PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Gallbladder”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,171 records · Page 65Linked to original sources

A new approach to absorptive function of gallbladder.

To investigate the mechanism of concentration of bile, the normal canine gallbladders were cannulated through the cystic duct into the gallbladder neck with polyethylene tube, and hypotonic, isotonic and hypertonic salines as well as hepatic and gallbladder biles were placed in the gallbladder. Low molecular electrolytes such as Na+ and Cl- were transported across the epithelial membrane against water flux. The hepatic bile was decreased markedly in volume and each level of electrolytes including bile acids approached that in the gallbladder bile. The different results were obtained by concentration of the hepatic bile in the gallbladder with chemically induced cholecystitis.

Absorption↗

Measurement of calcium content of gallstones by computed tomography and the relationship between gallbladder function and calcification of gallstones.

To evaluate the relationship between gallbladder function and calcification of gallstones, we studied gallbladder contractility by oral cholecystography, the computed tomography (CT) number of stones for 30 gallstone patients, calcium content of 13 stones operatively extirpated, and the degree of inflammatory change in 13 surgical gallbladder specimens. There was significant correlation between the calcium content and CT numbers of stones, and 1% of the calcium content of gallstone was approximately equal to 40 Hounsfield Units (HU) of the CT number. The calcium content of stones in patients with normal gallbladder contractility was extrapolated to be below 1.5%, while that with poor contractility ranged from 0% to 21%. Additionally there is a possibility that calcium content increases, related to the inflammatory change of gallbladder. Hence our results suggested that measurement of the CT number of stones is useful to evaluate the calcium content of gallstones, and that the gallbladder contractility could be one of the factors to influence calcification of stones.

Cholecystography↗

The relationship between interdigestive gallbladder and gastroduodenal motility in man.

The relationship between interdigestive gallbladder and gastroduodenal motility simultaneously with the behavior of plasma motilin and CCK levels in 20 subjects was investigated. We used an infusion catheter method for the measurement of gastroduodenal motility, and real-time ultrasonography for the measurement of gallbladder size. In gastric phase II, the gallbladder contracted with extension of the major axis and shrinking of the minor axis, with its minimum volume being 84% of the volume in phase I. The gallbladder then filled rapidly assuming a sphere-like shape with extension of the minor axis and shrinking of the major axis in gastric phase I. This motility was recognized only during the gastrointestinal interdigestive migrating complex (GI-IMC) cycle, originating in the stomach, and was associated with an increase of motilin levels, it was not seen before or after the intestinal IMC (I-IMC), which originated in the duodenum without contraction of the stomach or an increase of motilin levels. Furthermore no apparent relationship was recognized between CCK and gastric or gallbladder motility. Our findings suggest that gallbladder motility in the interdigestive period has a close relationship with gastroduodenal motility and is related to the appearance of the GI-IMC.

Adult↗

Gallbladder emptying and cholecystokinin and pancreatic polypeptide responses to a liquid meal in patients with diabetes mellitus.

To investigate gallbladder motility and its regulation in patients with diabetes mellitus (DM), we examined the gallbladder response to an intraduodenal test meal by measuring the temporal course of plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) levels. Eighteen patients with type 2 DM and 7 healthy subjects (controls) were enrolled. The gallbladder volume was calculated by the sum-of-cylinders method from ultrasonographic images, and plasma CCK and PP were measured by radioimmunoassays. No significant difference was found in either the gallbladder response or in the CCK response between patients with DM and controls. However, the fasting plasma PP level of patients with DM was more than tenfold higher than that of controls. The integrated PP response (IPPR) of patients with DM to the test meal was 8.3-fold higher than that of controls. When patients with DM were grouped according to whether they had been treated with insulin or not, the fasting plasma PP of patients with DM without insulin treatment was significantly higher than the level in those treated with insulin. These results suggest that overproduction of PP-like immunoreactive substance(s) may occur in patients with DM, but the high plasma PP immunoreactivity does not appear to be related to the fasting gallbladder volume or to gallbladder emptying and filling.

Adult↗

Effect of peripherally and centrally administered calcitonin on gallbladder emptying in dogs.

