
• Nausea and vomiting: Often accompanied by the abdominal pain^[6].
• Fever: In cases of acute cholecystitis, fever may be present^[7].
• Jaundice: Yellowing of the skin and eyes may occur if there is a blockage of the bile ducts^[8].
• Clay-colored stools: Due to the absence of bile in the stool^[8].
• Dark urine: Due to the presence of bilirubin in the urine^[8].

Causes

• Gallstones: The most common cause of cholecystitis/cholelithiasis. Gallstones are formed when there is an imbalance in the substances that make up bile, such as cholesterol and bilirubin^[9].
• Bile duct blockage: Blockage of the bile ducts can lead to the accumulation of bile in the gallbladder, causing inflammation^[10].
• Infection: In some cases, cholecystitis may be caused by a bacterial infection.

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the location and severity of abdominal pain, presence of nausea and vomiting, and any associated symptoms such as fever or jaundice.
• Inquire about the patient’s medical history, including any previous episodes of cholecystitis/cholelithiasis, gallstone-related complications, or other relevant medical conditions.
• Assess for risk factors such as obesity, rapid weight loss, a high-fat diet, or a family history of gallstones.

Physical Examination

• Perform a thorough abdominal examination, paying particular attention to the right upper quadrant for tenderness or a palpable mass.
• Check for signs of jaundice, such as yellowing of the skin and eyes.
• Assess vital signs, including temperature, heart rate, and blood pressure.

Laboratory Tests

• Complete blood count (CBC): May reveal an elevated white blood cell count, indicating infection.
• Liver function tests (LFTs): Assess liver function and may show elevated levels of bilirubin or liver enzymes in cases of bile duct obstruction.
• Amylase and lipase: These tests may be ordered to rule out pancreatitis, which can present with similar symptoms.

Diagnostic Imaging

• Abdominal ultrasound: The primary imaging modality for diagnosing cholecystitis/cholelithiasis. It can visualize gallstones, gallbladder wall thickening, and signs of inflammation.
• CT scan: Useful for evaluating complications such as abscess formation or perforation.
• Magnetic resonance cholangiopancreatography (MRCP): Provides detailed images of the biliary system and can help identify any blockages or abnormalities.

Other Tests

• Endoscopic retrograde cholangiopancreatography (ERCP): Used to evaluate the bile ducts and remove gallstones that may be causing a blockage.
• HIDA scan: A nuclear medicine test that evaluates the function of the gallbladder and the flow of bile.

Follow-up and Patient Education

• Schedule a follow-up appointment to review the results of diagnostic tests and discuss treatment options.
• Provide education on dietary modifications, including a low-fat diet, to reduce the risk of gallstone formation.
• Discuss the importance of maintaining a healthy weight and avoiding rapid weight loss.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Cholecystitis/cholelithiasis:

1. Ursodeoxycholic acid:
   • Cost: $50-$200/month.
   • Contraindications: Hypersensitivity to bile acids, complete biliary obstruction.
   • Side effects: Diarrhea, dyspepsia.
   • Severe side effects: Hepatotoxicity, pancreatitis.
   • Drug interactions: Aluminum-based antacids, bile acid sequestrants.
   • Warning: Regular liver function tests required.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Ibuprofen, Naproxen):
   • Cost: Generic versions can be $3-$20/month.
   • Contraindications: Active peptic ulcer disease, history of gastrointestinal bleeding.
   • Side effects: Upset stomach, gastrointestinal bleeding.
   • Severe side effects: Kidney damage, cardiovascular events.
   • Drug interactions: Anticoagulants, other NSAIDs.
   • Warning: Use with caution in patients with cardiovascular disease or renal impairment.
3. Antibiotics (e.g., Ciprofloxacin, Metronidazole):
   • Cost: Generic versions can be $5-$50/month.
   • Contraindications: Hypersensitivity to antibiotics, history of tendon disorders.
   • Side effects: Nausea, diarrhea.
   • Severe side effects: Tendon rupture, Clostridium difficile infection.
   • Drug interactions: Warfarin, other antibiotics.
   • Warning: Use with caution in patients with a history of tendon disorders.
4. Analgesics (e.g., Acetaminophen, Tramadol):
   • Cost: Generic versions can be $3-$20/month.
   • Contraindications: Hypersensitivity to analgesics, severe liver disease.
   • Side effects: Nausea, constipation.
   • Severe side effects: Liver toxicity, respiratory depression.
   • Drug interactions: Alcohol, other analgesics.
   • Warning: Avoid exceeding the recommended dose of acetaminophen to prevent liver damage.
5. Antispasmodics (e.g., Dicyclomine, Hyoscyamine):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Glaucoma, urinary retention.
   • Side effects: Dry mouth, blurred vision.
   • Severe side effects: Paralytic ileus, heat stroke.
   • Drug interactions: Other anticholinergic drugs.
   • Warning: Use with caution in elderly patients due to an increased risk of adverse effects.

