Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Technetium-99-m-diethyl-IDA (Solco HIDA) cholescintigraphy was performed on 50 patients with suspected acute cholecysitis. The final diagnosis was acute cholecytitis in 34 cases, other biliary tract disease in 5 cases and nonbiliary disease in 11 cases. A nonfilling gallbladder was regarded as indicative of acute cholecystitis. The sensitivity in detecting acute cholecystitis was about 90%, the specificity about 80%; the predictive value of a positive test was about 90% and that of a negative test about 80%. The false positives consisted of two cases of acute pancreatitis with normal gallbladders and one case of coincidental chronic gallbladder disease and duodenal ulcer. The false negatives were examined after one week's treatment. A severe common bile duct obstruction could be detected in cholescintigraphy, but a slight obstruction was not always distinguishable from conditions in which the bile flow was normal.
 ...
PMID:Cholescintigraphy in the diagnosis of acute cholecystitis. 70 72

Technetium 99m-pyridoxylideneglutamate (99mTc-PG) administered intravenously is excreted by hepatocytes into the bile canaliculi and enters the gallbladder through the cystic duct and consequently, can be used for scanning the hepatobiliary ductal system. A total of 166 patients representing 27 normal subjects, 84 patients referred for investigation for pain in the upper right quadrant of the abdomen and 55 jaundiced patients were evaluated with 99mTc-PG. In normal human volunteers, the agent reached the liver in five minutes, and the common bile duct, gallbladder, and duodenum within 15 minutes. Satisfactory images of the hepatobiliary tract were obtained using small dosages of 99mTc-PG. The gallbladder was not visualized when the cystic duct was occluded. In the presence of acute cholecystitis, cystic duct obstruction, or in chronic cholecystitis where other roentgenographic studies showd a nonfunctioning gallbladder, there was no concentration of 99mTc-PG in the gallbladder. In partial common bile duct obstruction is distended common bile duct was visualized along with delay in transit of radioactivity into the duodenum. Complete common bile duct obstruction was associatedwith no radioactivity in either the biliary or the gastrointestinal tracts up to 24 hours after injection. Hepatocellular disease was characterized by delayed liver clearance and delayed visualization of biliary and gastrointestinal tracts. 99mTc-PG scanning proved capable of differentiating between hepatocellular disease and extrahepatic biliary tract obstruction.
 ...
PMID:Hepatobiliary scanning using 99mTc-pyridoxylideneglutamate. 83 70

The work is based on the examination of 106 patients, operated in the clinic for acute cholecystitis associated with choledocholithiasis and strictures of Vater's papilla. The operation of choice is a removal of pathologically changed gallbladder, elimination of the cause of cholestasis with restoration of bile passage in the bowel. The technic of choledochoduodenostomy adopted in the clinic is described. The immediate mortality was observed in 2.8%. Choledochoduodenostomy yielded good results in 81.1%, external drainage -- in 70.6%.
 ...
PMID:[Acute cholecystitis in choledocholithiasis and stricture of the ampulla of Vater]. 85 7

Liver biopsy was done at the time of operation in 125 consecutive upper abdominal procedures to assess the incidence of unsuspected or undiagnosed hepatic abnormalities. Specifically excluded were hepatic lesions unexpectedly identified at laparotomy. Sixty-seven percent of the liver biopsy specimens were abnormal, the most frequent findings being fatty metamorphosis, cholestasis, triaditis, fibrosis, inflammatory infiltrate, cholangitis, cirrhosis, and hepatitis. The most frequent operation performed was cholecystectomy. In 63 patients with chronic cholecystitis, there was a 51% incidence of abnormal liver histology, while in nine patients with acute cholecystitis, the incidence was 78%. In 83% of all other operations, abnormal liver biopsy specimens were identified. Bile leakage, hemorrhage, and infection did not occur in this series, despite inclusion of patients with severe biliary obstruction, abnormal clotting factors, and intra-abdominal sepsis. New techniques of histochemical enzyme analysis and electron microscopy are expected to enhance the clinical correlation of occult hepatic lesions. We conclude that liver biopsy in a safe, informative adjunct to all upper abdominal procedures.
 ...
PMID:'Routine' liver biopsy in upper abdominal surgery. 88 45

In AIDS patients an acalculous cholecystitis may be responsible for abdominal pain subsiding after cholecystectomy. But the indications for cholecystectomy are not clear: cholecystitis is usually associated with diffuse cholangitis and this might cause the symptoms. Since 1985, 8 AIDS patients have undergone cholecystectomy for acute cholecystitis. Ultrasonography revealed a 5 to 12 mm thickening of the gallbladder wall in all of them and gallbladder stones in two; four patients had cholangitis. The decision to operate was based on persistent pain associated with fever, poor general condition and muscular rigidity at palpation. Four patients had septic shock at the time of surgery; one died in the immediate postoperative period. In all other patients pain and septic syndrome subsided. Two patients died of AIDS complications 20 days after surgery; the remaining five died of AIDS 6, 9, 10, 12 and 14 months respectively after surgery; in two of them cholestasis had reappeared due to cholangitis. To summarize, in the 8 AIDS patients studied cholecystectomy was performed for clinical deterioration. Gallbladder pathology was responsible for the abdominal pain and the febrile general condition which was relieved by cholecystectomy.
 ...
PMID:[Hepatobiliary manifestations in AIDS in adults. Place of cholecystectomy]. 129

