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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients presenting with right upper abdominal colicky pain, jaundice, and fever had a hepatobiliary scan using Tc 99m HIDA. The scan was suggestive of acute cholecystitis and a space occupying lesion in the liver. On operation, liver echinococcosis, located in the right lobe rupturing into the biliary ductal system, was found. Intraoperative cholangiography revealed filling defects in the main biliary ducts. Exploration of the common bile duct disclosed daughter cysts and cystic debris. Acute cholecystitis or stones were not found. We conclude that in patients with a clinical picture and HIDA scanning compatible with acute cholecystitis and a space occupying lesion in the liver, the diagnosis of hydatid cyst of the liver which has ruptured into the biliary tract should be considered.
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PMID:Hydatid cyst of the liver rupturing into the biliary tract--mimicking acute cholecystitis on hepatobiliary scanning. 403 41

The Research Committee of the World Organization of Gastroenterology has gather information regarding the etiology of acute abdominal pain. Seven diseases cover 96% of the causes of this syndrome in many countries of the world, but some geographical variations have been observed. One example of these variations is amoebic liver abscess, present in 5 to 10% of Mexico City patients. Right upper quadrant pain is often present in amoebic liver abscess and acute cholecystitis. Thus, differential diagnosis of these two entities is difficult. Using discriminant analysis and "stepwise" procedures in 100 cases with cholecystitis and a similar number of patients with amoebic liver abscess, we found six variables (symptoms and signs with a significant chi square to distinguish between these two diseases. The symptoms and signs chosen were hepatomegaly, Murphy's sign, duration of pain greater than or equal to 48 hours, previous history of abdominal pain, dysentery, and facial pallor. These variables proved to be better than laboratory test results. With five of these variables it was possible to obtain an accuracy of 92%. Using six variables, if cases of tie (three variables present and three absent) were excluded, accuracy rose to 96%.
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PMID:Differential diagnosis between amoebic liver abscess and acute cholecystitis. 635 41

A 22 year old woman was diagnosed as having a Fitz-Hugh and Curtis syndrome (FHCS) or venereal perihepatitis during laparoscopy for investigation of pain in right hypochondrium and fever. Abdominal ultrasonography images presented an unusual appearance suggestive of a perihepatic effusion and of thickening of Glisson's capsule, lesions that were confirmed on laparoscopy. This ultrasound image could not be formally distinguished from a normal variant, but ultrasonography is still a valid method of diagnosis of FHCS. An acute cholecystitis in a young woman should suggest the diagnosis; absence of a right renal, hepatic or gallbladder anomaly should lead to investigation by ultrasound of the possible presence of an abdominal effusion of fluid and pelvic inflammation. Perihepatitis is confirmed on laparoscopy, which also allows sampling for bacteriologic and serologic tests to identify the causal germ: gonococcus and particularly Chlamydia trachomatis. Treatment consists of administration of specific antibiotics (ampicillin or doxycycline).
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PMID:[The Fitz-Hugh-Curtis syndrome. Apropos of an unusual hepatic ultrasonic aspect]. 638 9

17 patients with primary carcinoma of the gallbladder were studied. In 7 cases a palliative operation for biliary or gastrointestinal obstruction was performed, in 6 patients a biopsy only. None of the 4 patients undergoing a more "radical" procedure survived 2 years. The main symptoms were pain, jaundice and weight loss. Other manifestations were acute cholecystitis and pyloric obstruction. A correct preoperative diagnosis was established only in 3 cases. Most of the small tumors are discovered by the surgeon who performs a cholecystectomy for stones. Simple cholecystectomy, however, is a palliative procedure in most cases with carcinoma involving all layers of the wall.
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PMID:[Clinical aspects and diagnosis of gallbladder cancer]. 644 31

Hepatobiliary scans using Tc-IDA are reliable in making the diagnosis of acute cholecystitis. Commonly, opioid drugs are administered in patients with acute cholecystitis to relieve pain. Opioid drugs cause biliary sphincter spasm. Whether these drugs adversely affect hepatobiliary scans is unknown. We studied 13 healthy volunteer subjects, performing three hepatobiliary scans in each one. Scans were performed without opioid drugs and 30 minutes after intramuscularly administered meperidine, morphine, hydroxyzine, hydroxyzine plus meperidine, butorphanol, and nalbuphine. Opioid drugs markedly delayed clearance of Tc-IDA from the common bile duct, simulating common bile duct obstruction. Hydroxyzine alone caused an insignificant delay. We have concluded that opioid drugs cause bile duct obstruction in healthy persons. If opioid drugs are administered before a diagnostic hepatobiliary scan, delayed clearance of Tc-IDA from the common bile duct might lead to an erroneous diagnosis and indicate a potentially unnecessary common bile duct exploration. Opioid drugs should not be administered for several hours before a diagnostic hepatobiliary scan.
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PMID:Opioid drugs cause bile duct obstruction during hepatobiliary scans. 653 76

