Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In some patients, gallstones are asymptomatic, lying dormant in the gallbladder or wedged in the cystic duct. In others, stones cause specific symptoms of gallbladder disease, such as biliary colic, acute cholecystitis, or cholangitis. Symptoms of flatulent dyspepsia are not markers of gallstone disease, since they occur equally in those with and without gallstones. Complications of gallstone disease include pancreatitis, biliary-enteric fistulas, hydrops, limy bile, porcelain gallsbladder, and carcinoma of the gallbladder. Cholecystectomy is indicated for symptomatic gallstones; for suspected stones in diabetics, who are at high risk should complications of gallstone disease occur; and in a few other limited situations. Prophylactic cholecystectomy for asymptomatic gallstones remains controversial.
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PMID:Manifestations of gallstone disease. 48 73

Asymptomatic biliary lithiasis can be defined as biliary lithiasis having determined no complication and no episode of biliary pain. Biliary pain is a consequence of acute increase of pressure inside the biliary tract. The increased pressure is induced by a stone transiently obstructing the cystic duct or the Oddi sphincter. In most patients, the site of the pain is epigastric. The level of the pain is high. The duration of the episode of biliary pain is usually less than 5 hours. Abdominal pain having other characteristics, dyspepsia, and headache are not related to biliary lithiasis.
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PMID:[Definition of asymptomatic biliary lithiasis]. 141 Nov 66

The management of calculous disease of the biliary tract has undergone significant changes during the past decade. Yet, the only radical method of treatment remains cholecystectomy. The surgical option has been improved by the development of laparoscopic cholecystectomy. From February 1990 to February 1991, we performed 368 laparoscopic cholecystectomies, with no mortality and a morbidity rate of 3.8%. There were 283 women and 85 men, with a mean age of 56.2 years (range 18 to 92 years). Two patients were asymptomatic but presented with a growing gallbladder polyp. All the other patients were symptomatic: biliary colic (63.8%), dyspepsia (18.6%), or acute cholecystitis (17.6%); 36 patients had an history of stone migration to the main biliary tract. Mean operating time was 58.3 minutes (22 to 180 minutes) and mean postoperative stay was 3.4 days. There were four systemic complications and 10 local technically related complications: two have been controlled by a laparoscopic approach (one hemorrhage and one biliary leak), one by laparotomy (bile duct injury). The other 7 local complications resolved spontaneously (4 biliary fistulas) or by percutaneous punction (3 subphrenic abscesses). Twenty-six patients (7%) required conversion to open cholecystectomy because of technical difficulties with the dissection or main biliary tract stones. We conclude that laparoscopic cholecystectomy is a safe and effective procedure.
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PMID:[Cholecystectomy using celioscopy: analysis of 368 operations]. 153 82

From a computerized database comprising 28 pertinent items in each of a consecutive series of 664 patients with cholelithiasis, differences were studied between men and women. In 52 patients there was a documented attack of acute pancreatitis (7.8%). Twenty-five of 174 men had pancreatitis, compared with 27 of 490 women (p less than 0.0001). Men developed gallstones later in life than women, but suffered gallstone pancreatitis earlier in life and in the course of their gallstone-related disease. A history of flatulent dyspepsia, chronic cholecystitis, and biliary colic was less common in men than in women with pancreatitis (p less than 0.0001). Men with pancreatitis had fewer stones in their gallbladders than did women (p = 0.0002). The cystic duct and the common bile duct in the pancreatitic patient were more likely to be dilated (p less than 0.0001). In the nonpancreatic group, these ducts were larger in men. Pancreatic duct reflux on operative cholangiography was more common both in patients with pancreatitis 62% cf 14% (p less than 0.0001), and in men (p less than 0.001). Predisposition to pancreatitis relates to duct size rather than stone size per se. Men are more susceptible to gallstone migration at an early stage of their disease. In addition they have a larger diameter duct system and possibly a different anatomic disposition of the sphincter of Oddi, which predisposes them to a higher incidence of pancreatitis than women. The data suggest that it is cystic duct size that is critical in the pathogenesis of gallstone pancreatitis.
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PMID:Sex differences in gallstone pancreatitis. 144 54

Gallstones are very common, but at least two thirds of detected stones are asymptomatic and a large number undoubtedly go undetected. The presence of symptoms or complications is the indication for surgery. It is important to accurately identify which symptoms are caused by gallstones, because removing the gallbladder will relieve only these symptoms. Making this determination is a challenge, however, because the classic picture of biliary colic may be inaccurate and the connection between gallstone disease and flatulent dyspepsia is questionable at best. Descriptions of both these conditions are based on anecdotal evidence or reports of uncontrolled surgical series. A review of recent controlled trials suggests that the pain of biliary colic is constant and infrequent, comes in episodes lasting 1 to 5 hours, is located in the epigastrium or right upper quadrant of the abdomen, and characteristically occurs at night. There are few additional symptoms other than nausea or vomiting, and colic is not induced by eating fatty meals. Flatulent dyspepsia--a symptom complex of vague pain in the right upper quadrant, fatty-food intolerance, and bloating--is probably not related to the presence of gallstones in the majority of patients.
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PMID:Gallstone symptoms. Myth and reality. 192