The effect of calcitonin on meal-stimulated gallbladder emptying (GBE) was examined after intravenous (i.v.) and intracerebroventricular (i.c.v.) administration in six mongrel dogs. The gallbladder contraction was surveyed by means of real-time ultrasonography in conscious dogs. Calcitonin given i.v. elicited an immediate and strong inhibition of postprandial GBE-the integrated 0- to 120-min gallbladder response was 118.1 +/- 8.0%.h after placebo, whereas it was 91.8 +/- 2.1%.h, 59.4 +/- 17.9%.h (P < 0.001), and 14.2 +/- 20.5%.h (P < 0.001) after 3.6, 18.0, and 90.0 pmol.kg-1 calcitonin, respectively. After i.c.v. administration (1.8 and 18.0 pmol.kg-1), only the higher calcitonin dose exerted a moderate inhibitory effect on postprandial GBE. The calcitonin doses required to evoke a 50% inhibition of meal-stimulated GBE were 15- to 10-fold lower after i.v. than i.c.v. application. Peripherally given calcitonin brought about a dose-dependent increase in the interdigestive gallbladder volume-the linear regression of the relative gallbladder volume versus calcitonin dose was y = 11.60 [ln(dose + 1)] + 97.02 (r = 0.864, P < 0.001). Intravenous application of calcitonin did not affect caerulein-induced GBE. The results obtained imply that: (i) calcitonin exerts an inhibitory influence on meal-induced GBE and that this effect is more pronounced after i.v. than after i.c.v. administration, and (ii) peripherally given calcitonin does not inhibit caerulein-induced gallbladder contraction in the dog.

Animals↗

Cardiac metastasis from squamous cell carcinoma of gallbladder.

A 65-year-old woman was admitted to our hospital with the diagnosis of gallbladder tumor. Right extended hepatic lobectomy plus lymph node dissection of the hepatoduodenal ligament and left hepaticojejunostomy with Roux-en-Y reconstruction was performed in July, 1993. The gallbladder tumor was histologically proven to be squamous cell carcinoma. Seventeen months later, the patient experienced dyspnea and pitting edema of the lower legs and was admitted, in December 1994, with a diagnosis of heart failure. Despite intensive cardiac support, she died 12 days after the second admission. Autopsy revealed multiple cardiac tumors in the left and right ventricles, left atrium, left coronary artery, and left diaphragm. Histologically, these tumors were shown to be squamous cell carcinoma, considered to have metastasized from the primary gallbladder carcinoma. As neither local recurrence of the gallbladder carcinoma nor any lymph node metastasis was found, the cardiac metastasis of the gallbladder carcinoma may have occurred via the hematogenous route. Although rare, this route of cardiac metastasis of gallbladder carcinoma may be an important aspect of distant metastasis, which should be monitored for during follow-up after resection of the primary tumor.

Aged↗

Characterization of NA+/H+ exchanger isoform (NHE1, NH32 and NHE3) expression in prairie dog gallbladder.

Gallbladder Na+ absorption is linked to gallstone formation in prairie dogs. Na+/H+ exchange (NHE) is one of the major Na+ absorptive pathways in gallbladder. In this study, we measured gallbladder Na+/H+ exchange and characterized the NHE isoforms expressed in prairie dogs. Na+/H+ exchange activity was assessed by measuring amiloride-inhibitable transepithelial Na+ flux and apical 22Na+ uptake using dimethylamiloride (DMA). HOE-694 was used to determine NHE2 and NHE3 contributions. Basal JNams was higher than JNasm with JNanet absorption. Mucosal DMA inhibited transepithelial Na+ flux in a dose-dependent fashion, causing JNams equal to JNasm and blocking JNanet absorption at 100 microm. Basal 22Na+ uptake rate was 10.9 +/- 1.0 micromol. cm-2. hr-1 which was inhibited by approximately 43% by mucosal DMA and approximately 30% by mucosal HOE-694 at 100 microm. RT-PCR and Northern blot analysis demonstrated expression of mRNAs encoding NHE1, NHE2 and NHE3 in the gallbladder. Expression of NHE1, NHE2 and NHE3 polypeptides was confirmed using isoform-specific anti-NHE antibodies. These data suggest that Na+/H+ exchange accounts for a substantial fraction of gallbladder apical Na+ entry and most of net Na+ absorption in prairie dogs. The NHE2 and NHE3 isoforms, but not NHE1, are involved in gallbladder apical Na+ uptake and transepithelial Na+ absorption.

