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PubMed1990

Nonvisualized gallbladder on oral cholecystography: implications for lithotripsy.

Currently, most protocols evaluating the efficacy of gallstone lithotripsy require a visualized gallbladder on oral cholecystography (OCG). The primary purpose of the OCG is to establish that the cystic duct is patent. When the gallbladder is visualized on OCG, it can also be used to number and size gallstones accurately. Patients with non-visualization of the gallbladder on OCG are excluded from consideration for lithotripsy. The purpose of this study was to evaluate retrospectively the ultrasonographic findings (i.e., number and sizes of stones in 32 patients with nonvisualization on the OCG). In 11 patients (34%) ultrasound (US) did not detect any stone, and it is presumed that the gallbladder failed to visualize for other reasons. Six patients (19%) had one or two stones and 15 (47%) patients had more than three stones. This suggests that 20% of patients with nonvisualization of the gallbladder on OCG would otherwise be eligible for lithotripsy provided that patency of the cystic duct can be demonstrated by other means, such as computed tomographic (CT) examination with oral biliary contrast or cholescintigraphy.

Cholecystography↗

PubMed1991

Unusual presentation of perforation of the gallbladder.

Perforation of the gallbladder is a known sequela of acalculus cholecystitis or trauma. A perforated gallbladder may be acute or chronic and can present with vague symptoms making the diagnosis difficult. With delayed recognition there is increased morbidity and mortality. The preoperative diagnosis requires an awareness of the symptoms and signs of acalculus cholecystitis as well as factors that predispose to the development of the diseased gallbladder. Awareness of the radiographic findings associated with a perforated gallbladder and acalculus cholecystitis is also important. The following is a case report of a child with a perforated gallbladder with a radiographic presentation not previously described. A review of the clinical pathogenesis and reported radiographic findings is also included.

Child, Preschool↗

PubMed1995

Suprahepatic gallbladder and right lobe anomaly of the liver in patients with biliary cancers.

The suprahepatic region is a rare ectopic location of the gallbladder. It usually combines with right lobe anomaly of the liver. Here we report two unusual cases of suprahepatic gallbladder with agenesis or hypogenesis of the right lobe of the liver and biliary cancer. A patient with a gallbladder tumor was admitted to our emergency room with acute cholecystitis and liver abscess. Imagining examinations and operation confirmed the suprahepatic position of gallbladder, agenesis of the right lobe, and dissemination of gallbladder cancer. In the patient with cholangiocarcinoma, CT scans and percutaneous transhepatic cholangiography documented the presence of a hilar tumor and hypogenesis of the right lobe. Both of these patients died from biliary tract cancer soon after operation.

Adult↗

PubMed1995

L-arginine/nitric oxide pathway modulates gastric motility and gallbladder emptying induced by erythromycin and liquid meal in humans.

There is recent evidence that nitric oxide, a soluble gas produced from L-arginine, is released by the smooth muscle cells and neurons of the gastrointestinal tract where it exerts a myorelaxive action. However, little is known about the effects nitric oxide has on gastric and gallbladder motility during the inter- and postprandial phases in man. We therefore investigated the effects 200 mg/kg/hr L-arginine exerts on the gastric and gallbladder motility induced by 2 mg/kg erythromycin or a liquid meal in 21 subjects in a double-blind, placebo-controlled study. Gastric and gallbladder emptying were evaluated by sonography. Fasting antral motility was expressed as antral motility index (MI). In fasting subjects, L-arginine administration determined a threefold increase in plasma nitrite concentrations. Administration of erythromycin caused a significant rise in the antral MI, which was inhibited by L-arginine (P < 0.05). Ingestion of a liquid meal also significantly increased antral MI, but it returned to basal values 90 min after the end of the meal. Although L-arginine administration caused a significant reduction in the antral MI (P < 0.05), it did not inhibit gastric emptying. L-Arginine provoked an approximately 40% increase in basal gallbladder volume, completely blocked erythromycin-induced emptying, and partially, but significantly, prevented the emptying induced by a liquid meal (P < 0.01). Our study suggests that nitric oxide may be implicated in the physiological modulation of gastric and gallbladder motility during the inter- and postprandial phases in man.

Adult↗

PubMed1994

Effect of single dose of oral erythromycin on gastric and gallbladder emptying. Simultaneous assessment by ultrasound.

To evaluate the effects of a single oral dose of erythromycin on gastric and gallbladder emptying, 10 volunteers, without a known history of gastrointestinal disease, were investigated. Erythromycin stearate (500 mg) or placebo was given on separate mornings 30 min before a standard solid meal in a randomized, double-blind, crossover study. Gastric and gallbladder emptying rates were simultaneously evaluated by means of real-time ultrasonography. Gastric antral area and gallbladder volume were determined before the meal and 30, 60, 120, 180, 240, and 300 min after commencing eating. Erythromycin, compared to placebo, significantly accelerates and increases the degree of both gastric and gallbladder emptying. As previously reported for intravenous and chronic oral assumption, also a single dose of oral erythromycin is able to accelerate gastric and gallbladder emptying in normal human subjects.

