Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with typical symptoms of biliary tract disease but no gallstones on ultrasonography may benefit from cholecystectomy for presumed chronic acalculous cholecystitis. We retrospectively analyzed the outcome of 50 patients with a preoperative diagnosis of chronic acalculous cholecystitis based upon history (chronic or recurrent, postprandial right upper quadrant abdominal pain), the absence of acid-peptic disease, and normal biliary sonography treated with laparoscopic cholecystectomy (LC) and transcholecystic cholangiography from 1991 to 1996. All patients had preoperative cholecystokinin-stimulated hepatobiliary scintigraphy (CCK-HBS). There were 42 women and 8 men with a mean age of 43 years. CCK-HBS was abnormal in 45 patients (< or = 35 per cent gallbladder ejection fraction or nonfilling of the gallbladder). There was no postoperative mortality and one morbidity (urinary retention). All patients had microscopic evidence of chronic cholecystitis. At mean follow-up of 30 months, (range, 7-62 months) 39 patients (78%) were free of abdominal pain. Thirty-five of 45 patients with abnormal CCK-HBS were pain free (positive predictive value, 0.78). Four of five patients with normal CCK-HBS were pain free (negative predictive value, 0.20). The positive and negative likelihood ratios for CCK-HBS were 0.99 and 1.13, respectively, confirming that this test was not useful for predicting benefit from LC. Seven patients with persistent right upper quadrant pain had abnormal postoperative sphincter of Oddi manometry; they improved after endoscopic sphincterotomy. Patients with symptoms typical of biliary colic with normal gallbladder sonography and absence of acid-peptic disease benefit from LC in the majority of cases. Those who remain symptomatic after LC may benefit from endoscopic retrograde cholangiopancreatography with sphincter of Oddi manometry and endoscopic sphincterotomy when manometry is abnormal.
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PMID:Outcome after laparoscopic cholecystectomy for chronic acalculous cholecystitis. 945 29

Xanthogranulomatous cholecystitis exists in a small but significant proportion of routine cholecystectomy specimens. A few recent reports have shown a possible association of this disease with carcinoma of the gallbladder. All cholecystectomized specimens were prospectively evaluated over a period of two and half years in a single surgical unit to examine the incidence of xanthogranulomatous cholecystitis and its association, if any, with carcinoma of the gallbladder in an area that is prone to gallbladder diseases. A total of 460 cholecystectomies were performed for various gallbladder diseases. Histological confirmation revealed chronic cholecystitis in 311 (67.6%) cases, carcinoma of the gallbladder in 62 (13.5%), acute cholecystitis in 29 (6.3%), xanthogranulomatous cholecystitis in 41 (8.9%), and xanthogranuloma and carcinoma of the gallbladder in one case (0.2%) only. Almost all cases were suspected to have chronic cholecystitis on clinical and ultrasonographic features. Two specimens on gross examination showed mass lesions, and hence were suspected to be carcinoma of the gallbladder. Subsequent frozen section and histopathology demonstrated xanthogranulomatous cholecystitis. Only one case of xanthogranuloma was found to be associated with carcinoma of the gallbladder but no firm association could be established between xanthogranulomatous cholecystitis and carcinoma of the gallbladder.
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PMID:Xanthogranulomatous cholecystitis. 959 Apr 3

Inflammation of the gallbladder is known to occur in patients with primary sclerosing cholangitis (PSC). However, the histological features of this form of cholecystitis have not been adequately defined. The aim of this study was to compare the inflammatory lesions of PSC-associated cholecystitis with those present in other cholecystopathies. The cases consisted of 11 gallbladders from patients with PSC who underwent liver transplantation. As controls, gallbladders from liver transplant patients with primary biliary cirrhosis (n = 4) and other chronic nonbiliary hepatopathies (n = 8), and 13 cholecystectomies from patients with chronic cholecystitis with (n = 10) and without (n = 3) lithiasis, were studied. The following histological features were tabulated on coded slides: presence, depth of involvement, and distribution of the inflammatory infiltrate, predominant cell type, presence of lymphoid aggregates, epithelial damage, metaplastic changes (pyloric or intestinal), fibrosis, smooth muscle hypertrophy, and presence of Rokitansky-Aschoff sinuses. At variance with the wide range of histological abnormalities present in other forms of chronic cholecystitis, most PSC-related cholecystitis showed a diffuse infiltrate (6 of 11) rich in plasma cells (6 of 11) predominantly confined to the lamina propria (9 of 11). The combination of these three features was present exclusively in PSC (5 of 11 PSC cholecystitis compared with 0 of 25 controls; P = .001). In conclusion, this study suggests that a characteristic form of cholecystitis may develop in patients with PSC.
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PMID:Diffuse lymphoplasmacytic acalculous cholecystitis: a distinctive form of chronic cholecystitis associated with primary sclerosing cholangitis. 959 76