Amiloride↗

Gallbladder carcinoma and chronic cholecystitis: differentiation with two-phase spiral CT.

The objective of the present study was to determine whether an analysis of two-phase spiral computed tomographic (CT) features provides a sound basis for the differential diagnosis between gallbladder carcinoma and chronic cholecystitis. Eighty-two patients, 35 with gallbladder carcinoma and 47 with chronic cholecystitis, underwent two-phase spiral CT. We reviewed the two-phase spiral CT features of thickness and enhancement pattern of the gallbladder wall seen during the arterial and venous phases. Mean wall thicknesses were 12.6 mm in the gallbladder carcinoma group and 6.9 mm in the chronic cholecystitis group. The common enhancement patterns seen in gallbladder carcinoma were (a) a highly enhanced thick inner wall layer during the arterial phase that showed isoattenuation with the adjacent hepatic parenchyma during the venous phase (16 of 35, 45.7%) and (b) a highly enhanced thick inner wall layer during both phases (eight of 35, 22.9%). The most common enhancement pattern of chronic cholecystitis was isoattenuation of the thin inner wall layer during both phases (42 of 47, 89.4%). In conclusion, awareness of the wall thickening and enhancement patterns in gallbladder carcinoma and chronic cholecystitis on two-phase spiral CT appears to be valuable in differentiating these two different disease entities.

Carcinoma↗

Gallbladder opacification 12-24 h after angiography by CT examination: a multivariate analysis.

BACKGROUND: To examine the incidence and predisposing factors of gallbladder opacification in delayed computed tomography (CT) after angiography. METHODS: CT examination 12-24 h after angiography was performed in 389 patients. Univariate and multivariate analyses were made. RESULTS: Two hundred thirty-three of 389 patients (60%) revealed gallbladder opacification. Type of contrast medium (P < 0. 01), total bilirubin (P < 0.01), and serum creatinine (P < 0.01) were significant and independent factors relating to gallbladder opacification. Ioxaglate (70%, relative odds = 2.86) and iohexol (63%, relative odds = 2.03) showed higher gallbladder opacification rates than that of iopamidol (45%, relative odds = 1.43) and diatrizoate (30%). Patients with a lower serum bilirubin level (relative odds = 1.67) and a raised serum creatinine level (relative odds = 2.01) showed higher incidence of gallbladder opacification. CONCLUSION: Gallbladder opacification after angiography is not an abnormal finding on delayed CT in patients with not only abnormal renal function but also normal hepatobiliary and normal renal function, especially for modern contrast media.

Angiography↗

Impact of tumor spread to the cystic duct on the prognosis of patients with gallbladder carcinoma.

INTRODUCTION: The importance of gallbladder carcinoma spread to the cystic duct has not yet been described. Although the cystic duct is contiguous with the gallbladder, it is located in the hepatoduodenal ligament and differs in structure from the gallbladder. The incidence and prognostic significance of cancer spread to the cystic duct in patients with gallbladder cancer is unclear. METHODS: Surgical specimens from 42 patients who underwent resection for advanced gallbladder carcinoma were examined retrospectively. RESULTS: Altogether, 13 (31%) of the patients had cancer spread to the cystic duct. The incidences of perineural invasion, lymph node metastasis, and venous invasion were significantly higher in these patients than in the other 29 patients without cancer spread to the cystic duct (P = 0.027, 0.034, and 0.034, respectively). The 3- and 5-year survival rates of these 13 patients were significantly lower than those of the other 29 patients (15.4% vs. 51.0% and 7.7% vs. 46.6%, respectively, P < 0.0001 each). Multivariate analysis using the Cox proportional hazard model identified positive cancer spread to the cystic duct and depth of invasion (beyond serosa) as significant independent indicators of a poor prognosis. CONCLUSIONS: Cancer spread to the cystic duct is an indicator of poor prognosis in patients with gallbladder carcinoma. This may be due to the high incidence of concomitant perineural invasion and lymph node metastasis associated with cancer spread.

Adenocarcinoma↗

Role of the NHE3 isoform of the Na+/H+ exchanger in sodium absorption by the rabbit gallbladder.

