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Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Distension of the gallbladder and bacterial infection can perpetuate an attack of acute calculous cholecystitis and produce its local and systemic complications. This prospective randomized trial was conducted on patients with their first episode of acute calculous cholecystitis which was associated with pyrexia and tachycardia to examine whether ultrasound guided percutaneous aspiration and lavage of the gallbladder followed by intra-lumenal instillation of 500 mg ampicillin (PALA) enhanced recovery from cholecystitis. Twenty patients were randomized to receive 500 mg of ampicillin every 6 hours for 5 days and another 20 patients were randomized to receive this treatment in addition to PALA within 12 hours of admission. Twenty four hours after admission to hospital, all the patients treated with PALA were apyrexial and had no residual right hypochondrial tenderness or guarding, a result superior (p less than 0.001) to that of the group without PALA where at least 75% of patients were still showing these signs. Two days after admission the WBC count of the PALA group was significantly (p less than 0.05) lower than that of the other group (6.32 +/- 0.1 x 10(9)/L vs 10.31 +/- 0.4 x 10(9)/L, mean +/- SEM, n = 20). Four days after admission, all members of the PALA group were comfortably tolerating solid food for the previous 24 hours and were, therefore, discharged home whereas all members of the other group were still in hospital and 85% of them were discharged home after hospitalization for 6 to 7 days. Three members (15%) of this group deteriorated and underwent emergency surgery. The results show that addition of PALA to the conventional non-operative treatment of acute cholecystitis enhances recovery and avoids the complications necessitating emergency surgery.
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PMID:Percutaneous aspiration, lavage and antibiotic instillation. New approach in the management of acute calculous cholecystitis. 204 14

The importance of clinical, laboratory and imaging data in the diagnosis of acute cholecystitis (AC) was studied in 825 patients with right upper quadrant pain hospitalized in the Surgical Clinic of the Fundeni Hospital--Bucharest, between January 1, 1986 and June 30, 1988. A number of 21 parameters were analysed in each case. Of these 825 patients, 259 were considered after surgery as AC. These 259 cases were divided, after the microscopical examination of the surgically-obtained specimens, into two groups: 1) pathologically confirmed AC (137 cases) and 2) pathologically non-confirmed AC (122 cases). The importance of every parameter in establishing a histologically confirmed diagnosis of AC was determined by the diagnostic probability calculated according to Bayes'theorem. The hierarchy of the value of parameters in the diagnosis of AC was based on their capacity to distinguish between the cases histologically confirmed and those detected on surgery, but without microscopically demonstrated changes of AC. The same decision criterion was used in building the decision trees in the exploration of the cases of presumed AC. In the 825 cases with right upper quadrant pain, the main and most frequent cause was chronic calculous cholecystitis (31.8%), followed by AC pathologically confirmed (16.6%), AC non-confirmed (14.7%) and chronic acalculous cholecystitis (12.4%). The most useful parameters in distinguishing between pathologically confirmed AC and pathologically non-confirmed AC were: 1) sudden onset of pain; 2) mild resistance to abdominal palpation; 3) frank peritoneal irritation; 4) stone impacted in the gallbladder neck (ultrasonography); 5) fever; 6) palpable gallbladder; 7) lithiasis (ultrasonography); 8) gallbladder wall with double outline (ultrasonography). Ultrasonography supplied a diagnostic probability of 85% for the correct diagnosis of AC in cases without a clinical picture suggestive for AC. The decision tree analysis supported the same conclusion: only ultrasonography gives a good distinction between pathologically confirmed AC and pathologically non-confirmed AC.
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PMID:Decision analysis in the clinical and imaging diagnosis of acute cholecystitis. 210 Aug 78

There remains some controversy regarding the timing of cholecystectomy after an attack of acute cholecystitis. Opinions vary between early operation within two and seven days and delayed operation readmitting the patient eight to twelve weeks later. There is, however, a small group of patients who require prompt emergency cholecystectomy. This group includes patients presenting with cholecystitis complicated by gas-forming organisms where the plain abdominal gas-forming organisms where the plain abdominal radiograph can establish the diagnosis.
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PMID:Clostridial cholecystitis--the need for early recognition and treatment. 210 27