Endoscopic papillotomy was attempted in 60 high risk patients (mean age 76 years) with complications of common bile duct stones and preserved gallbladder. Successful papillotomy and bile duct clearance was achieved in 56 patients (93%). One patient died of bleeding shortly after papillotomy. In 5 patients without signs of complication, cholecystectomy was performed prophylactically. Three patients were lost to follow-up. No cholecystectomy was performed in 47 patients (mean follow-up 24 months). 35 (74%) of these cases were free of biliary symptoms; 5 (11%) complained of nonspecific dyspeptic pain and only 2 (4%) had biliary colic. Complications due to the preserved gallbladder occurred in 5 of 47 patients (11%). Two patients had a short transient bout of jaundice and cholangitis respectively. Three patients developed acute cholecystitis with subsequent empyema. Four out of five complications occurred within one month and in three of them the cystic duct was occluded at papillotomy. In summary, treatment of common bile duct stones by endoscopic papillotomy appears to be justified in high risk patients with preserved gallbladder. Gallbladder related complications are mainly to be expected early in the follow-up or in cases with cystic duct occlusion at papillotomy. Because of the risk of empyema, early cholecystectomy is indicated in cases of acute cholecystitis.
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PMID:[Endoscopic papillotomy in preserved gallbladder]. 662 47

In 346 patients followed up 6, 12, 24 and 48 months after cholecystectomy the clinical results (VISICK and self-assessment) were very good in over 80%, 1% had symptoms due to organic disturbances and 15-20% had mostly mild symptoms (pain, fullness, food tolerance) without detectable causes. These functional disorders were found frequently in female patients with long preoperative history and frequent attacks of pain. Age of patient, character of pain, therapy before the operation, postoperative complications or change of body weight showed no correlation with later results. The results were almost always good in patients with acute pancreatitis or acute cholecystitis before the operation, or who underwent choledochotomy.
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PMID:[What determines the prognosis following cholecystectomy: anamnesis, surgical findings, postoperative complications?]. 685 98

A case of acute cholecystitis with recent perforation is presented where the diagnosis was made preoperatively by ultrasound. The necessity to correlate the localization of the pain and the ultrasound findings is emphasized.
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PMID:Sonographic findings in a case of acute cholecystitis with gallbladder perforation. A case report. 687 22

Technetium-99m IDA cholescintigraphy has provided a new, noninvasive means of visualizing biliary tract function. It has become the procedure of choice in patients with suspected acute cholecystitis because of its ability to most accurately detect functional obstruction or patency of the cystic duct as opposed to ultrasound's ability to detect only anatomic changes such as the presence of calculi or a thickened gallbladder wall. These latter findings are more important in establishing the diagnosis of chronic cholecystitis where ultrasound shares a position of prime importance with the oral cholecystogram. Tc-99m IDA cholescintigraphy has also been particularly useful in evaluating bile leaks, biliary-enteric anastomosis patency and the post-cholecystectomy patient with recurrent pain. In the patient with cholestasis, ultrasound is usually the procedure of choice since it establishes whether or not ductal dilatation is present and frequently can determine the cause of obstruction. Cholescintigraphy has played an ancillary role in many cases by demonstrating the level of partial obstruction, but it does not have the anatomic resolution to visualize the cause of obstruction. Occasionally, in the evaluation of cholestasis, cholescintigraphy has proven to be the only modality which has identified the presence of acute common duct obstruction or localized intrahepatic ductal obstruction. All in all, Tc-99m IDA cholescintigraphy has had a dramatic impact upon hepatobiliary diagnosis.
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PMID:Role of 99mTc-IDA cholescintigraphy in evaluating biliary tract disorders. 699 26

Patients with radiolucent gallstones (diameter less than 1.5 cm) and functioning gallbladder were treated for 6-12 months with CDCA (38 patients, 12-15 mg/kg/day) or UDCA (78 patients randomly allocated to receive 5-6 or 10-12 mg/kg/day). Complete dissolutions and partial plus complete dissolutions were respectively 26 and 58% for CDCA, 14 and 58% for UDCA at the lower dose, and 29 and 71% for UDCA at the higher dose. Statistical analysis did not show any significant difference between the three different treatments. In patients with stones of 4-10 mm diameter treated with UDCA, complete dissolution occurred at the lower dose in 0 of 14 cases while complete dissolutions occurred at the higher dose in 5 of 18 cases, suggesting that the latter dose may be more effective (0.05 less than P less than 0.1). A highly significant correlation was demonstrated between gallstone size and number of dissolutions with both doses of UDCA. No side effects were observed with UDCA, while with CDCA diarrhea occurred in 28% and a transient increase in SGOT in a single patient. 1 patient on UDCA required emergency cholecystectomy for acute cholecystitis. Dyspeptic and/or pain symptom-atology improved in 65 and 85% of the patients treated with CDCA and UDCA, respectively. No variations in the blood lipids were observed.
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PMID:Treatment of radiolucent gallstones with CDCA or UDCA. A multicenter trial. 703 Aug 35


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