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PubMed1986

Circulating gastrointestinal hormones in patients with flatulent dyspepsia, with and without gallbladder disease.

Fasting and post-prandial circulating levels of insulin, gastrin, gastric inhibitory polypeptide, pancreatic polypeptide and neurotensin were measured in patients with flatulent dyspepsia, with and without gallbladder disease and post-cholecystectomy. Levels were also measured in non-dyspeptic patients with gallbladder disease and normal controls. There were no consistent significant differences from controls for fasting and post-prandial responses in patients with a history of dyspepsia or those who experienced dyspepsia at the time of the test. In patients with gallbladder disease, with and without dyspepsia, there was a reduced neurotensin response compared to normal controls. It is concluded that circulating levels of these hormones are not related to symptoms of flatulent dyspepsia.

Dyspepsia↗
PubMed2006

A genomewide search finds major susceptibility loci for gallbladder disease on chromosome 1 in Mexican Americans.

Gallbladder disease (GBD) is one of the major digestive diseases. Its risk factors include age, sex, obesity, type 2 diabetes, and metabolic syndrome (MS). The prevalence of GBD is high in minority populations, such as Native and Mexican Americans. Ethnic differences, familial aggregation of GBD, and the identification of susceptibility loci for gallstone disease by use of animal models suggest genetic influences on GBD. However, the major susceptibility loci for GBD in human populations have not been identified. Using ultrasound-based information on GBD occurrence and a 10-cM gene map, we performed multipoint variance-components analysis to localize susceptibility loci for GBD. Phenotypic and genotypic data from 715 individuals in 39 low-income Mexican American families participating in the San Antonio Family Diabetes/Gallbladder Study were used. Two GBD phenotypes were defined for the analyses: (1) clinical or symptomatic GBD, the cases of cholecystectomies due to stones confirmed by ultrasound, and (2) total GBD, the clinical GBD cases plus the stone carriers newly diagnosed by ultrasound. With use of the National Cholesterol Education Program/Adult Treatment Panel III criteria, five MS risk factors were defined: increased waist circumference, hypertriglyceredemia, low high-density lipoprotein cholesterol, hypertension, and high fasting glucose. The MS risk-factor score (range 0-5) for a given individual was used as a single, composite covariate in the genetic analyses. After accounting for the effects of age, sex, and MS risk-factor score, we found stronger linkage signals for the symptomatic GBD phenotype. The highest LOD scores (3.7 and 3.5) occurred on chromosome 1p between markers D1S1597 and D1S407 (1p36.21) and near marker D1S255 (1p34.3), respectively. Other genetic locations (chromosomes 2p, 3q, 4p, 8p, 9p, 10p, and 16q) across the genome exhibited some evidence of linkage (LOD >or=1.2) to symptomatic GBD. Some of these chromosomal regions corresponded with the genetic locations of Lith loci, which influence gallstone formation in mouse models. In conclusion, we found significant evidence of major genetic determinants of symptomatic GBD on chromosome 1p in Mexican Americans.

Adult↗
PubMed1981

[Accuracy of ultrasonics in gallbladder diseases (author's transl)].

Report on 158 ultrasonics findings of gallbladder diseases, all of them controlled by laparotomy. The diagnostic accuracy for stones was 99.3% with one false-positive but without any false-negative result. Because ultrasonics is a less time consuming and inexpensive method without trouble for patients, it should be used - if possible with a real-time equipment - as the first apparatively-diagnostic procedure in cases of suspected gallbladder diseases.

Adult↗
PubMed1994

Hyperbilirubinemia without common bile duct abnormalities and hyperamylasemia without pancreatitis in patients with gallbladder disease.

OBJECTIVE: To determine the incidence of jaundice and hyperamylasemia in the absence of common bile duct abnormalities or clinical pancreatitis in patients undergoing cholecystectomy. DESIGN: A continuous, prospective analysis of a consecutive case series was performed on all patients undergoing cholecystectomy. SETTING: An urban, tertiary care university hospital. PATIENTS: Adult patients with gallbladder disease. INTERVENTION: All patients underwent cholecystectomy. MAIN OUTCOME MEASURES: The presence or absence of common bile duct abnormalities was evaluated by cholangiography, and pancreatitis was identified by clinical signs, imaging studies, and direct visual inspection during cholecystectomy. RESULTS: All patients (N = 1746) undergoing cholecystectomy were prospectively categorized as having chronic calculous (n = 1410), acute calculous (n = 217), chronic acalculous (n = 70), or acute acalculous (n = 49) gallbladder disease. It was uncommon for patients with chronic calculous cholecystitis to have an elevated bilirubin level with no choledocholithiasis and a normal common bile duct or to have hyperamylasemia without pancreatitis. Twenty-five percent of the patients with acute calculous cholecystitis had a serum bilirubin level between 34 and 86 mumol/L (2.0 and 5.0 mg/dL) with no common bile duct abnormality and 4% had hyperamylasemia without pancreatitis. Over one third of the patients with acute acalculous cholecystitis had an elevated bilirubin level with a normal common bile duct or an elevated amylase level without pancreatitis. CONCLUSION: Jaundice and hyperamylasemia can be produced by gallbladder disease alone.

