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PubMed1987

Coexistence of gallbladder disease and morbid obesity.

To further investigate the relationship between gallbladder disease and morbid obesity, 92 morbidly obese patients underwent routine cholecystectomy at the time of their bariatric procedures. The preoperative ultrasonographic findings were positive in only 20 patients. Of the 92 patients who underwent cholecystectomy, 87 (95 percent) had pathologic evidence of gallbladder disease. This included cholecystitis, cholesterolosis, cholelithiasis, or some combination of the three. The incidence of postoperative cholecystitis, the technical difficulty of reoperation, the unnecessary expense and exposure to a second hospitalization and a second operation are all completely eliminated when routine cholecystectomy is performed in concert with elective bariatric procedures.

Adult↗
PubMed2003

Comparison of three- and two-dimensional sonography in diagnosis of gallbladder diseases: preliminary experience.

OBJECTIVE: To compare three-dimensional sonography with two-dimensional sonography for diagnosis of gallbladder diseases. METHODS: Sixty-three patients with gallbladder diseases were examined with two- and three-dimensional sonography. The morphologic features presented on both modalities were analyzed, and the diagnostic accuracies of both modalities were evaluated and compared. RESULTS: Both two- and three-dimensional sonography facilitated correct diagnosis in all patients with gallstones. Three-dimensional sonography had no influence on the diagnosis of gallstones compared with two-dimensional sonography. Three-dimensional sonography showed the granular surfaces in 18 (81.8%) of 22 cases of polypoid lesions and the pedunculated fundus in 19 (86.4%) of 22, whereas two-dimensional sonography displayed them in 10 (45.5%) and 3 (13.6%) of 22, respectively (P < .05 and .001). Three- and two-dimensional sonography made correct differential diagnoses between non-neoplastic and neoplastic polyps in 20 (90.9%) and 12 (54.5%) of 22, respectively (P < .05). In gallbladder carcinoma, both three- and two-dimensional sonography accurately showed all the associated gallstones and intrahepatic bile duct dilatation. Two-dimensional sonography could not correctly define the locations of the lesions in 2 (28.6%) and tumor extension in 1 (14.3%) of 7 cases with pathologically proved gallbladder cancer, whereas three-dimensional sonography improved the diagnosis in these cases. CONCLUSIONS: Three-dimensional sonography adds no advantages for diagnosis of gallstones compared with two-dimensional sonography, but it is better than two-dimensional sonography for differential diagnosis of gallbladder polyps and may improve the localization and staging for gallbladder carcinoma; however, additional studies are needed for further determination.

Cholelithiasis↗
PubMed1987

Coronary risk factors and clinical gallbladder disease: an approach to the prevention of gallstones?

We examined the relationship of "coronary" risk factors to clinical gallbladder disease prevalence in a cross-sectional survey. Persons with hypercholesterolemia, hypertriglyceridemia, or low high-density-lipoprotein cholesterol levels had elevated risks for clinical gallbladder disease. Smokers of 20 pack-years or more and infrequent users of alcohol had increased risks, as did persons with hypertension or diabetes mellitus. After adjusting for age, body mass index, ethnicity, and the coronary variables, relationships persisted for diabetes in women (OR = 1.8) and frequent alcohol use in men (OR = 0.3). The proportion of gallbladder disease related to all coronary risk factors was estimated to be 52 per cent.

Adult↗
PubMed1993

Gallbladder disease in patients with cystic fibrosis.

We retrospectively studied 18 patients with cystic fibrosis, who underwent surgery for gallbladder disease from 1975 to 1990. A long delay between the onset of symptoms and the diagnosis was noted (mean 8.7 months). This delay was attributed to masking of the symptoms of biliary disease by the malabsorption and pulmonary symptoms seen in this patient population. We do not recommend routine intraoperative cholangiography in patients with cystic fibrosis and gallbladder disease. Cystic fibrosis is a disease with progressive pulmonary deterioration. Cholecystectomy can be performed in these patients with relative safety if careful preoperative and postoperative care is provided. We recommend early operative intervention in the patient with gallbladder disease and cystic fibrosis.

Adolescent↗
PubMed1983

Gallbladder disease in patients on long-term parenteral nutrition.