Administration, Oral↗

PubMed1995

Lysophosphatidylcholine-stimulated protein and glycoprotein production by human gallbladder mucosal cells.

It has been demonstrated in experimental cholecystitis in cats produced by lysophosphatidylcholine that the development of inflammation is associated with the exsorption of a large amount of protein into the gallbladder lumen. It was subsequently demonstrated that in feline experimental cholecystitis the protein produced was albumin and that its production was decreased by vesicular transport inhibitors, suggesting an active secretory process. In the present study, the effect of lysophosphatidylcholine on protein production by fresh, isolated human gallbladder mucosal cells was evaluated. Isolated gallbladder mucosal cells were incubated with [14C]leucine for 24 hr in tissue culture medium. The cells readily incorporated the radioactive label into cellular protein, a process inhibited by cycloheximide. Exposure of the cells to lysophosphatidylcholine for 1 hr in buffer solution resulted in loss of intracellular protein into the buffer solution. Exposure of the cells for 1 hr prior to lysophosphatidylcholine administration to vesicular transport inhibitors, colchicine, and cytochalasin B and to 4 degrees C culture conditions failed to alter the lysophosphatidylcholine-produced passage of the 14C label extracellularly. SDS-PAGE evaluation of the protein produced demonstrated that human gallbladder mucosal cells continuously produced a 66-kDa protein that was not increased by increasing concentration of lysophosphatidylcholine and a 14-kDa protein that increased with increasing concentrations of lysophosphatidylcholine. Employing Western blotting with specific antibodies, the 66-kDa protein was demonstrated to not be albumin but a 66-kDa glycoprotein, and the 14-kDa protein was demonstrated to contain phospholipase A2. Human gallbladder mucosal cells produced a protein and glycoprotein in response to lysophosphatidylcholine by a mechanism not related to vesicular transport.

Carbon Radioisotopes↗

PubMed1996

Effect of cisapride on gallbladder emptying and plasma CCK in normal and vagotomized human subjects.

Previous studies have provided conflicting results of cisapride on gallbladder emptying in response to a meal. We studied six volunteers and six patients after a truncal vagotomy in a double-blind, placebo-controlled, prospectively randomized study using 10 mg cisapride four times a day for three days. Gallbladder volume was quantitated using ultrasonography, and plasma CCK levels were measured with a sensitive and specific radioimmunoassay using the DINO antibody before and for 90 min after a fatty, mixed meal. Plasma effect was observed on the gallbladder either in normal subjects or vagotomized patients. Paradoxically, residual volume (RV) was increased in the vagotomized patients after treatment with cisapride: RV cisapride 7.1 (4.1-15.9) ml, RV placebo 5.1 (3.8-14) ml, P < 0.05. Further work is required to clarify the mechanisms of action of cisapride on the gallbladder and the sphincter of Oddi. The use of cisapride during litholytic therapy may impair gallbladder emptying and delay stone clearance.

Adult↗

PubMed1995

Effect of gastrin-releasing peptide (GRP) on guinea pig gallbladder contraction in vitro.

Few studies have reported the effects of gastrin-releasing peptide (GRP)/bombesin on the guinea pig gallbladder, and the results are contradictory. Because such contradictory results may, in part, be due to technical factors, we investigated the effect of GRP on guinea pig gallbladder smooth muscle, using an improved horizontal organ bath. The guinea pigs were killed and the gallbladder was removed. Four longitudinal muscle strips (2 x 12 mm) were suspended in Krebs-Ringer solution at 37 degrees C and aerated with 95% O2 and 5% CO2. The mechanical activity of the strips was recorded isotonically by displacement-voltage transducers, via L-arms, to which a piezoelectric element with a frequency of 100 Hz and movement of 50 microns was applied. GRP contracted gallbladder muscle strips dose dependently, but the calculated maximal response was 22.4% and 20.1% of the acetylcholine- and cholecystokinin octapeptide (CCK8)-induced responses, respectively. The GRP-induced contraction was unaffected by the muscarinic blocker, atropine, or by the CCK receptor antagonist, loxiglumide. It is concluded that GRP weakly, but apparently directly, stimulates guinea pig gallbladder contraction.

Acetylcholine↗

PubMed1986

Transient gallbladder distention in sick premature infants: the value of ultrasonography and radionuclide scintigraphy.