Acute Disease↗
PubMed1981

Gallbladder disease in children and adolescents.

A 20-year experience with gallbladder disease in 85 children and adolescents was reviewed. Sixty-five patients had idiopathic cholelithiasis and cholecystitis (group I); 20 patients had cholelithiasis and cholecystitis secondary to a predisposing disease or other pathologic diagnoses (group II). For group I patients, 100% were greater than age 12, 92.3% were female, 60% were overweight, 20% had a positive family history, and 27.7% had had a previous pregnancy. For group II patients, 60% were less than age 13, 45% were female, 15% were overweight, 5% had a positive family history, and none had previously been pregnant. Symptomatology in group I, but not group II, patients matched that seen in adults. Group I, but not group II, patients experienced delays in diagnosis. These data indicate that children and adolescents with gallbladder disease constitute two distinct populations and that idiopathic cholelithiasis and cholecystitis must be considered as a potential cause of chronic abdominal pain in otherwise healthy adolescents.

Adolescent↗
PubMed2005

Role of laparoscopic cholecystectomy in the early management of acute gallbladder disease.

BACKGROUND: This study evaluated the role of laparoscopic surgery in the early management of acute gallbladder disease in a single large UK teaching hospital. METHODS: Details of all emergency admissions for acute gallbladder disease from January 2000 to December 2001 were identified and additional information from the hospital records was reviewed retrospectively. RESULTS: Three hundred and eighty-five patients with gallstone disease (243 acute biliary pain, 142 acute cholecystitis) and 15 with acalculous disease were identified. The conversion rate was higher during early laparoscopic surgery for acute calculous cholecystitis than in operations for acute biliary pain (19 versus 4 per cent; P = 0.002). In patients with acute calculous cholecystitis the conversion rate was significantly lower in operations within 48 h of admission (one of 26) than when surgery was delayed beyond 48 h (14 of 52) or subsequently carried out electively (seven of 21) (P = 0.014). Elective surgery for previous acute cholecystitis was associated with a higher conversion rate (seven of 21 patients) than elective surgery for biliary pain (three of 65) (P = 0.002). CONCLUSION: Laparoscopic cholecystectomy for acute calculous cholecystitis should be performed, where possible, within the first 48 h of admission.

Acute Disease↗
PubMed1980

Real-time ultrasonography. Diagnostic technique of choice in calculous gallbladder disease.

We used high-resolution real-time ultrasonography to examine the gallbladder in patients with signs and symptoms suggestive of gallbladder disease. Using this noninvasive technique, the physician can examine the gallbladder and related anatomy thoroughly in less than five minutes. The technique is much easier to learn and perform than gray-scale ultrasonography. In 313 patients in whom gallstones were later confirmed at cholecystectomy or autopsy, the ultrasound examination achieved an accuracy of 96 per cent in the evaluation of cholelithiasis. Five examinations gave false-negative results, one a definite false-positive result, and two possible false-positive results; six examinations were inadequate. The sensitivity of the method was 98 per cent, and the specificity was between 93.5 and 97.7 per cent. In 124 patients evaluated prospectively by means of both ultrasound and oral cholecystography, the ultrasound study revealed calculi in five patients in whom calculi were not demonstrated on an adequate oral cholecystogram. No calculus detected with oral cholecystography was missed by ultrasound. We believe that ultrasound should replace oral cholecystography as the first technique in evaluation of the patient with suspected gallbladder disease.

Cholelithiasis↗
PubMed1998

Usefulness of intraductal ultrasonography in gallbladder disease.

This study was designed to compare intraductal ultrasonography of the gallbladder wall with histopathologic findings and to assess the clinical usefulness of this imaging method in gallbladder disease. Thirty-one gallbladder specimens were examined by intraductal ultrasonography retrospectively. The gallbladder is composed of three layers: an innermost hyperechoic layer, a middle hypoechoic layer, and an outermost hyperechoic layer. The second layer on ultrasonograms corresponds to the muscle layer plus the fibrous tissue of the superficial perimuscular connective tissue layer. In cases in which the thickness of the second layer was 500 microns or less, little fibrous tissue was seen and the second layer was approximately identical to the muscle layer on sonograms. Clinical study was performed on 22 gallbladders. The use of a guidewire through the papilla facilitated intraductal ultrasonographic examination. The intraductal sonographic probe could be inserted into the gallbladder fundus in 13 of 22 cases. In nine unsuccessful cases, technical difficulties were as follows: sharply angulated gallbladder (four cases), stenosis of the gallbladder (two cases), difficulty in transmitting power in the correct direction (three cases). With regard to the area visualized in 13 successful cases, in three cases the area visualized was 100%, in seven cases it was 75%, and three cases it was 50%. Intraductal ultrasonographic images could be obtained in 83.3% (10 of 12) of elevated lesions of the gallbladder. The indications for intraductal ultrasonography will be cases in which an abnormality was detected by transabdominal ultrasonography or other modalities in which the physician does not know whether or not to operate. In conclusion, we defined the intraductal sonographic images of gallbladder wall and clarified the clinical indications for use of this imaging method.