Recent anecdotal reports suggest that total parenteral nutrition may be associated with an increased incidence of both acalculous cholecystitis and cholelithiasis. The validity of this association, however, has not been tested in a large population of patients on long-term total parenteral nutrition. Therefore, we assessed the incidence of gallbladder disease among our patients 15 yr and older who had received a minimum of 3 mo of total parenteral nutrition. Of the patients meeting these criteria, 128 were on total parenteral nutrition a mean of 13.5 mo. Nineteen had gallbladder disease before receiving total parenteral nutrition, leaving 109 patients at risk. Of these patients, 25 (23%) developed gallbladder disease after the initiation of total parenteral nutrition. Because of their known propensity for cholelithiasis, 94 of our patients with ileal disorders (Crohn's disease or ileal resection, or both) were considered separately. The 40% incidence of gallbladder disease in these 94 patients was significantly higher than expected from a series of similarly defined patients with ileal disorders not receiving total parenteral nutrition (p less than 0.05). We propose that the enhanced risk of gallbladder disease among patients on long-term total parenteral nutrition results from multiple factors working in concert to promote gallbladder stasis.

Adolescent↗
PubMed1984

Gallbladder disease and cholecystectomy rate are independently variable.

In Britain, gallstones can be expected to develop in 1 in 3 women and 1 in 5 men. Gallbladder disease in Dundee was more frequent in 1974-83 than in 1953-73. During 1961-81 the number of cholecystectomies trebled in Dundee and doubled in Scotland as a whole, but this could not be explained by changes in the prevalence of gallbladder disease. Between 1974 and 1983 in Dundee, 48 patients died of gallstone disease. 22 out of 54 (41%) patients with common bileduct stones at necropsy and 26 out of 1034 (2.5%) with gallbladder stones only at necropsy died from an associated cause. A further 26 died from gallbladder surgery without bileduct surgery. Gallbladder disease was not associated with death from myocardial infarction, and there was no relationship between gallstones and gallbladder cholesterolosis. 22 patients were found to have secondary carcinoma of the gallbladder and 17 were found to have primary carcinoma of the gallbladder at necropsy.

Adolescent↗
PubMed1995

Gallbladder disease in pregnancy.

OBJECTIVE: To evaluate management and pregnancy outcomes in pregnant women with gallbladder disease. STUDY DESIGN: We reviewed the records from three teaching hospitals in central North Carolina from 1986 to 1993 to evaluate women who were admitted with gallbladder disease during pregnancy. RESULTS: Forty-two women were admitted with symptomatic cholelithiasis; 67% were white, the average age was 26 years, and the mean gestational age at presentation was 26 weeks. Conservative management with intravenous hydration, narcotics, dietary changes and antibiotics, if needed, was the first line of treatment in all 42 cases. Conservative management was successful in 17 women, with 8 requiring more than one admission. Nineteen patients failed medical management and needed cholecystectomy; three cases were laparoscopic. The diagnosis in the surgical group included 3 women with biliary colic, 14 with cholecystitis and 2 with gallstone pancreatitis. Four cholecystectomies were performed in the first trimester, 10 in the second and 5 in the third. Thirteen of 19 patients had no postoperative complications and delivered at term. Four women had uterine contractions controlled with tocolytics and delivered at 35 weeks or more. Two of 19 delivered prematurely--one at 32.5 weeks, 15 weeks after a laparoscopic cholecystectomy, and another at 34 weeks, 10 weeks after an open cholecystectomy. Of the patients who delivered prematurely, none were within the immediate postoperative period, and it appears unlikely that the cholecystectomy was causative. No maternal or perinatal mortality was noted. CONCLUSION: This review and others indicate that surgery should be reconsidered as possible primary management in pregnant women with symptomatic gallbladder disease.

Adult↗
PubMed1989

Operative therapy of gallbladder disease in patients with cystic fibrosis.

We retrospectively studied 20 patients with cystic fibrosis who underwent surgery for gallbladder disease from 1973 to 1986. A long delay between the onset of symptoms and the diagnosis was noted (mean 7.4 months). This delay was attributed to masking of the symptoms of biliary disease by the malabsorption and pulmonary symptoms seen in this patient population. There was a notable lack of common bile duct disease in our patients as well as in those reported in the literature. This may have been due to a combination of factors: the increased viscosity of the mucus, the small caliber of the gallbladder and ductal system, and the hypotonicity of the gallbladder. We do not recommend routine intraoperative cholangiography in patients with cystic fibrosis and gallbladder disease. Cystic fibrosis is a disease with progressive pulmonary deterioration. Cholecystectomy can be performed in these patients with relative safety if careful preoperative and postoperative care is provided. We recommend early operative intervention in the patient with gallbladder disease and cystic fibrosis.

