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PubMedDate not supplied

[Gallbladder contraction in patients with asymptomatic cholelithiasis].

There are many discrepancies between reports about gallbladder motility in gallstones disease. We studied gallbladder volume and contraction in 65 patients with asymptomatic gallstones and compared with 65 healthy controls by ultrasonography. The mass of the stones was less of the 25% of the gallbladder volume. We related stone size and number with its motor function. The results of the gallbladder contraction (GC) in the control group was 79.5% (DS = 9.5) and in the cholelithiasis group was 59.9% (DS = 19) with (p < 0.01). We found that the cholelithiasis group was heterogeneous and on closer inspection the patients fell into two subgroups separated by the inferior limit of normal GC (60%). The subgroup I (41 patients) had a fasting volume (FV) of 26.6 ml (DS = 14.1), a postprandial volume (PV) of 6.5 ml (DS = 3.8) and a GC of 75.3% (DS = 8.5). The subgroup II (24 patients) had a FV of 27.3 ml (DS = 20.3), a PV of 16.9 ml (DS = 15) and a GC of 40.5% (DS = 11.8). There was significant differences in PV and GC (p < 0.01). We concluded that defective gallbladder emptying is evident in a subgroup of patients but gallbladder contraction may be normal in patients with cholelithiasis and there are, not correlation between GC and the number and size of the stones.

Adult↗

PubMed1990

Gallbladder volume and contraction measured by sum-of-cylinders method compared with ellipsoid and area-length methods.

Gallbladder volume, determined by ultrasonography (US) using the sum-of-cylinders (SOC) method, is tedious and time-consuming. We therefore examined whether ellipsoid (ELL) or area-length (A-L) methods, which are easier to perform, could reliably replace the SOC method. Fasting gallbladder volume and emptying were determined according to these 3 methods in 20 normal subjects and 20 gallstone patients. Excellent correlations were found but the ELL method yielded significantly larger mean volumes and the A-L method revealed significantly smaller volumes than the SOC method. Analysis of differences between methods revealed a considerable lack of consistency. Volumes according to the ELL method were 35 percent larger to 46 percent smaller for normal subjects and 34 percent larger to 41 percent smaller for gallstone patients than volumes according to the SOC method. Volumes according to the A-L method were 35 percent larger to 15 percent smaller for normal subjects and 51 percent larger to 17 percent smaller for gallstone patients. Maximal decrement of gallbladder volume in ml and in percentage according to the 3 different methods did not differ. Regardless of the method used, both fasting and minimal gallbladder volumes were significantly larger in gallstone patients than in normal subjects, whereas maximal decrement of gallbladder volume in ml and percentage was not different. The present study indicates that the SOC method remains the method of choice for US determination of gallbladder volume for scientific purposes.

Adult↗

PubMedDate not supplied

[Comparative study of gallbladder volume and contraction in healthy subjects of various ages and sex by ultrasonography].

Gallbladder motor function moderates the enterohepatic circulation which is determinant in bile composition. Cholelithiasis due to cholesterol stones increases with age and is more frequent in women. We studied the effects of age and sex on the gallbladder volume and contraction in 160 healthy subjects. We used real time ultrasonography and the elipsoid method to calculate the volume and gallbladder contraction which was physiologically stimulated by a fatty meal. The results of the gallbladder contraction were: Group 1 female (young women): 82.2% (SD = 12.1), Group 1 male (young men): 86.0% (SD = 9.9), Group 2 female (adult women): 77.4% (SD = 9.4): Group 2 male (adult men): 75.8% (SD = 15.9); Group 3 female (elderly women): 83.6% (SD = 9.0) and Group 3 male elderly men): 77.3% (SD = 10.2). The fasting and postprandial volumes correlates directly with the age in both sexes. These differences were not statistically significant and we concluded that in absence of gallbladder pathology, the motor function of the gallbladder is not significantly modified by age and sex.

Adolescent↗

PubMed1989

Agenesis of the gallbladder. A cause of false-positive ultrasonography.

