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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient with intermittent right upper quadrant abdominal pain thought to represent acute cholecystitis had common bile duct obstruction due to an enlarged right renal pelvis. A Tc-99m-HIDA scan provided the first clue to the diagnosis. The case reinforces the value of cholescintigraphy in diagnosing pathology outside the biliary system.
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PMID:Hepatobiliary imaging of common bile duct obstruction by a hydronephrotic kidney. 706 Feb 97

Prospective analysis of the efficacy of 99mTc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on several factors including; (a.) quality of equipment available; (b.) capability of the technologist performing the examination; (c.) relative experience of the physician supervising the examination; and (d.) willingness of the surgical consultant to accept a positive examination as sufficient evidence to perform emergency surgery. The authors feel that cholecystosonography should be used to assess the presence of acute cholecystitis in jaundiced patients because of its capability in the assessment of bile duct dilatation, and because of the lower reliability of cholescintigraphy when bile duct obstruction is possible (i.e., in jaundice). Ancillary findings in cholecystosonography and cholescintigraphy can aid in the differential diagnosis of acute right upper quandrant pain syndromes.
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PMID:Prospective evaluation of 99mTc-IDA cholescintigraphy and gray-scale ultrasound in the diagnosis of acute cholecystitis. 708 92

Presently, radionuclide imaging in hepatobiliary disease is mainly used to evaluate the functional aspect in hepatobiliary disease. For the evaluation of hepatic function, three kinds of radiopharmaceuticals are now commercially available: these are the Kupffer-cell oriented radiotracer of 99mTc-colloid, the hepatocyte oriented radiotracer of 99mTc-PMT, and the receptor-binding radiopharmaceutical of 99mTc-GSA. These radiopharmaceuticals must be properly used, according to the purposes. 99mTc-PMT can be used to determine the degree of functional disorder in acute hepatic disease and evaluate the severity of diffuse hepatic disease, whereas 99mTc-colloid can effectively evaluate the potential etiology of the disease process and its chronicity. And 99mTc-GSA may also be used to evaluate the severity of the disease. In particular, the hepatic functional reserve must be evaluated with 99mTc-GSA. The biliary patency from the intrahepatic bile canaliculi to the common bile duct can be effectively evaluated with 99mTc-PMT. The diagnosis of acute cholecystitis is most reliably made by radionuclide imaging. And radionuclide imaging is sometimes to be used for the differentiation of cholestasis. In particular, the discrimination among the disease entities of chronic intermittent intrahepatic cholestasis including primary biliary cirrhosis, primary sclerosing cholangitis and juvenile intrahepatic bile duct hypoplasia can be made. Moreover, it is also be used in evaluating constitutional hyperbilirubinemia, biliary leakage, infantile jaundice and gallbladder or syphinctor Oddi motor dysfunction.
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PMID:[Radionuclide imaging in hepatobiliary disease]. 767 71

Although cholecystectomy is routinely performed as a part of treatment for gallstone pancreatitis, detailed histopathologic features of the gallbladder have not been described. In this study, the pathologic findings of 53 gallbladders from patients with clinical and laboratory evidence of gallstone pancreatitis are described. The presence of intraepithelial neutrophilic aggregates, a histologic finding associated with common bile duct obstruction, was identified in 32 (60.4%) cholecystectomy specimens and was the most common pathologic findings. Changes of acute cholecystitis and chronic cholecystitis were found in 15 (28.3%) and 6 (11.3%) gallbladders, respectively. Fat necrosis, which is characteristically associated with acute pancreatitis, was the most specific histologic change, but it was seen in the adventitia of only four gallbladders. The similarities of pathologic findings in gallstone pancreatitis and common bile duct obstruction emphasize the role of choledocholithiasis in the pathogenesis of pancreatitis associated with cholelithiasis.
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PMID:Pathology of the gallbladder in gallstone pancreatitis. 772 28

Gallbladder stones remain asymptomatic over a long period. The biliary colic is the typical pain caused by these stones. Dyspeptic symptoms seem to be unrelated to the presence of gallstones. Acute cholecystitis, a serious complication of gallstone disease, spans a wide spectrum of clinical findings. The typical signs are right upper abdominal pain and tenderness, fever, leucocytosis and Murphy's sign. 35% of patients experience gallbladder empyema or perforation. Localized gallbladder perforation, characterized by high fever, severe right upper abdominal pain and tenderness and a palpable mass is often difficult to distinguish from acute cholecystitis. Free perforation into the abdominal cavity causes diffuse peritonitis. Gallbladder perforation into the lumen of an adjacent organ produces fistulas, mostly with minimal symptoms or a pain relief after decompression of the inflamed gallbladder. Air in the bile ducts and on some occasions bile-acid-induced diarrhea may result. Rarely, the perforation of large stones leads to an occlusion of the GI tract and results in a gallstone ileus. Common bile duct stones may be asymptomatic or cause bile duct obstruction with biliary colics and jaundice. Acute bacterial cholangitis characterized by Charcot's triad (pain, jaundice and fever) and the acute biliary pancreatitis with its typical symptoms are the serious complications of common bile duct stones, associated with a high mortality rate. The clinical manifestations of a gallstone disease and its complications reveal important diagnostic features, but the most important diagnostic features, modalities are the imaging procedures. They are decisive for an accurate therapy.
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PMID:[Clinical manifestations of cholelithiasis and its complications]. 776 32