The absorption of water and electrolytes by the gallbladder seems to be largely dependent upon a Na+/H+ exchange at the apical membrane of the gallbladder epithelium. To find out if the exchanger involved is the NHE3 isoform, as in other absorbing epithelia, two studies were performed using the rabbit gallbladder. First, we studied 22Na absorption in Ussing chambers with Krebs buffer as a control solution, and in the presence of amiloride (100, 200 or 1000 microM), ethyl-isopropyl-amiloride (EIPA, 1 or 5 microM), or the phorbol ester, phorbol 12-myristate 13-acetate (PMA, 1 microM). A net mucosal-to-serosal Na+ flux was observed with control buffer. No inhibition of this net flux was observed with 5 microM EIPA, and the IC50 for amiloride was found to be 200 microM. PMA induced a reduction of absorption by 30% that was prevented by incubation with calphostin C. Resistance to amiloride and EIPA, and inhibition by PMA are consistent with the involvement of the NHE3 isoform. The second study involved reverse-transcriptase polymerase chain reaction (RT-PCR) of total gallbladder RNA, with two primers designed to amplify a 645-base-pair fragment from NHE3 mRNA. A cDNA fragment of the expected size was actually obtained from gallbladder RNA, while RT-PCR of RNA from the liver, which does not contain NHE3, gave negative results. A sequence of 492 nucleotides of the amplified product was determined, which was almost superimposable onto the known sequence of the corresponding fragment of rabbit NHE3. It is concluded that, in rabbit gallbladder, neutral NaCl absorption is, at least in part, dependent on the NHE3 isoform of the Na+/H+ exchanger.

Absorption↗

What's right when the gallbladder's left? A case report.

During laparoscopic cholecystectomy for cholelithiasis in a 40-year-old woman, we came upon a case of incidentally discovered left-sided gallbladder (LSG). Two anatomic variants of LSG are known: (a) "true LSG," in which, according to Gross, an accessory gallbladder originates from the left hepatic duct (LHD), the right embryonic bud is readsorbed, and the cystic duct joins either the CBD from the left or the LHD directly. Otherwise, a normal right-sided gallbladder adheres to the inferior left hepatic lobe, and the cystic duct joins the CBD from the right side (as in our case); (b) gallbladder under the fourth hepatic segment, medial to a right-sided round ligament, probably resulting from a prenatal obliteration of the right umbilical vein. Left-sided gallbladder is a paraphysiologic condition that when identified before surgery, must be studied by CT or MRI, when incidentally discovered during surgery must be promptly recognized by the surgeon, who must be aware of the unpredictable confluence of the cystic duct into the CBD. The following operative precautions are useful for avoiding a lesion of the CBD: The surgeon should start dissection of Calot's triangle as close as possible to the gallbladder margin, prepare and clip the cystic duct as close as possible to the infundibulum, and a 30 degrees angled telescope. If in doubt, the surgeon should perform an intraoperative cholangiography.

Adult↗

Laparoscopic cholecystectomy for triple gallbladder.

A very rare case involving true triplication of the gallbladder in a 38-year-old man with no other congenital abnormalities is reported. All three gallbladders had signs of chronic inflammatory disease and lithiasis. Acute cholecystitis and a double gallbladder were diagnosed preoperatively, but the diagnosis of a second accessory gallbladder was made only at the time of surgery. The patient underwent successful laparoscopic cholecystectomy. When a triplicate gallbladder is encountered, complete dissection of Calot's triangle and intraoperative cholangiographic evaluation should be performed to prevent damage to the biliary duct system. All three gallbladders should be removed to avoid unnecessary reoperation. All of this can be accomplished readily by laparoscopic surgery.

Adult↗

A gallbladder flap for reconstruction of the common bile duct. An experimental study on pigs.

