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

We carried out a review of 358 patients undergoing cholecystectomy during a seven-year period. Twenty-one patients were found to have classic biliary colic with a normal oral cholecystogram. All patients were female and had symptoms for three to 120 months (mean, 24 months). Cholecystosonography, upper gastrointestinal (GI) tract x-ray series, and infusion tomography of the gallbladder, when performed, were normal. Twelve patients underwent cholecystokinin (CCK) cholecystography. Failure of normal contraction of the gallbladder was noted in all 12. All 21 underwent cholecystectomy; three months postoperatively, all patients were relieved of their pain, and 15 of the 16 available for long-term follow-up (averaging 22 months) were completely cured of their symptoms. We conclude that the young woman with typical biliary colic and a normal oral cholecystogram, gallbladder ultrasound study, and upper GI tract x-ray series should undergo CCK cholecystography. If the results are positive, these patients can be reliably cured by cholecystectomy.
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PMID:Biliary colic and functional gallbladder disease. 710 15

Combined biliary drainage-cholecystokinin cholecystography (BD-CC) was evaluated in 81 patients with pain indistinguishable from biliary colic, but normal conventional diagnostic tests. The test was performed using a new technique of intubation and aspiration, with a steerable catheter and sump duodenal tube. Both positive and negative groups were followed. One third of patients had positive tests, and almost all had pathologic gallbladders, and a symptomatic outcome equal to that obtained by cholecystectomy for cholelithiasis diagnosed by conventional means. Some patients with severe pain had cholecystectomy despite a negative report. Pathologic findings were significantly fewer, and symptomatic outcome less satisfactory but sufficiently good to suggest that painful functional gallbladder abnormalities, not amenable to diagnosis by BD-CC exist. Hypercontraction was found to be a reliable index of gallbladder pathology. A false bilirubin precipitate was identified in some patients; this precipitate may be recognized by microscopy and pH testing. This finding should reduce false-positives in BD-CC.
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PMID:Results of combined biliary drainage and cholecystokinin cholecystography in 81 patients with normal oral cholecystograms. 714 12

Classic coronary pain--or angina--involves a substernal pressure that commonly begins with exertion and is relieved by rest. However, some patients experience angina in the absence of physical exertion or emotional stress, and not all chest pain that begins after exertion is angina. Atypical chest pain must be differentiated from other types of chest pain, including chest wall pain, pleurisy, gallbladder pain, hiatal hernia, and chest pain associated with anxiety disorders. Careful examination of the chest wall is essential, and abnormal heart sounds can tell you a great deal. Further testing is individualized. An exercise ECG is important in identifying the presence of ischemic heart disease and the amount of myocardium at risk. If the ECG is abnormal at rest, the patient should undergo a thallium stress test or exercise echocardiography. A coronary angiogram is indicated if the exercise test or an ECG during pain show that a lot of live heart muscle is at risk.
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PMID:Chest pain: how to distinguish between cardiac and noncardiac causes. Interview by Eric R. Leibovitch. 767 16

As part of a continuing audit of patients undergoing laparoscopic cholecystectomy (which now numbers over 1500) 468 of the 508 patients (92.1 per cent) operated on between October 1989 and March 1991 were studied between 350 and 988 days after the operation (mean 19 months). A questionnaire was filled in by each patient before operation and at the late follow-up visit. Eight specific symptoms were sought-non-colicky pain, colic, abdominal distension, nausea, vomiting, loss of appetite, flatulence, and dietary restriction. The result of each operation was assessed by two surgeons and by the patient. In 453 patients (96.8 per cent) the symptoms had improved as a result of the operation, but 260 patients (55.6 per cent) had some abdominal symptoms. The result was assessed as excellent in 310 patients (66.2 per cent); 143 (30.5 per cent) still had abdominal complaints but they were willing to cope with those symptoms. In 15 patients (3.2 per cent) the result was unsatisfactory. Statistical analysis of 26 preoperative variables showed few significant differences between patients with excellent results and patients with persisting or new symptoms. The percentage of patients with biliary colic was reduced from 82.9 per cent before to 6.4 per cent after laparoscopic cholecystectomy (P < 0.05), and of those with flatulence from 62.6 per cent to 45.3 per cent (P < 0.05). Flatulence persisted in 147 (50.2 per cent) of the 293 patients who had complained of flatulence before the operation, and of the 175 patients who had not complained of flatulence before surgery, 65 (37.1 per cent) reported the symptom for the first time after the operation. It appears that 'flatulent dyspepsia' after cholecystectomy has many causes, one of which may be removal of the gallbladder. It is concluded that the long-term results of laparoscopic cholecystectomy in patients with symptomatic gallstone disease were excellent but the prognosis in individual patients was unpredictable.
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PMID:Long-term results after laparoscopic cholecystectomy. 774 8

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

Bile duct stones are associated with a high rate of severe complications such as bile duct obstruction, cholangitis and biliary pancreatitis; therefore, stones of the common bile duct should always be removed. Today the endoscopic sphincterotomy and stone removal are the therapy of choice. When the gallbladder is still present, the duct stones should be removed endoscopically before laparoscopic cholecystectomy. For difficult bile duct stones, various procedures like mechanical lithotripsy, intracorporeal shock wave lithotripsy (ISWL), intracorporeal laser lithotripsy (ILL) and extracorporeal shock wave lithotripsy (ESWL) have been shown to increase the success rate of duct clearance to up to 95 to 100%. Before laparoscopic cholecystectomy, an ERCP should be performed, if there is a history or repeated biliary colic pain, cholangitis or biliary pancreatitis, if on ultrasound the diameter of the common bile duct is greater than 6mm, or if there are signs of cholestasis in the laboratory. In acute cholangitis, urgent endoscopic sphincterotomy has been shown to decrease the morbidity and mortality rate compared to surgical interventions. In acute biliary pancreatitis, early sphincterotomy also decreases the rate of morbidity significantly.
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PMID:[Endoscopic therapy of gallstones. Indications for ERCP]. 776 35