Because of the high diagnostic yield, its widespread availability and the possibility of bedside examinations, US has become the imaging modality of choice in patients with acute right upper quadrant pain caused by inflammatory disorders such as liver abscesses, acute cholangitis and acute cholecystitis. Computed tomography (CT) can be reserved for more complex cases. US, often in combination with fluoroscopy, is also widely used to control interventions. In patients with liver abscesses the therapeutic strategy is determined by the size of the abscess, its uni- or multifocal presentation and the causative micro-organisms cultured after diagnostic percutaneous aspiration. Small-sized pyogenic abscesses (< 3 cm), most fungal and amoebic abscesses can be treated medically. Large-sized pyogenic abscesses should be drained percutaneously and can be cured in 75-90%. Surgery should be restricted to patients with prolonged sepsis after percutaneous drainage and patients with infected pre-existing hepatic lesions. In patients with acute cholangitis drainage of the infected bile is essential. Invasive imaging such as percutaneous or endoscopic cholangiography procedures such as nasobiliary drainage, stent placement and sphincterotomy has decreased mortality rates dramatically. Percutaneous drainage should be considered in patients in whom endoscopic procedures fail. Surgery may have a place in the treatment of bile duct obstruction which causes cholangitis. In patients with suspected acute cholecystitis, imaging modalities such as cholescintigraphy and CT can be reserved for patients with inconclusive sonographic studies and more complex cases. The contribution of percutaneous gallbladder aspiration and culture to diagnose acute cholecystitis seems limited. Percutaneous cholecystostomy is an effective procedure with a low morbidity and mortality for high-risk patients. The drainage catheter in the gallbladder does not interfere with cholecystectomy at a later stage in patients with calculous cholecystitis. In most patients with acalculous cholecystitis, percutaneous cholecystectomy provides a definitive treatment.
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PMID:Imaging and intervention in patients with acute right upper quadrant disease. 777 13

Symptoms of acute cholecystitis developed in a 22-year-old woman with active SLE. Abdominal ultrasonography and biliary patency scan showed evidence of acalculous cholecystitis and common bile duct obstruction, respectively. Operation revealed acalculous cholecystitis and hemobilia; a liver biopsy specimen also showed hemobilia. Surgery relieved the patient's symptoms. This case demonstrates a new complication of SLE.
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PMID:Hemobilia in systemic lupus erythematosus. 836 52

The presence of intraepithelial aggregates of neutrophils in the gallbladder mucosa is proposed as a specific histologic marker of common bile duct obstruction. Medical records of 334 patients who underwent cholecystectomy over a 14-month period were reviewed. Based on clinical, laboratory, radiologic, and operative findings, 48 patients with common duct obstruction were identified. Pathologic changes of acute cholecystitis were found in eight patients. In the remaining 40 patients the proposed pathognomonic changes of biliary obstruction were observed. Sensitivity and specificity of the histologic criterion were 83.3% and 97.4%, respectively. On a pathophysiologic basis, the characteristic inflammatory response in the gallbladder mucosa is believed to be analogous to the reaction seen in the wall of the common bile duct and liver, and a part of the process of ascending cholangitis. In the absence of usual changes of acute cholecystitis, a pathologist may suggest the possibility of common duct obstruction if intraepithelial neutrophilic aggregates are seen on examination of the gallbladder.
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PMID:Pathology of the gallbladder in common bile duct obstruction: the concept of ascending cholecystitis. 845 73

With the experience of 80 cases of laparoscopic cholecystectomy, we started to operate all gallbladders by the laparoscopic way, even if there was the diagnosis of an acute cholecystitis. Between May 1991 and January 1992, 20 patients with acute cholecystitis have been operated by laparoscopic surgery. The patients' ages varied from 21 to 75 years (mean 53 years). The preoperative evaluation of the biliferous ducts, especially in case of cholestasis, should give a precise diagnosis of anatomic variations or stones. Therefore the ERCP as an additional preoperative examination was necessary in 10 (50%) cases. 14 (70%) could be operated by the laparoscopic way without surgical complications. In 6 patients closed procedures had to be changed to open cholecystectomy because of the following reasons: Scars and uncertainty about the anatomy in Calot's triangle (4x), severe adhesions to the colon (1x), and perforation of a gallbladder with necrotic wall, respectively. The good results, the possibility of a direct view of the situs, and the fact that anytime during the operation a change to the open procedure is possible, are reasons to start all cholecystectomies by the laparoscopic manner.
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PMID:[Laparoscopic cholecystectomy in acute cholecystitis. Experiences with 20 cases]. 847 74

A 75 year woman developed a primary malignant melanoma of the gallbladder. The patient presented with abdominal pain in the upper right quadrant typically seen in acute cholecystitis. Neither intravesical concretions nor cholestasis was seen. Ultrasound demonstrated hyperechogenic intraluminal "school of fish" reflections, which are typical for metastatic melanoma to the gallbladder. Intravesical fluid collection was not present. The tumor did not expand past the wall of the gallbladder. The main sonographic features are hyperdense intraluminal strands of tumor and the lack of fluid. Computed tomography showed solid intraluminal masses with hypodensive and partially hyperdensive reticular structure.
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PMID:[Malignant melanoma of the gallbladder]. 899 21


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