Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute acalculous cholecystitis is a virulent disease of uncertain etiology observed most commonly in critically ill patients. Although the precise mechanism is unknown, the most commonly postulated theories regarding its pathogenesis are bile stasis, sepsis, and ischemia. The role of ischemia in this process, whose etiology is multifactorial, has been difficult to elucidate. Consequently, we report two patients who developed acute acalculous cholecystitis without apparent risk for the disease other than severe visceral atherosclerosis. Both patients had symptomatic mesenteric vascular disease requiring revascularization and developed fulminant acalculous cholecystitis temporally related to exacerbation of their visceral ischemia. These cases suggest that patients with visceral atherosclerosis may be at increased risk for acute acalculous cholecystitis, perhaps due to impaired mucosal resistance when other factors, such as bile statis and sepsis, are also present.
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PMID:Does visceral ischemia play a role in the pathogenesis of acute acalculous cholecystitis? 230 85

We describe herein the unusual case of a 68-year-old Japanese man who underwent laparotomy for an acute abdomen caused by diffuse peritonitis, which revealed perforation of the gallbladder without any stones. A cholecystectomy was subsequently carried out, and histological examination showed marked atherosclerosis of the gallbladder associated with acute inflammatory changes. It is most likely that circulatory disturbance of the gallbladder wall due to the atherosclerosis played an important role in the events leading to perforation. Acute acalculous cholecystitis is an uncommon condition which is extremely difficult to diagnose preoperatively. The clinicopathological features of this patient are of particular interest and importance in terms of pathogenesis as well as treatment.
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PMID:Perforation of acalculous cholecystitis associated with localized atherosclerosis: report of a case. 908 55

Acute acalculous cholecystitis is characterized by acute inflammation of the gallbladder in the absence of stones, usually occurring in elderly and critically ill patients with atherosclerosis, recent surgery or trauma, or hemodynamic instability. Patients may present with only unexplained fever, leukocytosis, and hyperamylasemia without right upper quadrant tenderness. If untreated, rapid progression to gangrene and perforation occurs. Surgical cholecystectomy and cholecystostomy provide the most definitive treatment although recent studies indicate success with percutaneous or endoscopic cholecystostomy. Cholesterolosis and adenomyomatosis of the gallbladder are usually clinically silent and incidental findings at the time of cholecystectomy. Cholesterolosis is characterized by mucosal villous hyperplasia with excessive accumulation of cholesterol esters within epithelial macrophages. Usually clinically silent, the condition rarely is associated with biliary symptoms or idiopathic pancreatitis and cannot reliably be detected by ultrasonography. Adenomyomatosis describes an acquired, hyperplastic lesion of the gallbladder characterized by excessive proliferation of surface epithelium with invaginations into a thickened muscularis propria. Ultrasonography may reveal a thickened gallbladder wall with intramural diverticula. Adenomyomatosis may portend a higher risk of gallbladder malignancy. Most cases of cholesterolosis and adenomyomatosis identified by imaging require no specific treatment. Gallbladder polyps include all mucosal projections into the gallbladder lumen and include cholesterol polyps, adenomyomas, inflammatory polyps, adenomas, and other miscellaneous polyps. Most polyps are nonneoplastic and rarely cause symptoms. Cholecystectomy is advocated for polyps greater than 10 mm in size because of increased risk of adenomatous or carcinomatous features.
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PMID:Gallbladder polyps, cholesterolosis, adenomyomatosis, and acute acalculous cholecystitis. 1471 68