We studied the prevalence of gallstones in patients with upper abdominal pain, heaviness, or discomfort by ultrasound examination of the gallbladder. The actual ultrasound examination was performed by a clinical gastroenterologist blinded to the symptoms. Of 1,680 consecutive dyspeptic patients, 500 (29.8%) had gallstones. The gallbladder was contracted in 450 (91.2%), normal-size in 36 (7.2%), and distended in 8 (1.6%). Biliary colic was more frequently the presenting complaint in patients with a contracted gallbladder than in those with normal size gallbladder (p less than 0.001). Dyspepsia was more frequent in the presence of a normal size gallbladder than a contracted one (p less than 0.001). We conclude that ultrasonography of the gallbladder by the clinician has a high diagnostic yield, and the symptom complex has an excellent correlation with the sonographic appearance.
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PMID:Gallstone disease in north India: clinical and ultrasound profile in a referral hospital. 222 98

Cholecystectomy is standard treatment for symptomatic cholelithiasis. Long term relief from symptoms, however, has not been reported. We reviewed 671 elective cholecystectomies performed between 1982 and 1987 for biliary colic (group 1, 91 per cent), dyspepsia associated with gallstones (group 2, 5 per cent) and atypical pain syndromes (group 3, 4 per cent), to define precisely important variables for comparison with alternate methods of gallstone treatment. Cholecystectomy resulted in a mortality rate of zero per cent and an over-all morbidity rate of 4.5 per cent. The procedure-related morbidity rate was 2.2 per cent. Long term follow-up period for 81 per cent of these patients (mean of 45 months) showed that 88 per cent were free of symptoms. Patients in groups 1 and 3 were more likely to obtain relief from symptoms than those in group 2 (p = 0.10). We concluded that cholecystectomy is a definitive treatment for symptomatic cholelithiasis with minimal risk to the patient and a high degree of relief from symptoms. Alternative treatments for gallstones must compare favorably with these results of modern cholecystectomy prior to acceptance and widespread use.
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PMID:Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. 229 28

The term "technologism" is used for a phenomenon where inadequate evaluation of the patient's condition may lead to an excessive number of auxiliary examinations, with a possible incorrect interpretation of their results and a possible inadequate final solution. On analysis of ultrasonographic examinations of the gallbladder the author considered as inadequate evaluation of biliary dyspepsia on account of the high incidence of cholecystolithiasis - 55.6% in men and 48.7% in women, biliary colic in men because of the low incidence of cholecystolithiasis - 32.0% and abdominal colic in women on account of the high incidence of cholecystolithiasis - 52.4%. In the final surgical treatment this phenomenon was not observed. The author wants to draw attention to the fact that a similar phenomenon may occur not only in biliary-disease and in ultrasonography, but also in other medical disciplines.
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PMID:[Cholecystolithiasis and ultrasonography. Is "technologism" possible in medicine?]. 265 79

The case is described of a 32-year old woman with an 8 year history of oral contraceptive (OC) use who developed vascular complications. Significant findings in the patient's history included an appendectomy and repeated biliary colic dating back 7 years. The patient sought help for an attack of hepatic colic with vomiting, chills, and fever, dyspepsia, and intolerance of fats. Pain was noted on palpation and the clinical and sonographic findings indicated hepatomegaly. Based on the other clinical and laboratory findings, a preliminary diagnosis of infected hepatic hydatidic cyst was made and the intrahepatic hematoma was drained. The postoperative diagnosis was a large hematoma occupying the greater part of the right hepatic lobe. A pleural hemorrhage occurred during postoperative hospitalization and was treated medically, but 4 days after discharge from the hospital the patient returned with a pleural hemorrhage that required drainage. Hydatidosis is endemic in the region of Spain where the case occurred, and the grounds for differential diagnosis are specified. Several illustrations including sonograms, X-rays, and results of computerized axial tomography are included and explained. With the increasing use of OCs in Spain, it is likely that more such cases will be seen.
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PMID:[Hepatic hematoma and pleural hemorrhages caused by prolonged ingestion of oral contraceptives]. 687 43

Of 125 patients with radiolucent gallstones in functioning gallbladders treated with chenodeoxycholic acid (CDCA) between 1971 and 1977, 47 showed complete gallstone dissolution--an overall efficacy of 38%. However, a retrospective analysis of factors governing efficacy carried out in 1976 showed that in patients with stones less than 15 mm in diameter, treated with greater than 13 mg CDCA kg-1 day-1 for not less than one year who developed unsaturated bile (n = 27), efficacy rose to 78% complete and 93% partial plus complete gallstone dissolution. The usefulness of this selection/management approach was then confirmed prospectively in 42 comparable patients selected for treatment since 1977, efficacy (complete gallstone dissolution) reached 76%. The median duration of treatment for complete gallstone dissolution was 7.5 months for stones less than 5 mm in diameter, 12.0 for 5-10 mm stones; 22.0 for 10-15 mm stones and 28.5 for the only two patients (of 26) with large (greater than 15 mm) stones who ultimately showed complete gallstone dissolution. Seventy-eight patients withdrew from therapy, 21 within 6 months of starting CDCA (before their first follow-up cholecystogram): the remaining 57 withdrew because of: complications of gallstones (11 patients), inadequate treatment (dose and/or duration, 20 patients), inappropriate selection or unsuitable stones (19 patients) and resistance to CDCA (7 patients). Diarrhea, although common, was usually mild or transient. Biliary colic and non-specific dyspepsia tended to improve during therapy. To date, gallstone recurrence has been detected in 14 patients (30%), 3 months to 5 years after discontinuing treatment with CDCA.
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PMID:Outcome of chenodeoxycholic acid (CDCA) treatment in 125 patients with radiolucent gallstones. Factors influencing efficacy, withdrawal, symptoms and side effects and post-dissolution recurrence. 706 56


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