Ultrasonography has evolved into a nonhazardous relatively inexpensive means of diagnosing biliary tract disease. It is considered to have a 95 per cent sensitivity for the diagnosis of cholelithiasis. Occasionally, a small contracted gallbladder associated with stones and chronic cholecystitis will be difficult to visualize with ultrasonography. Two patients with agenesis of the gallbladder were recently treated by the authors. Each patient had ultrasonographic evidence suggestive of a contracted gallbladder with stones. Both patients were explored and found to have absent gallbladders and normal operative cholangiograms. Agenesis of the gallbladder is a rare congenital anomaly with a reported incidence of from 0.01 to 0.04 per cent. Approximately 220 cases have been reported in the literature. Most of these are from necropsy studies. Many of these were newborns with more serious anomalies. One might project an increase in adult cases on the basis of increased usage of ultrasonography in patients with abdominal problems. At the present time, only operative findings including cholangiography can be considered as diagnostic of gallbladder agenesis. However, as more of these cases are reported, preoperative awareness of this entity will be increased.

Adult↗

PubMedDate not supplied

Ultrasonography in acute gallbladder perforation.

The files of patients with acute cholecystitis from two large university hospitals from the years 1978-1985 were employed to find the cases with acute gallbladder perforation for this study. Only those patients (n = 9) were selected for the analysis of sonographic signs of acute gallbladder perforation who had less than 48 hours of symptoms before sonography, and were operated upon within 24 hours of the sonography. Patients (n = 10) with non-complicated acute cholecystitis and identical in regard to the duration of the symptoms and the timing of the sonography and the operation formed a control group. The sonographic findings in patients with gallbladder perforation were pericholecystic fluid collections, free peritoneal fluid, disappearance of the gallbladder wall echoes, focal highly echogenic areas with acoustic shadows in the gallbladder, and an inhomogeneous, generally echo-poor gallbladder wall.

Acute Disease↗

PubMedDate not supplied

Ultrasonography and gallbladder perforation in acute cholecystitis.

A group of 24 patients with perforated gallbladder operated upon between 1980 and 1987 was compared with a group of 21 patients operated upon in 1982 due to uncomplicated acute cholecystitis in order to find out whether it was possible to use some specific sonographic signs to find the patients at risk of perforation. Free fluid and fluid collections close to the gallbladder fossa were found in 9 patients. The patients with perforated gallbladders tended to have a slightly thicker gallbladder wall--7 mm (range 3-20 mm)--when compared with the uncomplicated cases of acute cholecystitis--5.3 mm (range 2-13 mm). Localized fluid collection in the wall of a gallbladder was seen in a patient just prior to the perforation. It was, however, not possible to find a common sign characteristic for imminent perforation. The study showed, however, that the combination of early diagnosis with ultrasound together with aggressive surgery reduced the mortality at gallbladder perforation to none in the last 9-year-period compared with 10 per cent in the previous 9-year-period.

Acute Disease↗

PubMed1988

Gallbladder function during gallstone dissolution. Effect of bile acid therapy in patients with gallstones.

Impaired gallbladder emptying has been associated with gallstone disease but any effect on or from bile acid therapy for gallstone dissolution is unknown. We evaluated gallbladder filling and emptying with low-dose cholecystokinin infusion (0.02 U/kg.h) by computer-assisted cholescintigraphy in 52 controls versus 31 gallstone patients: 17 treated with 12-15 mg/kg.day of chenodeoxycholic acid and 14 with 8-10 mg/kg.day of ursodeoxycholic acid. Thirteen of 31 patients with complete dissolution had four scans: before, after 3 mo of therapy, after stone dissolution, and after discontinuation of bile acids. The 18 failures had three scans: before and after 3 and 15-18 mo of therapy. Before therapy, the 31 gallstone patients had significantly impaired gallbladder emptying compared with controls, but filling was not decreased. Bile acids significantly decreased emptying in both treatment groups after 3 mo of therapy. In the dissolution group, emptying improved once the stones had dissolved and increased further upon discontinuing the bile acids. In the failures, impaired emptying persisted for up to 15-18 mo. Gallbladder filling in the 31 gallstone patients was also significantly decreased after 3 mo of bile acid therapy, particularly in the failure patients, 5 of whom exhibited zero filling. No differences were detected between ursodeoxycholic acid and chenodeoxycholic acid for either gallbladder function or efficiency of dissolution. Thus, bile acid therapy impairs gallbladder filling and emptying in gallstone patients. Gallstone dissolution improves emptying, which is further enhanced when bile acids are discontinued.

Adult↗

PubMed1986

Gallbladder function in diabetic patients.