As many as 163 young male patients with chronic noncalculous cholecystitis were studied for motility of the biliary tract. Normal findings were in 15.9% of cases. Hypocontractility of the gallbladder, hypermyotonia of the Oddi sphincter (with 33.7% and 44.2% respectively), and concurrent presence thereof were the most commonly seen types of dyskinesia. The results obtained suggest that the above abnormalities in motility of the biliary tract may have a part in the origination and/or progression of chronic cholecystitis.
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PMID:[The tonus of Oddi's sphincter and gallbladder contractility in patients with chronic cholecystitis]. 962 23

Inflammatory fluid secretion by the gallbladder mucosa in experimental cholecystitis is induced by activation of cyclooxygenase, which leads to an increase in prostaglandin formation. Cyclooxygenase exists as a constitutive (cyclooxygenase-l) and an inducible (cyclooxygenase-2) isoform. The aim of this study was to demonstrate the role of cyclooxygenase-2 in inflammatory fluid secretion of the feline gallbladder. Experiments were performed 10 weeks after a surgical procedure in which chronic cholecystitis was induced in cats by ligation of the cystic duct and implantation of a gallstone in the gallbladder. Gallbladder fluid transport was continuously monitored via a perfusion system. In inflammed gallbladders the continuous fluid secretion was reversed to absorption by intravenous injection of the selective cyclooxygenase-2 blocker, NS 398 (P <0.001). Increased levels of the inducible cyclooxygenase-2 were shown by immunoblotting in inflamed gallbladders. Selective pharmacologic blockage of cyclooxygenase-2 reduced the prostaglandin E2 release to the inflamed gallbladder lumen (P <0.01). These data suggest that cyclooxygenase-2 is involved in the inflammatory response during chronic cholecystitis. Selective cyclooxygenase-2 blockers may offer an alternative to traditional nonsterodial anti-inflammatory drugs with fewer side effects in patients with cholecystitis who are awaiting operation.
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PMID:Role of cyclooxygenase-2 for fluid secretion by the inflamed gallbladder mucosa. 984 84

Patients with symptoms similar to symptomatic cholelithiasis but with no sonographic evidence of gallstones can be difficult to manage. Cholecystokinin (CCK)-stimulated hepatobiliary scans can be helpful in determining whether the biliary tract is the potential source of the symptoms. We retrospectively reviewed the medical records of 69 patients at our institution who underwent CCK-stimulated hepatobiliary scans over a 2-year period. Twenty-nine of 69 patients had an abnormal gallbladder ejection fraction (defined as 35% or less). All 29 patients had no sonographic evidence of cholelithiasis. Seventeen of the 29 underwent cholecystectomy. There were no complications or deaths within the operative group. Fifteen of the pathologic specimens had evidence of chronic cholecystitis, one was cytomegalovirus cholecystitis, and one showed only cholesterolosis. There was no other intraperitoneal pathology to explain the abdominal symptoms. At an average follow-up of 11 months, eight patients (47%) in the operative group had complete resolution of their symptoms, six (35%) had significant improvement, two (12%) were unchanged, and one (6%) was worse. Twelve of 29 patients did not have a cholecystectomy. At an average follow-up of 11 months, four (33%) of these patients had improvement and eight (66%) reported no change or worsening of their symptoms. In the operative group, 53 per cent had reproduction of their symptoms with CCK stimulation, and in the nonoperative group, 33 per cent reported symptoms. Average gallbladder ejection fraction was 10 per cent (range, 0-32) in the operative group and 23 per cent (range, 0-35) in the nonoperative group. Liver function tests were similar in each group. CCK-stimulated hepatobiliary scans were helpful in defining biliary tract disease in patients without gallstones. These patients may benefit from cholecystectomy with minimal risk of morbidity and mortality.
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PMID:Laparoscopic cholecystectomy for an abnormal hepato-iminodiacetic acid scan: a worthwhile procedure. 1065 43

Despite major advances in surgical and nonsurgical therapy, biliary tract infections remain a significant cause of morbidity and mortality. The two classic biliary tract infections most commonly encountered are acute cholecystitis (either calculous or acalculous) and acute cholangitis. In addition, bile leakage associated with bile duct injuries during laparoscopic cholecystectomy has become a problem not infrequently encountered by surgeons. Acute calculous cholecystitis results from a combination of mechanical, biochemical, and infectious mechanisms, initiated by stone impaction in the cystic duct. After instituting empiric antibiotics, early laparoscopic cholecystectomy should be performed. Although conversion to open cholecystectomy is more common than in chronic cholecystitis, there appears to be no increased morbidity or mortality in that setting. Acute acalculous cholecystitis usually occurs in critically ill patients and may present both a diagnostic and therapeutic dilemma. Aggressive management, however, is warranted, both because of the critical nature of illness in these patients and the high incidence of perforation. Percutaneous cholecystostomy is indicated, particularly in high-risk patients both for diagnosis and treatment. Acute cholangitis results from a combination of bactibilia and biliary obstruction. The majority of patients can be successfully managed with intravenous antibiotics and fluid resuscitation. In those patients in whom initial management is not successful, biliary drainage, which is best accomplished nonoperatively, should be instituted. There is a very limited role for early surgical intervention in acute suppurative cholangitis. Biliary leaks resulting in bile "peritonitis" or bilomas are common sequelae of laparoscopic bile duct injury. Although surgeons may feel it is necessary to operate urgently, delineation of the proximal biliary anatomy via percutaneous transhepatic cholangiography and biliary stent placement is the appropriate first step in management. This procedure will usually control the bile leak and allow delineation of the anatomy and opportune timing of definitive reconstruction.
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PMID:Surgical treatment of biliary tract infections. 1069 43