Transient gallbladder distention in sick premature infants has been reported with increasing frequency over the last few years. It is important to be aware of this entity of gallbladder disease which resolves spontaneously and to be able to differentiate it from other problems that require surgical correction. We believe that ultrasonography is most helpful in confirming the diagnosis, excluding stone formation, and documenting any changes in size or appearance. However, there are no reliable ultrasonic criteria for distinguishing inflamed or pathologically distended gallbladders from noninflamed or temporarily enlarged gallbladders. Radioisotope imaging, though useful in demonstrating malfunction of the hepatobiliary system, should be interpreted with caution. In the final analysis, the dilemma as to whether gallbladder distention is a transient or persistent malfunction can be settled best by thoughtful clinical judgement.

Dilatation, Pathologic↗

PubMed1984

A rare case of early carcinoma of the gallbladder.

A 38-year-old woman was diagnosed preoperatively to have a benign polyp of the gallbladder with a delineated polypoid mass, as demonstrated with drip infusion cholangiography and ultrasonography. Cholecystectomy was performed. Postoperatively, however, this tumor proved to be an early stage carcinoma of the gallbladder. In the neck of the gallbladder, there was a protruded polypoid elastic tumor of 1.1 X 0.9 cm in width and 2.5 cm in height. The tumor was supported by a stem of 0.1 cm in diameter and 0.2 cm in height. Histopathological examination revealed a well differentiated papillotubular adenocarcinoma, which exhibited no invasion of the stem itself or its basal region. This is a rare case of early carcinoma of the gallbladder (Stage I) which grew only towards the lumen of the gallbladder cavity, and did not invade the wall. Postoperatively, cholecystectomy alone was thought to be sufficient for cure.

Adenocarcinoma↗

PubMed1999

Port site recurrence of unexpected gallbladder carcinoma after a laparoscopic cholecystectomy: report of a case.

Unexpected gallbladder carcinoma was identified in a 71-year-old woman after she underwent a laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis. A subsequent laparotomy for a resection of the liver bed and a dissection of the lymph nodes around the hepatoduodenal ligament was done. Two and a half years later, the patient developed subcutaneous metastasis at the epigastric trocar site through which the gallbladder was removed. A third operation was thus performed, revealing no evidence of peritoneal dissemination, liver metastasis, or lymph node metastasis, and the abdominal wall mass was resected. The histological findings confirmed the diagnosis of metastatic carcinoma of the gallbladder. We recommend that when planning LC, the possibility of malignancy should thus be kept in mind. However, if there is any sign which does not completely exclude malignancy, such as a contracture or wall thickness of the gallbladder, LC should be performed by the abdominal wall lifting method and using a protective bag for the removal of the gallbladder.

Abdominal Muscles↗

PubMed1979

A fluorescence histochemical study for the motility of the gallbladder.

For the purpose of elucidating the motility, particularly the mechanism of contraction of the gallbladder, we classified gallbladders isolated surgically into three groups for a study. That is, the three groups comprised Group I of 40 cases of cholelithiasis with good contraction, Group II of 10 cases of cholelithiasis with poor contraction and Group III of 10 cases of cholelithiasis after gastrectomy for a total of 60 cases. Using gallbladders of these cases, we started with a fundamental study on the autonomic nervous action by the fluorescence histochemical method of Flack and Hillarp and obtained results as follows. Similar results were obtained for Group I and Group II; the gallbladder was subjected to adrenergic innervation and cholinergic innervation, and there was a clear localized difference between true-cholinesterase and pseudo-cholinesterase of the cholinergic nerve. In Group III, proliferation of adrenergic nerve was observed compared with Groups I and II, while disappearance of cholinergic nerve was seen. The gallbladder of Group III showed slight contraction with cholecystokinin, but it was not blocked with atropine.

Autonomic Nervous System↗

PubMed1990

Gallbladder contractility and gallstone formation in the Richardson Ground Squirrel.

The pathogenesis of cholesterol cholelithiasis in man is probably multifactorial and the mechanism by which gallbladder stasis occurs in gallstone patients has not been studied in detail. In the present study, time-dependent changes in gallbladder motility of the Richardson Ground Squirrels were investigated. 100 of animals were examined for their contractile responses of gallbladders to CCK-OP and Ach in vitro. Also, biochemical changes of serum and bile were investigated. There were no significant differences in motility of gallbladders to CCK-OP or Ach between control and cholesterol-fed animals. The results of this study indicate that gallbladder muscle contractility remains unchanged during the dietary induction of cholesterol gallstones in the Richardson Ground Squirrel.

Acetylcholine↗

PubMed1982

The influence of cholic acid and cholesterol on cell proliferation in the gallbladder mucosa of the mouse.

