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

Two hundred and fifty cases of biliary tract disease were studied as regards case history, physical and laboratory investigations, surgery and follow-up. It was found that females especially multipara were frequently affected; majority of cases were in 3rd to 5th decade of their life, rise in age showing decline in incidence. Majority of cases (82.4%) were vegetarians and had used vegetable fats (oriental diet). Most of the cases (98.8%) belonged to middle and poor class and were lean and thin. Pain in the right upper quadrant of the anterior abdominal wall had been the commonest symptom, in about half the cases it got aggravated by fatty meals. A mass was felt in the right hypochondrium in 29.6% and Murphy's sign was positive in 55.5% of cases. Radio-opaque calculi were present in 8% of cases, in another 10.8% the calculi were demonstrated by oral cholecystography, radiography could detect calculi in 47 (25.4%) cases and its overall diagnostic success rate has been low (56.8%). Ultrasonography proved more valuable tool for diagnosis; bile culture was positive in 8.8% of cases only for Esch coli, proteus, klebsiella, staphylococci or paracolon. Right subcostal incision gave the best results. Chronic cholecystitis with cholelithiasis (74%) was more common than acalculus cholecystitis (26%), incidence of carcinoma was 2.8%, and in 5 out of 7 cases malignancy was associated with cholelithiasis. Early diagnosis and cholecystectomy for gallstones can prevent malignancy. Surgery on the whole proved beneficial and it can be more rewarding if pre-operatively other causes of dyspepsia are either excluded or confirmed. Excluding cases of malignancy, the mortality has been quite low and thus acceptable.
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PMID:Gall bladder disease: an analytical report of 250 cases. 263

Sonograms of 45 consecutive patients with histologically proven acute cholecystitis were retrospectively reviewed. The following sonographic criteria were evaluated for the presence of: thickening of the gallbladder wall; enlargement of the transverse diameter; gallbladder pressure pain (Murphy's sign); local hypoechoic areas in the bladder wall, and finally the indistinct internal appearance. All 4 patients (8.9%) with acalculous cholecystitis were detected by ultrasound. Its sensitivity as a test to detect acute cholecystitis is 88.9%, its specificity and accuracy 97.8 and 96.1%, respectively.
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PMID:Ultrasonography of acute cholecystitis: clinical and histological correlation. 353 83

Three children presenting with HAV hepatitis had an initial clinical onset suggestive of acute cholecystitis (pain and guarding in the right hypochondrium, fever and delayed jaundice) associated with important ultrasonographic abnormalities, also very suggestive of acute cholecystitis: bladder wall thickness greater than 10 mm (3 cases), the presence of 2 or 3 layers of different echogenicities (3 cases), presence of an ultrasonographic Murphy's sign (one case), contents of the gallbladder echogenic (one case). The authors discuss the hypothesis of an actual initial acute cholecystitis.
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PMID:[Acute cholecystitis disclosing A virus hepatitis]. 390 76

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

Ceruletide is a decapeptide isolated from the skin of an Australian frog. Its chemical and biologic relationship to cholecystokinin and its potent relaxant effect on the sphincter of Oddi makes it useful in biliary colic. In this double-blind placebo-controlled experiment, 60 subjects with moderate to severe pain caused by biliary colic were injected with ceruletide, 1 ng/kg iv or with an equal volume of saline solution. Pain in the right hypochondrium, referred pain, and Murphy's sign were scored before and after treatment. Data indicate that ceruletide is effective in biliary colic.
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PMID:Ceruletide analgesia in biliary colic. 647 36

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

The objective of this study was to derive and test clinical scoring system in order to predict the presence of gallstones and to identify inappropriate referrals. The design of this scoring system comprised a prospective audit of all referrals with suspected gallstones and a prospective validation of the system on new patients. The subjects used in the study consisted of 300 inpatient, outpatient and general practitioner referrals to a radiology department with suspected gallstones during the period 1984-1986 (1st cohort) and 200 similar referrals from 1987 to 1988 (2nd cohort). The main outcome measures were gallstones as determined by oral cholecystogram and/or ultrasound of the gallbladder. 32.7% and 24.0% of referrals in the first and second cohorts, respectively, had gallstones. A scoring system to predict gallstones was derived on the first cohort based on age, Murphy's sign, duration and type of pain, presence or absence of flatulence, and source of referral. This scoring system discriminated well between those with and without stones in both cohorts. Low risk groups, comprising about 15% of the referrals in each cohort, were identified with a prevalence of gallstones of 4.5% (1st cohort) and 3.0% (2nd cohort). If these patients had not been referred the radiological workload would have dropped by 15%, with a very small reduction in diagnostic yield. We conclude that prior to radiological assessment it is possible, on the basis of source of referral and symptoms, to identify a group of patients with a low prevalence of gallstones. These cases, with a low diagnostic yield, contribute substantially to the workload of a radiological department.
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PMID:Identification of inappropriate radiological referrals with suspected gallstones: a prospective audit. 829 72

A case of obstructive acute cholecystitis following percutaneous liver biopsy is presented. The patient complained of intense and continuous pain in the right upper quadrant of the abdomen 2 days after the liver biopsy. On abdominal examination, Murphy's sign was present. Hemogram revealed a fall in the hematocrit level from 44 to 38 because of hemobilia. Ultrasonography showed a dilated gallbladder with moderate thickness of the wall and a blood clot of 20 x 9 mm inside. The patient was subjected to laparoscopic cholecystectomy. The acute inflammation of the gallbladder was secondary to obstruction of the cystic duct by the blood clot. The postoperative period was uneventful.
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PMID:Acute cholecystitis secondary to hemobilia after percutaneous liver biopsy. 1146 18

Actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.
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PMID:Actinomycosis of the gallbladder: case report and review of the literature. 1602 23

Primary squamous cell carcinoma of gallbladder accounts for only 0-12.7% of all cases of gallbladder cancer. We here report a case of primary squamous cell carcinoma of gallbladder presenting as acute cholecystitis. A 50 year old man was admitted with the complaints of pain in right hypochondrium and fever of 2 days duration. Abdominal examination revealed tenderness along with guarding and rigidity in right hypochondrium with positive Murphy's sign. The patient was conservatively treated as a case of acute cholecystitis. After 12 hrs of unrewarding treatment patient was operated upon and cholecystectomy done. The specimen revealed thick walled gallbladder with multiple calculi. Histopathology revealed squamous cell carcinoma grade II.
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PMID:Primary squamous cell carcinoma of gallbladder presenting as acute cholecystitis. 1629 80


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