Gallbladder emptying and filling was studied in eight diabetic and six normal control patients. None of the patients had gallstones. Cholescintigraphy was performed using [99mTc]disofenin, and gallbladder emptying was studied using a 45-min i.v. infusion of the octapeptide of cholecystokinin (OP-CCK) 20 ng/kg X hr. The peak filling rate was greater in diabetic than in normal subjects; however, emptying of the gallbladder in response to OP-CCK was significantly less in the diabetic subjects (51.6 +/- 10.4% compared with 77.2 +/- 4.9%). When the diabetic group was subdivided into obese and nonobese diabetics, the obese diabetics had a much lower percentage of emptying than the nonobese diabetics (30.0 +/- 10.4% compared with 73.1 +/- 9.3%). These findings suggest that obese diabetics may have impaired emptying of the gallbladder even in the absence of gallstones. The more rapid rate of gallbladder filling in obesity may indicate hypotonicity of the gallbladder. The combination of these abnormalities may predispose the obese diabetic to the development of gallstones.

Adult↗

PubMed1985

Atropine antagonizes cholecystokinin and cerulein-induced gallbladder evacuation in man: a real-time ultrasonographic study.

Dose-response curves for cholecystokinin (CCK), cerulein (CRL), and the effect of atropine on peptide-induced gallbladder evacuation, were evaluated in 13 normal subjects. Gallbladder volume was monitored by means of real-time ultrasonography. After an overnight fast, CCK was infused in six subjects iv, with increasing doses from 0.002 IDU/kg/min for 15 min, and CRL in seven subjects from 0.5 ng/kg/min for 5 min, until maximum gallbladder evacuation (greater than 70% of the fasting volume) was achieved. Forty-eight hours after the first study, CCK and CRL were readministered at the maximum contracting dose in each subject with and without a pretreatment with atropine (1 mg iv as bolus). The results showed maximum gallbladder evacuation at 0.016 IDU for CCK, and at 4 ng for CRL. Atropine significantly blunted the gallbladder response both to CCK and to CRL. It is therefore suggested that the cholinergic system is involved in the gallbladder response to CCK and to CRL.

Adolescent↗

PubMed1985

Increases in gallbladder prostaglandin synthesis before the formation of cholesterol gallstones.

Increased synthesis of prostaglandins in the wall of the gallbladder may play a role in the pathogenesis of cholesterol gallstones by mediating mucus hypersecretion and thereby accelerating nucleation and the precipitation of cholesterol-supersaturated bile. We induced gallstones in prairie dogs and guinea pigs by feeding a cholesterol-supplemented diet for periods as long as 6 weeks. Gallbladder prostaglandin synthesis was quantitated by specific radioimmunoassays that measured the amount of various prostanoids released from the gallbladder during in vitro incubation. The gallbladders of cholesterol-fed prairie dogs showed increased synthesis of prostaglandin E2, prostaglandin F2a, and thromboxane and increased concentrations of glycoprotein in gallbladder bile. These changes were evident as early as 2 weeks after institution of the cholesterol diet, although cholesterol gallstones did not form until 4 or more weeks. In contrast, cholesterol feeding of the guinea pig did not induce cholesterol supersaturation. In this species pigment gallstones formed, probably as a result of a cholesterol-induced hemolytic anemia, and gallbladder mucus hypersecretion did not occur. Pigment gallstone formation in the guinea pig was associated with an increase in prostacyclin synthesis, but the synthesis of prostaglandin F2a and thromboxane was decreased. Increased prostaglandin synthesis may contribute to the formation of cholesterol gallstones but does not appear to participate in pigment gallstone formation.

Animals↗

PubMed1979

Gallbladder emptying in response to cholecystokinin. A cholescintigraphic study.

The threshold and dynamics of gallbladder emptying in human subjects in response to cholecystokinin (Pancreozymin, Boots Co. Ltd) were defined by radionuclide imaging with a gamma camera. The radiopharmaceutical employed, 99mTc-HIDA, was taken up rapidly by the liver and efficiently excreted into the biliary system so that gallbladder filling was easily distinguishable from negligible background activity. Counts were recorded continuously on magnetic tape during i.v. infusion of sequentially increasing doses of cholecystokinin: Each dose level was maintained for 15 min. At later playback, the area of interest was adjusted to include only the gallbladder and to exclude radioactivity present in the gut during gallbladder emptying. In 19 normal subjects (10 male and 9 female), a threshold dose of cholecystokin was identified for gallbladder contraction: 0.010 Crick-Harper-Raper units/kg-min in 16 subjects, and 0.020 Crick-Harper-Raper units/kg-min in the remaining 3. The rate of emptying appeared smooth and linear at each dose level: Doubling the dose of cholecystokinin in every case significantly increased the emptying rate. There appeared to be no effect of increasing age on emptying more rapidly than females, but the difference was not significant. This cholescintigraphic technique would appear to offer a simple, accurate, yet noninvasive method for continuously monitoring the events during gallbladder contraction in humans.

