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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The value of serum liver function tests and abdominal ultrasound as screening tests of the need for endoscopic retrograde cholangiopancreatography (ERCP) was determined in patients with unexplained abdominal pain without associated jaundice. In 1989 and 1990 1005 ERCPs were undertaken, of which 138 (14%) were for this indication. The duct or ducts of interest were delineated by ERCP in 95% of patients. The lesions found were bile duct stones in 10 patients, chronic pancreatitis in five, pancreatic carcinoma in one, peptic ulcer or duodenitis in four. A satisfactory ultrasound examination had been performed in 94% of patients. For chronic pancreatitis, its sensitivity was 60% and specificity 95%. For choledocholithiasis, the ultrasonic detection of duct dilatation or stones had a sensitivity of 90% and specificity of 86%. Of the liver function tests, the alkaline phosphatase was more sensitive (67%) than the transaminases (44%) in indicating the presence of bile duct stones and had a high specificity (95%). None of the 10 patients with duct stones had normal ultrasound and normal alkaline phosphatase. Thus it was found that demonstration of a normal common bile duct by abdominal ultrasound and normal serum alkaline phosphatase together have 100% specificity in excluding bile duct stones. Using such knowledge over the two year period of this study would have spared 36 patients the need for ERCP.
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PMID:Value of ultrasound and liver function tests in determining the need for endoscopic retrograde cholangiopancreatography in unexplained abdominal pain. 145 84

We report a patient who presented with right upper abdominal pain and jaundice 4 months after an elective cholecystectomy. A clinical diagnosis of choledocholithiasis was supported by imaging. Ultrasound and computed tomography also led us to diagnose an incidental liver tumour which guided biopsy demonstrated as an oxidized cellulose ('Oxycell') granuloma.
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PMID:Case report: an oxidized cellulose granuloma--another hepatic pseudotumour? 191 4

Cholangitis is an infection of the biliary ductal system that results from the combination of bactibilia and biliary obstruction. Choledocholithiasis has been the leading cause of cholangitis. However, in recent years, especially at tertiary referral centers, nonoperative biliary manipulations, often in patients with unresectable malignancies, have become the most common cause of cholangitis. As a result, the complete triad of fever and chills, jaundice, and abdominal pain, as originally described by Charcot, is now seen less frequently. Most patients still have leukocytosis and abnormal liver function tests, but many patients with indwelling tubes may develop cholangitis without significant jaundice. E. coli, Klebsiella species, and the enterococci remain the most frequently isolated organisms, and anaerobes including Bacteroides fragilis are recovered in 15% to 30% of patients. However, Enterobacter and Pseudomonas species, as well as yeasts, are now being isolated more frequently from patients with indwelling tubes, who often have been treated previously with antibiotics. Computed cholangiography usually is necessary to determine the cause and site of biliary obstruction. In the majority of patients with cholangitis, cholangiography can be delayed until the patient has been afebrile for a minimum of 24 to 48 hours. Initial therapy includes bowel rest, intravenous fluids, and antibiotics. Many antibiotic regimens are now available to cover the gram-negative aerobes, the enterococcus, and the anaerobes that are likely to be causing the biliary infection. The combination of a penicillin and an aminoglycoside has been the gold standard. However, recent studies suggest that the newer broad-spectrum penicillins provide adequate therapy for these patients. Only a small percentage (5%-10%) of patients with toxic cholangitis require emergency biliary decompression. The choice of percutaneous or endoscopic drainage should be made on the basis of the presumed site and cause of obstruction as well as local expertise. The nature of the biliary obstruction may be the most important determinant of outcome. At present, patients with end-stage malignant obstruction account for most of the deaths, whereas approximately 95% of patients survive an episode of cholangitis.
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PMID:Acute cholangitis. 224 16

We performed endoscopic retrograde cholangiopancreatogram (ERCP) on 200 patients over a four and a half year period. The duct of interest was successfully cannulated in 173 cases (87%). The most common indications were obstructive jaundice, cholangitis, chronic upper abdominal pain and suspected pancreatic disease. The commonest findings were cholelithiasis and malignant strictures of the common bile duct (CBD). Forty seven patients (27%) had normal examinations. Sixty-two of 87 (71%) patients with choledocholithiasis underwent endoscopic sphincterotomy (ES). The success rate for active stone extraction was 82% (27/33) while 64% (14/22) of patients managed expectantly cleared their CBD stones spontaneously after ES. The immediate complication rate of ES was 13% and included pancreatitis, stone impaction, cholangitis and bleeding. There was no complications amongst patients who underwent ERCP alone and no mortality in this series. Twenty three patients (26%) with choledocholithiasis proceeded to surgery because the stones were considered too large to remove endoscopically. One patient had endoscopic stone removal without prior ES while another had a permanent stent inserted for drainage. We conclude that ERCP and ES are useful and safe modalities in the assessment of biliary tract diseases and the treatment of choledocholithiasis.
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PMID:Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy--a Singapore experience. 228 53

Cholecystitis and cholelithiasis are infrequent in children and have been historically associated with adolescent pregnancy or hemolytic disorders; however, the incidence and spectrum of cholelithiasis seem to be changing. Between 1970 and 1988, 47 children 17 years of age or less underwent cholecystectomy for cholecystitis or cholelithiasis in our hospital. The patients were divided into chronologic groups: Group 1 encompassed 1970 through 1979 (15 patients) and group 2, 1980 through 1988 (32 patients). The groups were compared for age, sex, pregnancy, blood dyscrasia, family history, obesity, use of total parenteral nutrition (TPN), and incidence of choledocholithiasis with its sequelae. A significant increase in the number of patients with cholelithiasis was found. Infants and young children were affected more frequently in group 2, and many of these young patients had a history of TPN. Choledocholithiasis was also more common in group 2 and presented with life-threatening sequelae. Calculous biliary tract disease should be considered as a possible cause of abdominal pain in children. Timely operative intervention can prevent the increasingly common sequelae of childhood cholelithiasis.
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PMID:Changing spectrum of cholelithiasis and cholecystitis in infants and children. 251 75