Enlarged hilar lymph nodes are usually reported as the most frequent US finding in acute viral hepatitis. The authors compared this finding with other pathologic conditions--i.e., asymptomatic cholelithiasis and acute cholecystitis--and with gallbladder wall thickening, which is also observed in acute hepatitis. From their results, they drew the following conclusions: a) lymph node enlargement at the hepatic hilum was a very frequent finding (11/15) at US in the patients with acute viral hepatitis; b) its occurrence was statistically more frequent than in both cholelithiasis and cholecystitis; c) gallbladder wall thickening was found in 53.3% of the patients with acute hepatitis; d) lymph node enlargement and gallbladder wall thickening were not related. The authors suppose enlarged lymph nodes to be suggestive of hepatic damage in a pattern of immunological hyperactivity rather than the result of inflammatory gallbladder conditions during acute hepatitis. Since only 2 cases could be followed, the authors cannot discuss the prognostic significance of enlarged lymph nodes after cytolytic enzymatic signs of viral hepatitis have disappeared.
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PMID:[Enlargement of the lymph nodes of the hilus hepatis: a further ultrasonographic sign of acute viral hepatitis]. 211 Jun 81

The article analyses 610 patients with acute cholecystitis complicated by circumscribed peritonitis which determines the results of surgical treatment in many patients. The clinical manifestations of circumscribed peritonitis complicating destructive cholecystitis are discussed. It is shown that laparoscopy plays a role in the early diagnosis of atypical or asymptomatic course of this complication, particularly in elderly and old-aged patients. Data on the surgical treatment of acute cholecystitis complicated by localized circumscribed and ++non-circumscribed peritonitis are presented. The authors show the possibility of choosing the optimal operation--laparoscopic drainage of the gallbladder and abdominal cavity--in the first stage of treatment of patients with phlegmonous cholecystitis and localized ++non-circumscribed peritonitis in the presence of serious concomitant diseases.
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PMID:[Diagnosis and treatment of acute cholecystitis complicated by local peritonitis]. 214 98

In order to more specifically define gallbladder carcinoma with real-time ultrasonography, a retrospective study was performed involving 29 sonographically false-negative and 22 sonographically false-positive cases of gallbladder carcinoma. Among the false negative cases, 18 (62.1%) were diagnosed as gallbladder stone only, 6 cases (20.7%) were incorrectly diagnosed as either acute or chronic cholecystitis, 2 cases (6.9%) were diagnosed as bile sludge, 2 cases (6.9%) were diagnosed as polyps, and 1 case (3.4%) was diagnosed as liver tumor. In false-positive cases, 8 (31.8%) were erroneously diagnosed as liver tumor. In false-positive cases, 7 (31.8%) were erroneously diagnosed as a mass projecting from the gallbladder wall but were pathologically proven to be polyps (4 cases) or bile sludge (3 cases); 8 cases (36.4%) were incorrectly diagnosed due to irregular thickening of the gallbladder wall but histology revealed them to be acute (3 cases) or chronic (5 cases) cholecystitis. Seven cases (31.8%) had a solid mass in porta hepatis, indicating gallbladder carcinoma; of these, 2 cases were lumps of bile sludge and 5 cases were acute cholecystitis with empyema. The differentiation of gallbladder carcinoma from cholecystitis (acute or chronic), polyps, and bile sludge is sometimes very difficult. With an understanding of the sonographic pitfalls and difficulties in the diagnosis of gallbladder carcinoma, a more specific diagnosis may be made.
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PMID:Ultrasonographic difficulties and pitfalls in diagnosing primary carcinoma of the gallbladder. 217 11