Adult↗

PubMed1983

Bradykinin-induced cardiovascular reflexes from the gallbladder in cats.

To determine whether bradykinin, an algesic substance produced in certain inflammatory states, can stimulate gallbladder receptors to cause significant cardiovascular reflexes, we applied this agent to the serosal surface of the gallbladder in cats anesthetized with methoxyflurane. As a control, bradykinin was also applied to the serosal surface of the liver surrounding the gallbladder. Significant cardiovascular reflexes were obtained from the gallbladder in an increasing, dose related fashion over a range of concentrations from 50 pg/ml to 100 micrograms/ml of bradykinin. The cardiovascular responses occurred after a latency of 13 +/- 0.92 seconds (mean +/- SE) and included increases in mean arterial pressure, systemic vascular resistance, heart rate and myocardial contractility (dP/dt at 40 mmHg developed pressure). There was also a small but significant increase in left ventricular end-diastolic pressure, but no change in aortic flow. Application of bradykinin to the liver did not evoke any cardiovascular responses. Bilateral vagus nerve transection just above the diaphragm did not alter the cardiovascular responses to application of bradykinin on the gallbladder. However, the hemodynamic responses were partially diminished by right splanchnic nerve transection and were completely eliminated by bilateral splanchnic nerve transection. We conclude that bradykinin, a substance that is formed within the gastrointestinal tract and possibly in bile, can stimulate gallbladder receptors to induce significant reflex activation of the cardiovascular system.

Animals↗

PubMedDate not supplied

Cytologic examination as an adjunct to laparoscopy and guided biopsy in the diagnosis of hepatic and gallbladder neoplasia.

Laparoscopic examination guided biopsy and cytologic examination of samples obtained by aspiration, brush or scrape from the liver or gallbladder were performed on 26 patients suspected of having hepatic or gallbladder neoplasia. Laparoscopic findings were diagnostic of hepatic neoplasia (primary or secondary) in 13 cases and gallbladder carcinoma in 9 cases. The yields of positive diagnoses on biopsy alone, cytology alone and combined biopsy and cytology were 11 (84.6%), 11 (84.6%) and 12 (92.3%), respectively, in cases of hepatic neoplasia and 4 (44.4%), 5 (55.5%) and 5 (55.5%), respectively, in cases of gallbladder carcinoma. The cytologic typing concurred with the histologic typing in six of ten cases (60%) of hepatic neoplasia and all four cases (100%) of gallbladder carcinoma. It is suggested that cytologic examination be used as an adjunct to histologic examination of guided biopsies in the diagnosis of hepatic neoplasia. It is also concluded that it is possible to make a tissue diagnosis in patients with gallbladder carcinoma by obtaining material for cytology and biopsy through laparoscopy.

Adenocarcinoma↗

PubMed1983

Defective gallbladder contractility in the ground squirrel and prairie dog during the early stages of cholesterol gallstone formation.

To examine the effect of changes in bile lithogenicity on gallbladder muscle function, in vitro gallbladder contractility was studied in an animal model of cholesterol gallstones: Richardson ground squirrels fed either a trace (control) or a 1% wt/wt cholesterol (test) diet. Lithogenic index of gallbladder bile increased on the test diet from 0.52 +/- 0.03 to 0.81 +/- 0.04 (p less than 0.001). Isometric tensions generated in response to cholecystokinin-octapeptide, acetylcholine, or potassium depolarization, were all reduced greater than 50% in the test gallbladder muscles (p less than 0.05), without any significant shift of the normalized dose-response curves. Tension in response to cholecystokinin-octapeptide differed significantly (p less than 0.05) between each stage of stone formation compared with controls: 42% decrease in test animals before development of stones; 65% decrease in those with gallstones. Ileal muscle from these animals, when tested with the same three stimuli, showed no adverse effects of the high-cholesterol diet. Another animal model, the prairie dog, also demonstrated a similar in vitro defect in gallbladder contractility associated with increases in bile lithogenicity. Thus, in the ground squirrel, a progressive defect in smooth muscle contractility to three different stimuli coincides with early changes in bile lithogenicity. The defect is not associated with any loss of sensitivity to these stimuli, and appears to be localized specifically to the gallbladder muscle. Its presence in two animal models of cholelithiasis suggests that biliary stasis is an important factor in the early stages of cholesterol stone formation.

