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

In acute cholecystitis the cystic duct is usually obstructed by a gallstone and the gallbladder is often tensely distended with clear fluid. Because these findings suggest that fluid absorption in the gallbladder may be reversed in cholecystitis, we examined the effect of inflammation on the gallbladder mucosal function in dogs. In 20 dogs cholecystitis was induced by ligating the cystic duct and allowing inflammation to develop from bile stasis and the presence of a chronic indwelling cannula in the gallbladder. Every morning an aliquot of normal hepatic bile was infused into the gallbladder through a cannula in the gallbladder fundus. After either 4 or 24 hr the gallbladder contents were aspirated, the volume was measured, and the concentrations of bile acids, cholesterol, phospholipids, and protein were determined. Changes in volume were checked using [14C]PEG as a nonabsorbable tracer. A net absorption of fluid, bile acids, cholesterol, and phospholipids occurred during the first 24 to 48 hr after ligation of the cystic duct. Thereafter, fluid, cholesterol, and protein were secreted into the lumen, but absorption of bile acids continued. The lithogenic index of bile placed in the inflamed gallbladder was always greater when the bile was removed 24 hr later. The rate of fluid secretion into the lumen of the inflamed gallbladder increased after a meal and decreased after indomethacin. These findings demonstrate that inflammation can stimulate the gallbladder mucosa to secrete fluid, a process that may be important in the pathophysiology of acute cholecystitis in man. Since inflammation also resulted in an increased cholesterol saturation of gallbladder bile, cholecystitis per se may contribute to the formation of cholesterol gallstones.
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PMID:Transport of fluid and biliary lipids in the canine gallbladder in experimental cholecystitis. 377 2

Our objective was to study endogenous peritonitis and related catheter outcome in peritoneal dialysis (PD) patients. The study was designed to investigate endogenous peritonitis and related catheter loss in all end-stage renal disease (ESRD) patients who started peritoneal dialysis from January, 1989 to September, 1995. In a tertiary-referral university hospital, 192 ESRD patients (117 male, 75 female) who entered the home program from 1/89 to 9/95 were studied. Sixteen episodes of endogenous peritonitis occurred in 15 PD patients (7 male, 8 female) with a mean age of 63 years (range 33-81 years). Five patients were diabetic. Two hundred and seventeen episodes of peritonitis in 192 patients occurred over 4149 patient-months, resulting in one episode/19.1 patient-months. Sixteen episodes of endogenous peritonitis were encountered in 15 patients, accounting for 7% of all episodes of peritonitis. The mean duration of PD before contracting endogenous peritonitis was 24.2 months (range 7-52 months). Eleven episodes were related to diverticular leak/perforation, three to sigmoidoscopy/colonoscopy/PEG procedures, one to unknown etiology, and one to cholecystitis. During 11 episodes, severe constipation preceded. All the patients were initially treated conservatively with antibiotics. Five episodes (31%) responded to antibiotic therapy alongside antifungal prophylaxis and continued PD. One episode (6%) required cholecystectomy without catheter removal and resumed PD. Six episodes (38%) required catheter removal due to subsequent fungal peritonitis in a mean of 11 days (range 3-24 days): 4 patients transferred to hemodialysis and 2 patients resumed PD. Three patients underwent catheter removal along with colectomy and colostomy: 2 patients transferred to hemodialysis and 1 patient died in ten days. One patient refused surgery and died in 16 days. Endogenous peritonitis resulted in a high incidence of catheter loss and dropout from PD. Peritonitis due to bowel leak without frank bowel perforation can be managed with antibiotic therapy and antifungal prophylaxis. Aggressive management of constipation may decrease endogenous peritonitis.
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PMID:Endogenous peritonitis and related outcome in peritoneal dialysis patients. 886