BACKGROUND/PURPOSE: In this article we investigate whether a gallbladder flap could be used for reconstruction of the common bile duct (CBD), thereby providing drainage via an intact sphincter of Oddi. METHODS: Eight LWD pigs were used for the experiments. The gallbladder was dissected from its fossa, care being taken not to damage its vessels. The CBD was then displayed and approximately 5 mm resected. In two pigs a tube, and in six pigs a sphere, was constructed from the gallbladder flap. Anastomoses were constructed between the gallbladder flap and the CBD. Blood samples were drawn and on day 10 a laparotomy and an intraoperative cholangiography was performed. RESULTS: No pigs showed any sign of biliary leakage and standard liver parameters were not affected by surgery. In the two pigs who had a tube constructed, cholangiography showed extrahepatic stenosis and intrahepatic biliary dilatation. In the six pigs who had a sphere constructed, cholangiography was without any sign of extrahepatic stenosis or intrahepatic dilatation. CONCLUSION: Reconstruction of the CBD by way of a gallbladder flap seems to be a safe procedure to accomplish biliary drainage. This procedure could be of clinical significance for reconstruction of the CBD after resections for benign strictures and tumors, and for reconstruction after blunt or penetrating trauma. In this article we investigate whether a gallbladder flap could be used for reconstruction of the common bile duct (CBD), thereby providing drainage via an intact sphincter of Oddi.

Anastomosis, Surgical↗

Unexpected gallbladder cancer during laparoscopic cholecystectomy.

BACKGROUND/PURPOSE: In the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC). METHODS: This study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed. RESULTS: Fifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively. CONCLUSIONS: A simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.

Adult↗

Primary hydatid disease of the gallbladder: a rare clinical entity.

Hydatid disease is endemic in Greece, and has been known from Hippocrates' time to cause cysts in the liver. We report here three very rare cases of primary gallbladder hydatid disease without prior history or evidence of concurrent disease activity in any other location. To our knowledge, only two previous reports exist, each of one patient suffering from primary gallbladder hydatid disease. Unlike the insidious hydatid cysts of the liver, gallbladder hydatidosis in our patients was associated with early diagnosis, due to gallbladder dysfunction symptoms presenting early in its course. Moreover, the size of gallbladder cysts compared to liver cysts at diagnosis was small (maximal diameter, <5 cm), making total cyst excision along with cholecystectomy feasible for all of our patients. During long-term follow up of the patients (up to 10 years), no disease recurrences were noted. We provide supporting evidence that primary gallbladder hydatidosis presents a different pathophysiological and clinical course, having better prognosis, when compared with the usual liver disease.

Aged↗

Primary sclerosing cholangitis in which differential diagnosis from gallbladder carcinoma was difficult.

We report a case of localized primary sclerosing cholangitis (PSC) which was difficult to distinguish from gallbladder carcinoma. A 75-year-old woman with elevated serum bilirubin was hospitalized and underwent endoscopic nasobiliary drainage (ENBD). There was no history of diseases such as gallbladder stone, pancreatitis, or ulcerative colitis. Cholangiography through the ENBD tube showed localized stenosis of the common bile duct; the gallbladder could not be seen. Angiography showed no encasement of the hepatic artery. Ultrasonography showed a tumor in the cystic duct, and the tumor had invaded the gallbladder and common bile duct. We diagnosed gallbladder carcinoma on radioimaging, and performed an S4aS5 subsegmentectomy of the liver and resection of the extrahepatic biliary tree. Pathologically, no malignant cells were detected, and fibrosis around bile ducts and infiltration of inflammatory cells into hepatic tissue were found. It is well known that PSC is sometimes difficult to differentially diagnose from cholangiocarcinoma. Our case is of high interest because ultrasonography showed findings suggestive of gallbladder carcinoma. It is therefore necessary to keep the possibility of PSC in mind for the diagnosis and treatment of such localized biliary stenosis.

Aged↗

Pancreatic bladder or double gallbladder draining into pancreatic duct?

We report a case of pancreatic bladder which could also be interpreted as double gallbladder draining into the pancreatic duct. A 6-year-old Japanese boy underwent a cholecystectomy of the smaller bladder under the diagnosis of duplication of the gallbladder, leaving the normal gallbladder and an unremarkable biliary ductal system. The smaller bladder was histologically similar to the gallbladder tissue. At age 25, relaparotomy was performed. It was confirmed that the residual aberrant duct from the smaller bladder joined directly with the duct of Wirsung and that the patient had fusiform dilatation of the extrahepatic bile duct. The extrahepatic portion of the bile duct was excised along with the "normal" gallbladder and the residual aberrant duct. The present anomaly seems to validate the designation of pancreatic bladder whose cystic duct joined directly with the pancreatic duct, but may also be explained from the view point of double gallbladder.

Bile Ducts↗