Adolescent↗
PubMed2004

Gallbladder disease in young Congolese with sickle cell anemia: an ultrasound survey.

Patients with sickle cell anemia have been shown to present with a high prevalence of gallbladder disease. Relatively few data exist on the prevalence of gallbladder disease in Africans with autosomal recessive gene for sickle hemoglobin. To establish this relationship, we examined the 1-year incidence of gallbladder disease among 190 consecutive children and young adults with sickle cell anemia aged 3-24 years using ultrasound. There were 130 males (68.4 per cent) and 60 females (31.6 per cent). Incidence of cholelithiasis, cholecystitis, hydrops of gallbladder, and biliary sludge were 58.4, 25.3, 18.4, and 2.1 per cent, respectively. Of the 190 patients, 61 (37.3 per cent) presented hepatobiliary symptoms. The incidence of cholelithiasis depended on age. The age group 10-14 years and leucocytes > 10000/mm3 were considered as risk factors of the cholelithias onset, while female gender was isolated as a risk factor for the hydrops of the gallbladder outcome. In conclusion, the ultrasonographic examination is recommended for patients with hepatobiliary symptoms with respect to the high prevalence of the autosomal recessive gene for sickle hemoglobin in Congo, Central Africa.

Adolescent↗
PubMed1979

The use of ultrasonography in the diagnosis of calculous gallbladder disease.

During a 12-month period from September 1976 to September 1977, 114 patients in a community hospital had ultrasonography as part of their diagnostic work-up for suspected gallbladder disease. While 65 per cent had an additional study, such as an oral cholecystogram or intravenous cholangiogram, 35 per cent had ultrasonography as the only study to make the diagnosis. All patients in this group had laparotomy and cholecystectomy to confirm or disprove the diagnosis of calculous gallbladder disease. The overall accuracy rate of ultrasonography for calculous gallbladder disease was 90 per cent, which compares favorably with the standard oral cholecystogram. Ultrasonography has some distinct advantages in certain clinical situations such as acute cholecystitis, jaundice, pancreatitis and pregnancy. A review of our clinical experience in the everyday use of ultrasonography for calculous biliary disease has been discussed, and guidelines for the use of ultrasonography as part of the diagnostic armamentarium for gallbladder disease are presented.

Cholangiography↗
PubMed1982

Angiographic findings in normal and diseased gallbladders including ischaemic cholecystitis and infarction of the gallbladder.

Angiographic studies were performed on 60 normal and diseased gallbladders obtained from cholecystectomy specimens and necropsy examinations. The normal macro and microangiographic pattern was confirmed, as was the reduction in the number of blood vessels in chronic cholecystitis and cholelithiasis. Histological correlation however showed that the degree of arteriographic change paralleled the degree of histological disease. The microvascular pattern was directly related to the degree of mucosal villous atrophy, a change which may be important in the pathogenesis of some types of gallbladder disease. The most severe angiographic changes occurred in the case of ischaemic cholecystitis, and contrasted with the normal blood vessel pattern in a case of thin walled infarction of the gallbladder.

Angiography↗
PubMedDate not supplied

Two incidental cases of abdominal aortic aneurysm and gallbladder cancer. Further data influencing the management of patients affected by aneurysm and gallbladder disease.