Alternative Drugs:

• Chenodeoxycholic acid: An alternative bile acid that can be used in patients who cannot tolerate ursodeoxycholic acid.
• Oral dissolution therapy: A combination of bile acids and solvents that can be used to dissolve cholesterol gallstones.
• Lithotripsy: A non-surgical procedure that uses shock waves to break up gallstones.

Surgical Procedures:

• Laparoscopic cholecystectomy: The gold standard treatment for symptomatic cholecystitis/cholelithiasis. Cost: $10,000 to $30,000.
• Open cholecystectomy: A surgical procedure that involves the removal of the gallbladder through a larger incision. Cost: $15,000 to $40,000.

Alternative Interventions

• Acupuncture: May help alleviate pain and improve overall well-being. Cost: $60-$120 per session.
• Herbal supplements: Some herbal remedies, such as milk thistle and dandelion, may have potential benefits for gallbladder health. Cost: Varies depending on the specific supplement.
• Gallbladder flush: A controversial practice involving the consumption of certain substances to promote the elimination of gallstones. Cost: Varies depending on the ingredients used.
• Dietary modifications: A low-fat diet and avoidance of trigger foods may help reduce symptoms and prevent gallstone formation. Cost: Varies depending on individual food choices.

Lifestyle Interventions

• Weight management: Maintaining a healthy weight and avoiding rapid weight loss can help reduce the risk of gallstone formation. Cost: Varies depending on individual choices (e.g., gym membership, healthy food options).
• Regular exercise: Engaging in regular physical activity can help improve overall health and reduce the risk of gallbladder problems. Cost: Varies depending on individual choices (e.g., gym membership, exercise equipment).
• Stress management: Stress reduction techniques, such as meditation or yoga, may help alleviate symptoms and improve overall well-being. Cost: Varies depending on individual choices (e.g., meditation classes, yoga studio membership).

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – D98 Cholecystitis/cholelithiasis (ICD-10:K80, K81)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Cholecystitis/cholelithiasis effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Cholecystitis/cholelithiasis. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Mayo Clinic. (2021). Cholecystitis – Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/cholecystitis/diagnosis-treatment/drc-20364895
2. PH3C. (n.d.). International Classification of Primary Care. http://www.ph3c.org/PH3C/docs/27/000496/0000908.pdf
3. AAPC. (2021). ICD-10 Code for Cholecystitis- K81- Codify by AAPC. https://www.aapc.com/codes/icd-10-codes/K81
4. RxReasoner. (n.d.). ICPC-2 Codes. https://www.rxreasoner.com/icpc2codes/component/O
5. gesund.bund.de. (n.d.). K80 Cholelithiasis – ICD-10 code. https://gesund.bund.de/en/icd-code-search/k80
6. AAFP. (2014). Surgical and Nonsurgical Management of Gallstones. https://www.aafp.org/pubs/afp/issues/2014/0515/p795.html
7. SIR. (n.d.). ICD-10 Codes for gallbladder and pancreas. https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/practice-resources/gall-bladder-bile-duct-and-pancreas-icd-10-codes.pdf
8. PubMed. (2014). Gallstone Disease: Diagnosis and Management of Cholelithiasis. https://pubmed.ncbi.nlm.nih.gov/25473723/
9. NICE. (2014). Gallstone disease: diagnosis and management. https://www.nice.org.uk/guidance/cg188
10. UpToDate. (2021). Approach to the management of gallstones. https://www.uptodate.com/contents/approach-to-the-management-of-gallstones