The aim of our study was to assess the diagnostic accuracy yielded by endoscopic retrograde cholangio-pancreatography (ERCP) in a group of 41 patients presenting with persistent or recurrent abdominal pain and/or cholestasis following cholecystectomy. Each patient had previously undergone, without success, a different combination of non-invasive tests. Cannulation with adequate opacification of at least one duct was achieved in all patients. Aetiologically diagnostic findings obtained with ERCP were as follows: normal 36.8%, choledocholithiasis 34%, benign biliary stenosis 9.8%, chronic pancreatitis 4.9%, pancreatic carcinoma 2.4%, ampullary carcinoma 2.4%, cholangiocarcinoma 2.4%, miscellaneous 7.3%. ERCP gave a final diagnosis in 26 patients (63%) and in all the cases presenting with cholestasis. ERCP plays a first-line role in the diagnostic assessment of patients with the post-cholecystectomy syndrome. However, there is still a considerable part of this population in whom ERCP does not contribute to a diagnosis.
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PMID:ERCP in the assessment of patients with post-cholecystectomy syndrome: benefits and limitations. 263 83

The clinical significance of unexplained dilation of the common bile duct (CBD) seen at endoscopic retrograde cholangiopancreatography (ERCP) in non-jaundiced patients with abdominal pain, was studied in a group of 14 patients. A CBD diameter of more than 15 mm was associated with choledocholithiasis (29%), periampullary carcinoma (14%), papillary stenosis (14%), or no definite pathology (43%) during a follow-up of 20 months. Dilation of the CBD exceeding 20 mm, was associated with periampullary carcinoma or papillary stenosis in 80% of the patients. It is recommended that such a group of patients be followed very closely, and the ERCP examination repeated within a few months.
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PMID:The significance of unexplained dilated common bile duct at endoscopic retrograde cholangiopancreatography. 322 88

This paper reviews the literature reports concerning sickle cell disease and the hepatobiliary system. Sickle cell disease can cause progressive injury to the liver with significant fibrosis, often cirrhosis, and decreased liver function by adulthood. Asymptomatic patients commonly have hepatomegaly and elevated liver enzyme levels. The presence of sickle cell disease obscures features otherwise useful in differential diagnosis. Acute episodes of the disease selectively affect the liver in 10% of patients, causing hepatic crisis with abdominal pain, nausea, fever, jaundice, and transaminase elevation. Viral hepatitis is often clinically indistinguishable from hepatic crisis, but in viral hepatitis the abdominal pain is usually less, the jaundice tends to be more severe, and the transaminase elevation more prolonged. The two can be distinguished by serology and liver biopsy. Furthermore, acute cholecystitis or choledocholithiasis may have clinical and laboratory features similar to sickle cell hepatic crisis or viral hepatitis. By adulthood, 50%-70% of sickle cell patients have gallstones. Elective cholecystectomy is indicated for those who are symptomatic, but, because of operative mortality, there is disagreement concerning surgery for asymptomatic patients. The literature contains nine well-documented cases of acute hepatic failure related to sickle cell disease. The mechanism is unclear; however, as the necrosis is often not severe, a metabolic problem is suggested.
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PMID:Hepatobiliary system in sickle cell disease. 351 88

Late complications have been examined in 96 patients consecutively treated for choledocholithiasis by endoscopic sphincterotomy in the years 1976 to 1980. Forty-four of the patients (46%) had the gallbladder in situ. Patients treated for short-term complications--that is, in the 1st month after sphincterotomy--are not included in this study. The mean length of follow-up study was 4.1 years (range, 2 months to 8 years and 9 months). Late bile duct symptoms occurred in seven patients (7%): three (6.8%) in patients with the gallbladder in situ and four (7.6%) in cholecystectomized patients. Stones were found in the common bile duct in three of these patients, one with and two without the gallbladder. The median duration from sphincterotomy to late complication was 8 months (range, 2 months to 5 years). Six of the patients had cholangitis, and the seventh had jaundice with abdominal pain. Two of the patients died of their complications. In conclusion, our results indicate that the frequency of late complications to endoscopic sphincterotomy is low and apparently independent of possible prior cholecystectomy.
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PMID:Long-term follow-up study of patients after endoscopic sphincterotomy for choledocholithiasis. 368 77

Obstructive choledocholithiasis in a 12-year-old mare was corrected surgically by choledocholithotripsy. The mare had a history of chronic weight loss, intermittent fever, partial anorexia, jaundice, recurrent abdominal pain, and an abdominal mass palpable per rectum. Values for alkaline phosphatase, bilirubin, gamma-glutamyl transferase, sorbitol dehydrogenase, and bromsulpthalein half-life were increased and bilirubinuria was evident before surgery. Two liver biopsies revealed periportal and portal fibrosis, bile duct proliferation, cholestasis, and variable amounts of hepatocellular necrosis, with infiltration by polymorphonuclear cells. Immediate clinical improvement was seen after surgery, and results of selected liver function tests gradually returned to normal. Since surgery, the mare has returned to her normal weight, has remained clinically normal for liver disease for 28 months, and has been useful as a broodmare.
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PMID:Choledocholithotripsy in a mare. 401 95


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