Reports have suggested that patients with gallstones have gallbladder bile that is less acidic and more saturated with calcium carbonate than patients without gallstones. This failure to acidify bile may play a role in the formation of gallstones. We, therefore, compared gallbladder bile pH, ionized calcium, and calcium carbonate saturation index from patients undergoing either incidental gallbladder removal (controls, n = 23) or elective cholecystectomy for gallstones (n = 55). Gallstones were classified as either cholesterol (n = 39) or black pigment (n = 16) stones. No difference in gallbladder bile pH was noted among the controls, cholesterol stone, and pigment stone patients. In addition, no difference in ionized calcium concentration or CCSI was noted among the three groups. The pH in additional patients (n = 49) with acute cholecystitis, common bile duct obstruction, biliary tract infection, and cystic duct obstruction was significantly more acidic. We conclude that neither a defect in bile acidification nor increased saturation of calcium carbonate explains why human cholesterol or pigment gallstones form.
 ...
PMID:Patients with uncomplicated cholelithiasis acidify bile normally. 139 97

Radionuclide cholescintigraphy is used to help establish the diagnosis of acute cholecystitis and is thought to provide additional information regarding the patency of the biliary duct system. Nonvisualization of the extrahepatic biliary duct system and lack of excretion into the duodenum despite uptake in the liver (a positive study) is considered indicative of common bile duct obstruction. The authors retrospectively reviewed 281 hepatobiliary cholescintigrams done at Stamford Hospital from July 1, 1987 to June 30, 1989. Previous authors have demonstrated a false-positive rate of eight to 15 per cent in those cases that have a documented normal extrahepatic biliary system at operation. Of those patients explored after a common bile duct obstruction pattern depicted by cholescintigram in the authors' series, 46 per cent of patients were found to have normal extrahepatic biliary systems. Factors possibly contributing to this high false-positive rate are discussed. The utility of radionuclide hepatobiliary scans may be limited for diagnosis of biliary duct obstruction.
 ...
PMID:Radionuclide cholescintigraphy in patients with suspected biliary tract obstruction. 192 86

Extracorporeal shock wave lithotripsy (ESWL) has been reported to be a safe and relatively effective non-invasive treatment for radiolucent gallbladder calculi in selected patients. Ideally, the goal of successful treatment is the passage of all fragments from the gallbladder into the intestinal tract. Biliary colic has been reported in up to 35% of treated patients, although complications such as cholecystitis, cholangitis, common bile duct obstruction, and pancreatitis are surprisingly infrequent. Cholescintigraphy is the procedure of choice in patients with biliary colic and suspected acute cholecystitis. It has proven to be more sensitive than ultrasound in detecting acute common bile duct (CBD) obstruction, since functional obstruction precedes morphologic dilatation of the CBD. This report reviews two cases of post-lithotripsy cystic and common duct obstruction and discusses the role of Tc-DISIDA scintigraphy following gallstone ESWL.
 ...
PMID:Biliary complications of gallstone lithotripsy detected by Tc-99m DISIDA scintigraphy. 203 26

An investigation of specific course of the disease in 911 patients operated upon for acute cholecystitis with bilirubinemia has shown that mechanical jaundice resulting from choledocholithiasis takes place in a third of the patients. Obstruction of the bile duct was confirmed in 27.1% of the patients during cholangiography. Prevalence of a number of factors was noted indicating of a toxic lesion of the liver (destructive forms of acute cholecystitis in 81.0% of the patients, higher level of bilirubinemia in long terms of the disease, the presence of coexistent pancreatitis in 30.5%, cholangitis--in 39.3%). An investigation of 207 bioptates of the liver in acute cholecystitis has revealed fatty degeneration of hepatocytes in 56.5%, pericholangitis--in 43.0%, cholestasis--in 21.3% of the cases. The cause of jaundice in acute cholecystitis mainly is an alteration of the hepatic cells due to pyo-resorptive intoxication manifested as cholestasis and hepatitis.
 ...
PMID:[Pathogenesis of jaundice in acute cholecystitis]. 259 23

A large number of drugs may be associated with impaired bile flow. Drug-associated cholestasis presents like other forms of cholestasis with pale stools, dark urine, pruritus and jaundice. Abdominal pain may be present in some instances and can be so severe as to lead to a false diagnosis of acute cholecystitis. Biochemically, drug-associated cholestasis resembles other forms of cholestasis although the presence of eosinophilia may suggest drug involvement. Many types of drug-induced cholestasis run a benign course with resolution of signs and symptoms within 3 months but occasionally the jaundice can take a year or more to resolve. Progression to cirrhosis is uncommon. Some patients may develop a syndrome resembling primary biliary cirrhosis. The mechanisms of drug-associated cholestasis are uncertain but may arise from alteration of bile formation within the hepatocyte or bile excretion at the level of the canaliculus or the extrahepatic ducts. Histological examination of the liver may be helpful in classifying the types of jaundice but the diagnosis of drug-induced cholestasis is usually one of temporal association and exclusion of other causes.
 ...
PMID:Drug-induced jaundice. 265 64


1 2 3 4 5 Next >>