Gallbladder↗
PubMed1982

Gallbladder disease in young women.

The records of 96 young women 25 years of age and less, who underwent cholecystectomy in the years 1977 to 1980 inclusive, were reviewed looking for correlations among obesity, parity, oral contraceptive usage and gallbladder disease. The main risk factor in this population was the presence, either past or present, of pregnancy. Oral contraceptive usage and obesity did not result in an increased risk of having gallbladder disease develop in this population. It is believed that this population is too young to demonstrate such an association. It was only when coupled with pregnancy that obesity or oral contraceptive usage resulted in an increased risk of having gallbladder disease develop.

Adult↗
PubMed1980

Ultrasonography and oral cholecystography: a comparison of their use in the diagnosis of gallbladder disease.

The charts of all cholecystectomy patients at the White Memorial Medical Center, Los Angeles, from January 1977 to December 1979 were reviewed; of 374 patients, 76 had had both abdominal ultrasound scan and oral cholecystography performed preoperatively. Cholecystography accurately diagnosed gallbladder disease in 71 of these 76 patients, an accuracy rate of 93.4% with one false-positive and four false-negative results. Ultrasonography correctly predicted gallbladder disease in 66 of 76 patients, an accuracy rate of 86.8%, with one false-positive and nine false-negative results. On the basis of this study and others in the literature, ultrasound scanning is recommended as the initial screening diagnostic study for gallbladder disease. Oral cholecystography should follow in patients in whom ultrasonography fails to identify gallbladder calculi.

Cholecystography↗
PubMed1994

Ultrasonographic angiography in gallbladder diseases.

Ultrasonographic (US) angiography was performed by sonographic examination with injection of carbon dioxide microbubbles through a catheter following conventional angiography in 41 patients with various gallbladder diseases. Three enhancement patterns were found; strong enhancement in the lesion from the periphery to the center was noted in patients with adenocarcinoma and benign polyp (type I), irregular partial enhancement at the margins of the lesion in those with adenosquamous carcinoma (type II), and internal regular enhancement in those with chronic cholecystitis, xanthogranulomatous cholecystitis and adenomyomatosis (type III). Pseudopolypoid lesion such as gallbladder debris showed no enhancement. US angiography may be useful in the differential diagnosis of gallbladder diseases, especially to differentiate the wall thickening type of gallbladder carcinoma from chronic cholecystitis or adenomyomatosis, and the pseudopolypoid lesion and fundal type of adenomyomatosis from benign polyp or polypoid-type carcinoma.

Adenocarcinoma↗
PubMed1975

Development and evaluation of use of cholecystokinin in the diagnosis of acalculous gallbladder disease.

The need to differentiate patients with acalculous gallbladder disease who would benefit from cholecystectomy and those who would not led to the search for a procedure that would be of value in this respect. For this purpose, cholecystokinin (CCK) has been used, and many reports have indicated that CCK does identify patients in whom the gallbladder is the source of pain. A review of papers dealing with CCK as a diagnostic aid suggests, however, that some radiographic evaluations have not been subjected to adequate, unbiased interpretation and that some follow-up studies have been incomplete and of short duration. Despite these objections there is evidence that CCK can be useful as a diagnostic aid, and further, continued, well-designed studies are indicated.

Cholecystography↗
PubMed1980

Gray-scale ultrasonography as a screening procedure in the detection of gallbladder disease.

The sonographic and surgical findings in 180 patients who underwent cholecystectomy for gallbladder disease were reviewed and correlated. Four abnormal groups were established. In Group I, the gallbladder was visible and contained structures which cast an acoustic shadow. In Group II, there was constant shadowing in the region of the gallbladder fossa, but the gallbladder itself was not visible. In Group III, there was a constant, immobile, echo-dense, nonshadowing area in the gallbladder wall. In Group IV, nonshadowing echoes were seen within the gallbladder lumen. The overall accuracy of ultrasound was 98.9%; the false-negative rate was 2.2%, the false-positive rate 2.8%. 5.6% of Group I patients had normal oral cholecystograms. Because of its high accuracy, minimal preparation, speed of diagnosis, and cost-effectiveness, the authors recommend that ultrasonic cholecystography be considered as a screening method, particularly for small polyps (< 4 mm).

Cholelithiasis↗