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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A patient's clinical presentation should prompt an imaging evaluation that is cost effective for accurate diagnosis and leads to appropriate treatment of gallbladder inflammatory disease. In the setting of recurrent biliary colic, chronic cholecystitis is the main diagnostic consideration. Imaging hallmarks include gallstones and gallbladder wall thickening for which ultrasonography is uniquely suited. When a patient appears more toxic with right upper quadrant pain, one would more strongly consider acute cholecystitis. Because the morbidity and mortality of acute cholecystitis are reduced with early cholecystectomy, it is incumbent upon the clinician to make the diagnosis promptly and accurately. Hepatobiliary imaging with an IDA derivative has proven superior sensitivity, specificity, and accuracy for this condition. The examination has validity because it detects cystic duct obstruction, the primary pathophysiologic event responsible for most acute calculous and acalculous disease. Utilizing morphine augmentation when delayed filling is present has reduced the total examination time to less than 2 hours. Use of ancillary findings including gallbladder hyperemia and the "hot rim" sign help predict complicated cholecystitis, enabling more urgent intervention. The bulk of data presented in this review supports hepatobiliary imaging as the modality of first choice in the evaluation of acute cholecystitis. In the intensive care setting, where acalculous disease and atypical presentations are common, hepatobiliary imaging also plays a major role. We recommend liberal use of Sincalide pretreatment, morphine augmentation, and delayed images to promote gallbladder filling. If the gallbladder is nonvisualizing despite these maneuvers, sonography is often added as an aid to detect secondary signs of acute cholecystitis and help confirm the diagnosis with greater certainty prior to high-risk surgery.
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PMID:Hepatobiliary imaging. 191 52

Decrease in gall-bladder volume after intake of a test meal was assessed by ultrasound in 30 patients (24 females, 6 males; mean age 55 [22-82] years) with indications for elective or early elective cholecystectomy for cholelithiasis. Patients were assigned to three groups, based on intraoperative and histological gall-bladder changes: group 1 (n = 17), without changes or with mild chronic cholecystitis; group 2 (n = 4), with severe chronic inflammatory changes; group 3 (n = 9), with acute cholecystitis or cystic duct occlusion. A volume decrease of at least 30% after the test meal excluded only acute wall inflammation (negative predictive value 95.5%), while a volume reduction of at least 50% made it possible in a high percentage of cases (negative predictive value 88.2%) to predict correctly an absence of severe chronic wall changes. Before organ-preserving treatment (extracorporeal lithotripsy or local litholysis) is undertaken, gall-bladder volume reduction of at least 50% should be documented.
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PMID:[Diagnostic value of ultrasonographic testing of the gallbladder function in cholelithiasis]. 193 51

The results of treatment of 25 patients with acute and chronic cholecystitis accompanied by diabetes mellitus, who underwent transplantation of the pancreatic islet cells (PIC), and 40 patients with identical pathology, who underwent no PIC transplantation, are presented. In chronic cholecystitis and diabetes mellitus with the aim of preparation for the operation, PIC were administered intramuscularly, in acute cholecystitis and diabetes mellitus intraportally, after cholecystectomy. Transplantation of the PIC cultures in patients with diabetes mellitus contributes to correction of the impaired metabolic processes, reduction of the incidence of postoperative complications.
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PMID:[Clinical aspects of allotransplantation of the pancreatic islet cells in patients with diabetes mellitus and acute and chronic cholecystitis]. 207 72

We have evaluated the results of a bacteriological study of bile in 115 patients undergoing biliary surgery in the Valdivia Hospital (Chile). 35.6% of the positive bile cultures corresponded to patients with acute cholecystitis and only 22.5% to chronic disease. The culture was positive in 56.3% of cases of common bile duct stones and in 86.7% of cholangitis. Most positive bile cultures were monomicrobial, corresponding to patients with chronic cholecystitis. Most isolates were from Enterobacteriaceae, 49% of which corresponding to Escherichia coli. The in vitro sensitivity study showed that, as a rule, the strains were sensitive to the used antimicrobials.
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PMID:[Bacteriological study of bile from the gallbladder and bile ducts of patients surgically treated for biliary pathology]. 209 58

From April to August 1990, 60 patients underwent laparoscopic cholecystectomy. Patients with biliary colic were included, but those who had florid acute cholecystitis, morbid obesity or scars in the upper portion of the abdomen were excluded. Three patients had acute cholecystitis, 56 had chronic cholecystitis and 1 had hydrops of the gallbladder. Nineteen patients had had previous lower abdominal surgery. Five patients did not require analgesia, but the remainder needed parenteral analgesia on an average of 1.7 occasions and enteral analgesia on an average of 1.8 occasions. There were no intraoperative complications, and no patient had the procedure completed by standard surgery. Postoperative hospital stay averaged 2.5 days. The mean follow-up was 39 days. Few postoperative complications were noted: two patients suffered from ileus; two patients had biliary colic postoperatively (one required endoscopic sphincterotomy with stone extraction, and in the other no common-duct stones were seen on retrograde cholangiography); one patient had an intra-abdominal abscess, which was drained percutaneously; and one patient complained of upper abdominal pain that was incisional in origin. Laparoscopic cholecystectomy should be considered the procedure of choice for elective treatment of uncomplicated symptomatic gallstone disease.
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PMID:Laparoscopic cholecystectomy: a report of 60 cases. 182 56