Acetylcholine↗

PubMed1984

Influence of gallstones and ursodeoxycholic acid therapy on gallbladder emptying.

Altered gallbladder motility could predispose to, or result from, gallstone formation and could also explain the alleged relief of biliary colic seen during bile acid therapy. Therefore, in 14 controls, 25 patients with radiolucent gallstones, and 14 patients with radiopaque gallstones, we used two techniques to measure gallbladder contraction--radionuclide imaging and real-time ultrasound--in response to one of two stimuli--a Lundh meal or intravenous cholecystokinin-octapeptide. Using the radionuclide technique, postprandial gallbladder emptying (t1/2) was prolonged (p less than 0.01) both in patients with radiopaque (26.7 +/- 3.1 min, mean +/- SEM) and radiolucent (21.7 +/- 3.1) gallstones when compared with controls (10.2 +/- 1.5). In patients with radiolucent stones, the t1/2 of gallbladder emptying became further prolonged (p less than 0.05) after 1 mo of therapy with 8-10 mg/kg body wt X day of ursodeoxycholic acid, to 32.1 +/- 4.4 min. A similar pattern of results was seen after cholecystokinin-octapeptide and also with real-time ultrasound. Thus, after both stimuli and using two independent techniques, gallbladder contraction was reduced in patients with gallstones. The slower and less complete gallbladder emptying with ursotherapy might explain the reduction in biliary colic noted during treatment.

Adult↗

PubMed1984

The concentrating function of the feline gallbladder after truncal vagotomy.

Truncal vagotomy is associated with a raised incidence of cholesterol gallstone disease and increase in the size of the gallbladder and of the bile acid pool. Investigations of hepatobiliary function in man and mammals after truncal vagotomy have not established if the enlarged gallbladder is simply dilated, or if the absorptive capacity of the mucosa has changed. We studied the concentrating function of the gallbladder with a perfusion technique in anaesthetized cats three weeks and three months after intrathoracic truncal vagotomy and compared the results with a control group. The histology of the gallbladder was studied with light microscopy. Three weeks after vagotomy the gallbladder size, histologic picture and concentrating function did not differ from observations in the control cats. Three months after the vagotomy the gallbladder was slightly enlarged, sludge was found in the luminal contents, an inflammatory response was seen in the mucosa and the net rate of water absorption was increased two to three times compared with the controls. Possible mechanisms in the increased rate of net water absorption are tentatively discussed.

Animals↗

PubMed1984

Gallbladder emptying and gastrointestinal cyclic motor activity in humans.

UNLABELLED: The purpose of the present work was to answer two questions: does the human gallbladder empty in the fasting state, and, if so, is the emptying related to a specific phase of the activity in the gastrointestinal tract? The material consisted of nine healthy volunteers and the motility recordings were done with a perfused low-compliance system. Gallbladder emptying was recorded by the use of scintigraphy with 99mTc-HIDA. Eleven activity fronts were observed, and seven periods of gallbladder emptying were recorded. Reduction in counts over the gallbladder ranged from 8% to 32%. All emptyings took place in connection with phase-II activity in the intestine. Three were in close proximity to the following phase-III activity, and the other four occurred early in a phase II. Four activity fronts were not accompanied by output of bile. CONCLUSIONS: bile output from the gallbladder occurs in fasting humans, and gallbladder emptying takes place in connection with phase-II activity in the intestine but not always in close connection with the following phase-III activity.

Adult↗

PubMed1983

DNA synthesis index: higher for human gallbladders with cholesterol gallstones than with pigment gallstones.

[3H]dThd uptake by the gallbladder epithelium was estimated in 33 patients with cholesterol stones, in 13 patients with pigment stones, and in 12 gallbladders without stones. Proliferative parameters were estimated by autoradiography after in vitro incubation with [3H]-dThd. Stones were identified by quantitative infrared spectroscopy. The degree of inflammation of the gallbladder wall was estimated by a histologic scoring method. In the gallbladders containing cholesterol stones the DNA synthesis index (1.39 +/- 0.28%) was higher (P less than .01) than in the gallbladders without stones (0.19 +/- 0.04%). No significant increase in proliferative parameters was found in the gallbladders with pigment stones (0.24 +/- 0.06%). No correlation was found between total stone number, weight or volume, and the DNA synthesis index. No evidence was observed that inflammation could influence the epithelial cell proliferation. Something in the bile of patients with cholesterol stones rather than the physical presence of stones may be the cause of the variations observed.

Autoradiography↗