Several recent reports have indicated an increased prevalence of gallstones in association with pregnancy. If these reports are true, the early puerperium should be a favorable time to detect the disease in its initial stages and follow its natural course. Accordingly, the gallbladder was examined by ultrasound in 980 women during the immediate postpartum period and in 150 nulliparous, age-matched healthy volunteers. Gallstones were detected in 12.2% of the puerperal women and in 1.3% of the control group. In 70 patients who had stones in a functioning gallbladder, 22 (31%) had had attacks of biliary colic. The history of pain was more common in patients with stones greater than 10 mm in diameter. Forty-one women with small stones (< 10 mm) were followed clinically and ultrasonographically for between 6 and 24 (mean = 8.7) mo. All remained pain-free, and in twelve subjects (29%) the stones disappeared. Gallbladder bile was examined in 11 normal volunteers (controls) immediately after delivery and in 19 women with small stones 39 +/- 6 days postpartum. Bile was saturated with cholesterol in the controls and was unsaturated in patients with gallstones. We conclude that in our population pregnancy is a very important pathogenetic factor favoring gallstone formation. Attacks of biliary colic appear early and frequently in young Chilean women with this disease. Unexplained disappearance of small stones frequently occurs: in some cases it is likely to be the result of spontaneous dissolution because bile becomes unsaturated within a few weeks of delivery.
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PMID:Pregnancy and cholelithiasis: pathogenesis and natural course of gallstones diagnosed in early puerperium. 842 37

The main symptom of gallstone disease is biliary pain. Biliary pain is not necessarily colicky or postprandial, and it most frequently occurs at night during the same clock-time. The relief of biliary pain by cholecystectomy would support the idea that the gallbladder or the stones caused pain. Long-term follow-up studies after cholecystectomy are infrequent, however. Our studies show that biliary pain is relieved in 99% of patients after 4 years of follow-up. The nonspecific symptoms associated with gallstones (i.e., dyspepsia, bloating, belching, etc.) remained in 12% of these patients. We have also shown that the gallbladder itself, without stones, can cause pain and that this biliary pain is relieved in 77% of patients by cholecystectomy. The impact of gallstones on the patient depends on the quality of cholecystectomy as classically measured by morbidity and mortality. However, quality must also be monitored by comparing the long-term relief of biliary pain and the cost. Quality cannot be monitored through inaccurate national databases or multicenter trials. Rather, the continuous quality improvement (CQI) technique of larger centralized health care systems may be the most accurate monitoring system. This technique coordinates the entire health care system by assuming that any process can improve its quality, no matter how good it may already be. Our CQI laparoscopic cholecystectomy database has yielded preliminary perspectives on accurate data collection and improving costs. After a thorough examination, 5% of the database contained cases not done laparoscopically (coding errors), whereas it missed 21% of true laparoscopic cholecystectomy cases (staff errors). Only with the accuratized database were we able to provide insight into cost-savings procedures.
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PMID:Clinical manifestations and impact of gallstone disease. 848 Aug 72

Water injection was used in the treatment of 56 cases of biliary colic. The method was based on the writings of Zhang Zhongjing about the role of the Qimen point in treating diseases and clinical practice in this respect, water injection being performed at the most sensitive spot in the region defined by the lines joining the Qimen (Liv 14), Riyue (GB 24), and Juque (Ren 14) points. Pain disappeared in 32 (57.1%) of the 56 cases treated, and the total effective rate was 96.4%, showing a significantly better result compared with that of the control group treated with Western medicine (P < 0.05).
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PMID:Treatment of biliary colic by water injection in the region of Qimen, Riyue, and Juque points. 856 56

A case of Fitz-Hugh-Curtis syndrome (venereal perihepatitis) is reported. This syndrome is observed almost exclusively in women as a complication of genital gonococcal or chlamydial infections. A sudden, acute biliary-type pain generally characterizes the disease; only a few cases present symptoms related to associated genital infection. The real clinical incidence of venereal perihepatitis is quite high; in fact, a lot of the emergency admitted patients diagnosed with biliary colic or acute cholecystitis as a matter of fact suffer from this syndrome. If haematological investigations, ultrasonography and cholangiography do not confirm a suspected biliary lithiasis, it will be needed to investigate the genital tract. After clinical and ultrasound examinations, neisseria gonorrhoeae and chlamydia trachomatis must be sought in vaginal and cervical secretions and serum antichlamydial antibodies level is to be sought too. Through these examinations, the venereal perihepatitis can usually be diagnosed. In uncertain cases laparoscopy can be useful: in fact, it can reveal the typical violin-string-like adhesions between the anterior liver capsule and the anterior abdominal wall, and, in the same session, it allow to resect them. Tetracycline, doxycycline and, more recently, ofloxacine gave good results in the syndrome's treatment.
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PMID:[Venereal perihepatitis: Fitz-Hugh-Curtis syndrome]. 858 15


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