In order to more specifically define gallbladder carcinoma with real-time ultrasonography, a retrospective study was performed involving 29 sonographically false-negative and 22 sonographically false-positive cases of gallbladder carcinoma. Among the false negative cases, 18 (62.1%) were diagnosed as gallbladder stone only, 6 cases (20.7%) were incorrectly diagnosed as either acute or chronic cholecystitis, 2 cases (6.9%) were diagnosed as bile sludge, 2 cases (6.9%) were diagnosed as polyps, and 1 case (3.4%) was diagnosed as liver tumor. In false-positive cases, 8 (31.8%) were erroneously diagnosed as liver tumor. In false-positive cases, 7 (31.8%) were erroneously diagnosed as a mass projecting from the gallbladder wall but were pathologically proven to be polyps (4 cases) or bile sludge (3 cases); 8 cases (36.4%) were incorrectly diagnosed due to irregular thickening of the gallbladder wall but histology revealed them to be acute (3 cases) or chronic (5 cases) cholecystitis. Seven cases (31.8%) had a solid mass in porta hepatis, indicating gallbladder carcinoma; of these, 2 cases were lumps of bile sludge and 5 cases were acute cholecystitis with empyema. The differentiation of gallbladder carcinoma from cholecystitis (acute or chronic), polyps, and bile sludge is sometimes very difficult. With an understanding of the sonographic pitfalls and difficulties in the diagnosis of gallbladder carcinoma, a more specific diagnosis may be made.
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PMID:Ultrasonographic difficulties and pitfalls in diagnosing primary carcinoma of the gallbladder. 217 11

We investigated the effect of the severity of chronic cholecystitis on the incidence of false positive cholescintigrams in the diagnosis of acute cholecystitis. In a 4-year period 66 patients underwent cholescintigraphy (without evidence of significant hepatocellular disease or biliary tract obstruction) followed within 6 days by surgical removal of the gallbladder. At histopathology the gallbladders were categorized as normal, acute cholecystitis, or chronic cholecystitis. In addition, the severity of chronic cholecystitis was graded on a three-point scale. Using nonvisualization of the gallbladder for up to 4 h as the criterion for acute cholecystitis, the sensitivity and specificity for acute cholecystitis were 97 and 66%, respectively. Of the 35 gallbladders without acute cholecystitis, 4 were normal and the rest had various grades of chronic cholecystitis. The incidence of false positive studies increased with the severity of chronic cholecystitis (p less than 0.05). In addition, there were no false positive studies among the normal gallbladders and all gallbladders with grade three chronic cholecystitis gave false positive results. The data suggests that the severity of chronic cholecystitis affects the likelihood of obtaining false positive results with cholescintigraphy in the diagnosis of acute cholecystitis.
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PMID:Cholescintigraphy for acute cholecystitis: false positive results caused by chronic cholecystitis. 218 Jul 75

Apolipoproteins AI, AII and B were identified in the normal and pathological human bile duct and the gallbladder epithelium using an avidin-biotin immunoperoxidase technique. Small intestine and stomach sections served as positive and negative controls respectively. Staining was focal for apolipoproteins AI and AII, and continuous for apolipoprotein B. In addition to homogenous and granular cytoplasmic staining, foamy cytoplasmic staining, particularly for apolipoproteins AI and AII, was observed around lipid droplets in cells containing much lipid. No correlation between a particular pathological condition of the gallbladder (acute cholecystitis, mucocele, chronic cholecystitis, cholesterolosis) and staining pattern or intensity of staining was found for any of the apolipoproteins, although both apolipoproteins AI and AII stained more intensely than apolipoprotein B in each group. Positive staining was also found for all apolipoproteins in epithelial cells which had invaded the underlying connective tissue (gallbladder carcinoma), suggesting that the epithelial cells are capable of synthesizing apolipoproteins de novo. In this latter case, apolipoprotein B stained more intensely than for either AI or AII, and significantly (p less than 0.05) more strongly than that found in the other pathological groups. The identification of apolipoproteins in the gallbladder epithelium raises the interesting question of their origin and functional role.
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PMID:Apolipoprotein localization in the human bile duct and gallbladder. 223 98

Cholecystostomy and cholecystectomy remain appropriate and effective therapy for acute and chronic cholecystitis. Cholecystectomy is the gold standard against which all alternative methods of treatment of inflammatory biliary stone disease should be judged. The pathogenesis, diagnosis, and surgical treatment of acute and chronic cholecystitis have been described. Techniques of cholecystostomy, cholecystectomy, and intraoperative cholangiography used by the author have been given. Our results and those generally described in the literature indicate that the overall mortality rate for cholecystectomy, in all age groups, is approximately 0.5%. This rate increases slightly in patients with acute cholecystitis and in those over the age of 65 years. Cholecystectomy remains the most effective and the definitive treatment for acute and chronic cholecystitis.
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PMID:Surgery for acute and chronic cholecystitis. 224 14

In a retrospective study (1972-1980) we analyzed the postoperative mortality of 2916 consecutive cholecystectomies or interventions on the common bile ducts respectively. The mean age of the patients was 54 years (17-92 years), 63% were older than 60 years; 74% were women. We show that age, histology, intervention, stone localization, sex and concomitant internal diseases influenced the early postoperative mortality. The overall mortality was 0.7% (21 patients), 0.7% in the under 60 years old patients, 1.8% in the older aged group. The mortality in chronic cholecystitis was 0.5%, in acute cholecystitis 2.6%. After simple cholecystectomy we observed a mortality of 0.3%, after cholecystectomy and common bile duct intervention 2.5% (p less than 0.001), and after intervention on the common bile ducts 7.3%. Stones only in the gallbladder were associated with a mortality of 0.3%, cholecysto- and choledocholithiasis with 2.8% and choledocholithiasis alone with 7.3%. The mortality in men was significantly (p less than 0.001) higher as in women (1.2 against 0.6%). In 76% of the deceased we diagnosed preoperatively a concomitant internal disease.
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PMID:[Postoperative mortality in surgery of cholelithiasis: a retrospective analysis from the years 1972-1980]. 231 81


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