Abdominal aortic aneurysm and cholelithiasis are two common diseases in the elderly population. The prevalence of abdominal aortic aneurysms ranges between 1.8 and 6.6% in autoptic series and it's estimated that 2.5% of the over sixty year old population is affected. Carcinoma of the gallbladder is the most common malignant tumor of the biliary tract and in the United States is the fifth most frequent digestive tract malignancy; it's incidence ranges between 2 to 10 cases of 100,000 persons/year. No adequate guidelines are now available to assist the surgeon, in the case of concomitant gallbladder disease and abdominal aortic aneurysm. In this paper the management of abdominal aortic aneurysm in a patient with gallbladder disease is discussed in order to assist the surgeon deciding whether to perform concomitant aneurysm resection and cholecystectomy. In 162 aneurysmectomies (1987-1997) 18 (11.11%) patients underwent combined aneurysmectomy and cholecystectomy operation. The patients ranged in age from 49 to 88 years (average 69 years). In two cases the anatomo-histological specimen examinations (twelve sections) demonstrated a gallbladder carcinoma. The overall mortality rate was 5.56% either for aneurysmectomy alone or for combined therapy. In case of abdominal aortic aneurysm and concomitant gallbladder disease, in choosing simple endoaneurysmectomy, the surgeon has to consider the risk of early and late complications of leaving a diseased gallbladder in place. In case of concomitant performance of both operations, the risks of a possible septic graft contamination must be considered. We believe that the patient may be best served by performing the vascular and nonvascular procedures in the same operation. In this paper a new proof, till now never considered in the international literature, is presented to support our opinion: the possibility of concomitant unknown cancer or precancerous lesions in a lithiasic gallbladder. Diagnosis of these lesions is, indeed, not easy to perform in the preoperative phase and is often a postoperative anatomo-histological detection.

Aged↗
PubMed1999

The role of morphine-augmented cholescintigraphy and real-time ultrasound in detecting gallbladder disease.

OBJECTIVE: Rapid diagnosis of acute cholecystitis is essential to minimize morbidity and mortality. The purpose of this study was to assess the diagnostic utility of cholescintigraphy using morphine augmentation compared with ultrasound, in acute and chronic gallbladder disease. METHODS: Cholescintigrams were performed on 103 patients suspected of having acute cholecystitis. In 79 patients (Group A) morphine sulfate was administered to reduce the scintigraphic imaging time if the gallbladder was not visualized during the first hour. In 24 control patients (Group B) no morphine was administered. All patients were evaluated clinically and 93 patients had concurrent ultrasound examination. RESULTS: The clinical presentation was nonspecific. The ultrasound findings were sensitive in detecting gallbladder disease (100%), but had low specificity (24%). Only findings of sediments and pericholecystic fluid were specific for cystic duct obstruction. Morphine augmentation reduced the imaging time by 126 min in patients with chronic cholecystitis. CONCLUSION: Real-time ultrasound has low specificity for gallbladder disease. In the presence of an abnormal ultrasound, it is essential to perform a hepatobiliary scan, either to exclude gallbladder disease or distinguish acute from chronic cholecystitis. Low-dose morphine administration is a safe and useful adjunct to standard cholescintigraphy by substantially reducing the time required to obtain a diagnostic study.

Acute Disease↗
PubMed2005

Effect of estrogen therapy on gallbladder disease.

CONTEXT: Estrogen therapy is thought to promote gallstone formation and cholecystitis but most data derive from observational studies rather than randomized trials. OBJECTIVE: To determine the effect of estrogen therapy in healthy postmenopausal women on gallbladder disease outcomes. DESIGN, SETTING, AND PARTICIPANTS: Two randomized, double-blind, placebo-controlled trials conducted at 40 US clinical centers. The volunteer sample was 22,579 community-dwelling women aged 50 to 79 years without prior cholecystectomy. INTERVENTION: Women with hysterectomy were randomized to 0.625 mg/d of conjugated equine estrogens (CEE) or placebo (n = 8376). Women without hysterectomy were randomized to estrogen plus progestin (E + P), given as CEE plus 2.5 mg/d of medroxyprogesterone acetate (n = 14,203). MAIN OUTCOME MEASURES: Participants reported hospitalizations for gallbladder diseases and gallbladder-related procedures, with events ascertained through medical record review. Cox proportional hazards regression was used to assess hazard ratios (HRs) and 95% confidence intervals (CIs) using intention-to-treat and time-to-event methods. RESULTS: The CEE and the E + P groups were similar to their respective placebo groups at baseline. The mean follow-up times were 7.1 years and 5.6 years for the CEE and the E + P trials, respectively. The annual incidence rate for any gallbladder event was 78 events per 10,000 person-years for the CEE group (vs 47/10,000 person-years for placebo) and 55 per 10,000 person-years for E + P (vs 35/10,000 person-years for placebo). Both trials showed greater risk of any gallbladder disease or surgery with estrogen (CEE: HR, 1.67; 95% CI, 1.35-2.06; E + P: HR, 1.59; 95% CI, 1.28-1.97). Both trials indicated a higher risk for cholecystitis (CEE: HR, 1.80; 95% CI, 1.42-2.28; E + P: HR, 1.54; 95% CI 1.22-1.94); and for cholelithiasis (CEE: HR, 1.86; 95% CI, 1.48-2.35; E + P: HR, 1.68; 95% CI, 1.34-2.11) for estrogen users. Also, women undergoing estrogen therapy were more likely to receive cholecystectomy (CEE: HR, 1.93; 95% CI, 1.52-2.44; E + P: HR, 1.67; 95% CI, 1.32-2.11), but not other biliary tract surgery (CEE: HR, 1.18; 95% CI, 0.68-2.04; E + P: HR, 1.49; 95% CI, 0.78-2.84). CONCLUSIONS: These data suggest an increase in risk of biliary tract disease among postmenopausal women using estrogen therapy. The morbidity and cost associated with these outcomes may need to be considered in decisions regarding the use of estrogen therapy.