Ultrasonography has a primary role in the imaging of biliary disease. Most cases are straightforward, but the authors emphasize unusual manifestations, uncommon diseases, and artifacts that may present diagnostic challenges. Issues in differential diagnosis are discussed for the following findings: internal gallbladder echoes (calculi vs tumefactive sludge, air, hematobilia, parasitic infestation, cholecystosis, neoplasia, and artifacts), gallbladder wall thickening (acute cholecystitis vs acalculous cholecystitis, artifacts, ascites, hypoalbuminemia, hepatitis, and sclerosing cholangitis), pericholecystic fluid (cholecystitis vs ascites, perforated ulcer, and trauma), bile duct dilatation (biliary obstruction vs sclerosing cholangitis, biliary air, anomalous portal system, biliary atresia, Caroli disease, and cholangiocarcinoma), perinatal and neonatal biliary disease, and sclerosing cholangitis.
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PMID:Pitfalls and differential diagnosis in biliary sonography. 218 99

From analysis of the results of ultrasonic examination in 1,428 patients with acute cholecystitis the authors determined the semeiotics of various forms and complications of the disease. The most common ultrasonic sign of acute cholecystitis is a triad of symptoms: enlarged gallbladder, thickened walls, and fixed hyperchostructures with an acoustic shadow in the projection of the neck of the gallbladder. Ultrasonic examination allows the presence of destructive cholecystitis to be detected with high precision on basis of the sign of a double gallbladder contour. Complications like pericystic infiltration, pericystic abscess with or without perforation, empyema of the gallbladder, acute pancreatitis, and choledocholithiasis can also be recognized in patients with acute cholecystitis by ultrasonic examination. Comparison of the data of ultrasonic examination with those obtained in laparoscopy or operation showed that the diagnosis coincided in 98.9% of cases.
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PMID:[Ultrasonic semeiotics and diagnosis of acute cholecystitis]. 218 95

From among more than 7000 sonographic examinations of the gallbladder performed over a period of 2 years, different types of acoustic artifacts were observed in 42 patients. Artifacts originated in the gallbladder wall in 37 cases and within the lumen in 5 cases. Eighteen patients had symptoms related to the hepatobiliary area. Twenty-four patients were fully asymptomatic although cholelithiasis was demonstrated in 8. In 21 cases (50%) some type of gallbladder pathology was associated with the presence of acoustic artifacts. Thirteen patients were cholecystectomized and the associated gallbladder pathology consisted of cholelithiasis (N = 5), cholesterolosis (N = 2), adenomyomatosis (N = 2), emphysematous cholecystitis (N = 2), and acute cholecystitis (N = 2). In 3 of these patients a sonographic/pathologic correlation was established. Only 5 of the 18 symptomatic patients presented acoustic artifacts in an otherwise normal gallbladder. Recognition of those pathological conditions favorable to the appearance of artifacts and reverberation shadows is extremely useful for differentiating merely clinically irrelevant anomalies from those that require prompt management.
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PMID:Acoustic artifacts and reverberation shadows in gallbladder sonograms: their cause and clinical implications. 218 31

We report our experience with percutaneous transhepatic cholecystostomy in 10 elderly patients with acute cholecystitis, complicated by empyema formation. Most of these patients has severe underlying disease, rendering them at high risk for surgical intervention. In all patients, the percutaneous procedure was followed by a rapid regression of clinical symptoms and of radiologic abnormalities. Six were considered inoperable. Three of these remain free of biliary symptoms, respectively 22, 10, and 7 months after percutaneous cholecystostomy. Three others died of nonbiliary disease 1-4 months after cholecystostomy. Three patients underwent successful elective cholecystostomy 1-5 wk after percutaneous cholecystostomy. In one patient, cholecystectomy had to be performed because of recurrence of hydrops, 1 wk after catheter removal. In our opinion, percutaneous transhepatic cholecystostomy is a safe and effective procedure in the treatment of elderly patients with acute complicated cholecystitis. It can be followed by elective cholecystectomy in good surgical candidates, or by an expectant conservative management in high surgical risk patients.
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PMID:Percutaneous transhepatic cholecystostomy for acute complicated cholecystitis in elderly patients. 222 Jul 30


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