A retrospective analysis was performed of case histories and of results of sonographic investigations in liquidators of the Chernobyl accident suffering from chronic abnormalities of the biliary ducts. Patients with cholecystitis were studied for the biochemical composition of their bile. The incidence of the gallbladder disorders (chronic cholecystitis, angiocholitis, dyskinesias of the biliary ducts) has not changed much over the last 10 years having elapsed since the accident. The biochemical composition of bile was found to have been changed to a greater extent in the liquidators of the Chernobyl accident than it was in those having avoided danger of exposure to ionizing radiation. Mechanisms of origination of cholelithiasis are discussed on the basis of investigations designed to study biochemical properties of bile and findings secured with the aid of the ultrasound techniques.
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PMID:[Biliary tract diseases in persons suffering as a result of the accident at the Chernobyl Atomic Electric Power Station]. 1082 67

To evaluate patients with gallbladder polyps and to compare them with patients with chronic acalculous cholecystitis, 301 patients with chronic acalculous disease of the gallbladder, of which 45 had polyp disease of the gallbladder, were reviewed out of 7181 cholecystectomies performed from June 1985 through June 1995. Of the 45 patients, 30 (Group A) were diagnosed preoperatively by ultrasound and 15 (Group B) postoperatively on pathologic examination. In each group, the most common polyp was cholesterol type (19/45) with multiple lesions in 10 of these 19 patients. Chronic cholecystitis was present elsewhere in the gallbladder in 40 per cent of Group A and 80 per cent of Group B patients (P = 0.02). Forty-three patients had polyps less than 5 mm in diameter, one a 1.5-cm gallbladder cholesterol polyp, and one a 1.3-cm tubulovillous polyp with a focus of carcinoma in situ. During this same period, 17 patients had primary malignancy of the gallbladder, none of which were found in polypoid lesions. In Group A patients there were significantly fewer preoperative tests than in typical acalculous patients [2.3 versus 3.8 (P<0.03)], including upper endoscopy (P<0.02) and hepatobiliary scintigraphy (P<0.00001). Of the patients with polyps, 42 of 45 (93.3%) had resolution of symptoms postoperatively with a mean follow-up of 178.9+/-505.0 days (range 1-2438 days). Most patients with biliary tract symptoms and a small (<5-mm) gallbladder polyp underwent fewer preoperative diagnostic tests than patients with chronic acalculous cholecystitis. This abbreviated preoperative workup appears warranted in view of the high incidence of symptom resolution.
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PMID:Isolated small gallbladder polyps: an indication for cholecystectomy in symptomatic patients. 1096 24

138 patients with chronic papillooditis were investigated, 15 of them in a stage of decompensation. In 83.3% of the cases, the diagnosis was not clinically determined (including 68 of 92 endoscoped before their hospitalization--82.9%). 34 patients were diagnosed as having chronic gastroduodenitis, 15--ulcer, 42--chronic cholecystitis, 11--chronic pancreatitis, 4--cholangitis, 9--postcholecystectomic status. All these diseases developed simultaneously with the papillitis. In a second endoscopic check-up with an examination of papilla Vateri, the patients were in all the cases diagnosed without difficulties and the diagnose was confirmed by biopsy. In 21 patients there was confirmed primary papillooditis and in 127--accompanying disorders: chr. gastroduodenitis--29, chr. atrophic gastritis--18, ulcer--15, chr. cholecystitis--42, postcholecystectomic status--9, choledocholithiasis--14, chr. pancreatitis--11. Most often misdiagnosis occurs if: 1) during the routine endoscopic investigation the endoscopist does not examine papilla of Vater; 2) chr. papillitis exists simultaneously with one of the already mentioned diseases that are easier of approach for diagnostics and explanation of the disorders; 3) the clinical picture of papillitis cannot be differentiated from the one of the basic or accompanying disease; 4) the bile drainage is not prevented; 5) the result of the venous biligraphy does not lead to the diagnosis and ERCP is carried out only in a case of a clinical suspicion.
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PMID:[Clinical difficulties and errors in making a diagnosis of chronic papillo-odditis]. 1098 69


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