Aged↗
PubMed2003

Histological analysis of gallbladder diseases in relation to opisthorchiasis in endemic areas of Thailand.

Chronic gallbladder disease frequently accompanies infection with the liver fluke, Opisthorchis viverrini, in Northeast Thailand. However, the pathology and pathogenesis of the gallbladder disease have not been described. Accordingly, gallbladder specimens from 187 consecutive patients who had undergone cholecystectomy at a referral hospital in an endemic area in Thailand were histologically characterized in relation to O. viverrini infection. The infection was assessed by the presence of parasite eggs in the bile and/or antibody response to the liver fluke. The average level of parasite-specific IgG was significantly higher in patients with Opisthorchis eggs in the bile than those without (P<0.001). The main histopathologic features of the gallbladder included inflammation, mucosal atrophy/or hyperplasia, goblet cell metaplasia, mucous gland hyperplasia, Rokitansky-Aschoff sinus formation, dysplasia and fibrosis. The fibrosis was strongly associated with elevated levels of Opisthorchis-specific antibody (P<0.001) but not with the presence of parasite eggs. Other pathologic features did not vary in frequency or severity with parasitological status. Our results show that severe fibrosis of the gallbladder is a more common histologic feature of cholecystitis among those with O. viverrini infection compared to those without infection. The close relationship between parasite-specific IgG and severe fibrosis suggests that specific immune response to the parasite play an important role in the pathogenesis of the fibrotic change.

Adolescent↗
PubMed2000

Laparoscopic cholecystectomy for acalculous gallbladder disease.

Use of laparoscopic cholecystectomy (LC) to treat patients with symptoms due to gallstone disease is well established. However, use of LC for patients with acalculous gallbladder disease remains controversial. In this study, we examined the use of hepatobiliary iminodiacetic acid (HIDA) scans with cholecystokinin (CCK) infusion to identify patients with acalculous gallbladder disease who would benefit from LC. From December 1991 to February 1997, 4480 patients underwent cholecystectomy at Baylor University Medical Center, including 72 patients who underwent LC for acalculous disease following preoperative HIDA scan. We retrospectively analyzed their preoperative symptoms and workup. Follow-up was obtained by telephone questionnaire in 59 of 72 patients (82%). Overall, 48 of 59 patients (82%) reported an excellent outcome following LC. We found no significant difference in outcome in patients who underwent HIDA scan with CCK infusion, regardless of gallbladder ejection fraction or exacerbation of symptoms caused by the infusion. Preoperative symptom complex was also not predictive of postoperative outcome. LC is an effective treatment for patients with acalculous gallbladder disease. A preoperative HIDA scan with CCK infusion does not accurately predict treatment success or failure. Patients with a normal ejection fraction and absence of symptoms from a HIDA scan can still have excellent relief of symptoms after LC.

Journal Article↗
PubMed1993

Familial acalculous gallbladder disease.

Four patients, all sisters, presented a long-standing history of pain in the gallbladder region and no calculi. All were first thoroughly investigated and then relieved of their symptoms by cholecystectomy. This prompted an investigation of their family over three generations, which revealed a surprisingly large number of relatives, mostly female, with acalculous gallbladder disease. Our review of various syndromes causing pain in the gallbladder region, including biliary dyskinesia, cystic duct syndrome, and chronic acalculous cholecystitis, makes a case for the existence of familial incidence of noncalculous and calculous gallbladder disease, possibly related to the disturbance of the autonomic nervous system affecting emptying of the gallbladder.

Adult↗