The effect of a cholesterol-cholic acid diet on cell proliferation in the gallbladder epithelial cells of the mouse was investigated systematically. As early as 48 h after the commencement of the diet an outburst of proliferative activity in the gallbladder epithelium was observed. This accelerated proliferation was accompanied by an increased exfoliation of epithelial cells into the gallbladder lumen. In the further course of the experimental diet the 3H-labelling index fell but remained significantly higher than in the control group. The epithelium displayed villus-like folds, and the gallbladder wall became noticeably thicker. The cholesterol-cholic acid diet stimulated proliferation not only in the gallbladder epithelial cells but also in fibroblasts and hepatocytes.

Animals↗

PubMed1997

Superficial elevated-type early gallbladder carcinoma treated by laparoscopic cholecystectomy.

A 60-year-old woman was admitted to our department for detailed examination of a polypoid lesions of the gallbladder detected at the time of a mass survey by ultrasound. Endoscopic ultrasonography (EUS) demonstrated a broad-based mass lesion, about 10 mm in size, with an irregular surface, at the peritoneal side of the body of the gallbladder. The layer structure of the gallbladder wall had not been destroyed by the mass. Computed tomography showed no direct invasion of the liver or other evidence of metastasis. Type-IIa (superficial elevated-type) early gallbladder cancer was suspected and laparoscopic cholecystectomy was performed. Histologically, the tumor proved to be a papillo-tubular adenocarcinoma, 9 x 8 mm in size, confined to the mucosa and without lymphatic permeation, vascular involvement, perineural invasion, or other signs of metastasis. Laparoscopic cholecystectomy for gallbladder cancer can be indicated only when a lesion is a pedunculated protruded-type (type-Ip) cancer, or a broad-based cancer 10 mm or less in size located on the peritoneal side with no destruction of the layer structure of the wall demonstrated by EUS. This strategy is justified only with precise evaluation of the lesion by EUS.

Adenocarcinoma↗

PubMed1997

Polypoid adenomyoma of the gallbladder.

We describe a distinctive polypoid lesion of the gallbladder (16 mm in diameter) at the fundus, associated with a granulomatous mass in the liver adjacent to the gallbladder fossa, in a 64-year-old Japanese woman. Preoperatively, the lesion was diagnosed as advanced gallbladder cancer infiltrating the liver, and hepatopancreato-duodenectomy was performed. In the resected specimen, the polyp was round and pedunculate in shape, and, microscopically, it consisted of a mixture of small glandular and surrounding muscular elements, but atypia was not noted. The constituent elements were identical with those of adenomyoma, but the polypoid appearance was unusual. The hepatic lesion proved to be a foreign body granuloma containing multiple barium fragments and giant cells. A deep gastric ulcer, which penetrated into the gallbladder fossa, was also noted, near the granuloma. The histologic features indicate that the polypoid appearance of the tumor was due to a secondary modification of pre-existing adenomyoma by hepatic granuloma. To our knowledge, this is the second reported case of an adenomyomatous lesion of the gallbladder with a polypoid appearance.

Adenomyoma↗

PubMed1997

Effect of oral protease inhibitor administration on gallbladder motility in patients with mild chronic pancreatitis.

Oral administration of a protease inhibitor (camostat) induces pancreatic hypersecretion via hormonal and neural systems in humans. Camostat may also affect gallbladder motility via these systems. The aim of this study was to evaluate the effect of camostat on gallbladder function. Gallbladder emptying in response to caerulein administration and to egg yolk ingestion was examined ultrasonographically in 15 patients with mild chronic pancreatitis before and after 6 months of camostat treatment, and in 10 control subjects. The plasma cholecystokinin concentration after yolk ingestion was measured by radioimmunoassay. Fasting gallbladder volume and contractile function, whether stimulated by caerulein or yolk, did not differ between pancreatitis patients before camostat treatment and controls. Plasma cholecystokinin levels, basal and yolk-stimulated, did not differ between nontreated pancreatitis patients and control subjects. Fasting volume had decreased significantly by 1, 3, and 6 months of camostat treatment, while contractile function was not affected. Camostat did not influence plasma cholecystokinin levels. Oral administration of a protease inhibitor appears to decrease fasting gallbladder volume via a mechanism other than cholecystokinin release.

Administration, Oral↗

PubMed1989

Ultrasound findings in carcinoma of the gallbladder.

The ultrasound findings in 5 cases of primary carcinoma of the gallbladder are described. A mass protruding into or replacing the gallbladder or abnormal gallbladder wall were found in all cases. Four of the patients had gallstones and a dilated biliary tree. With careful technique in evaluation of the gallbladder wall in patients with gallstones early carcinoma of the gallbladder may be detected with greater frequency.

Aged↗