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

Eighty-two patients with right upper quadrant pain and a clinical suggestion of acute cholecystitis had their gallbladder and biliary ducts ultrasonographically examined in the period immediately following admission to the hospital. Biliary calculi or signs of cholecystitis, or both, were found in 65 per cent of the cases at ultrasound examination. An additional 10 per cent had pathologic changes unrelated to the biliary tract. In 44 of 48 cases the presence of calculi or inflammation could be confirmed at surgery, autopsy or endoscopic retrograde cholangiopancreaticography. Only one patient with a normal ultrasound examination was later found to have a small calculus in a common bile duct of normal caliber.
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PMID:Ultrasonography in the diagnosis of acute cholecystitis. 639 Oct 92

A 69-year-old white male was admitted to the hospital for right upper quadrant pain, fever, and vomiting. Acute cholecystitis was not thought to be present because of a negative ultrasonogram and oral cholecystogram. A 99mTc-PIPIDA hepatobiliary study showed definite evidence of gallbladder perforation, with pockets of radiolabeled bile in the abdomen. Immediate surgery confirmed the scan diagnosis. In patients who are at high risk for gallbladder perforation the technetium-99m-labeled iminodiacetic acid hepatobiliary scan should be considered as a first procedure to rule out acute cholecystitis and possible gallbladder perforation.
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PMID:Perforation of the gallbladder diagnosed preoperatively. 686 82

A group of 75 patients with acute right upper quadrant pain was evaluated with both sonography and cholescintigraphy. Accuracy in screening for gallbladder disease was significantly greater with sonography (96%) than with cholescintigraphy (74%). For selecting patients with acute cholecystitis from this population that included acute and chronic cholecystitis as well as nonbiliary pathology, PIPIDA was less accurate (77%) than might be expected based on previous reports primarily due to false positive nonvisualization caused by chronic cholecystitis. Of patients with nonbiliary pathology, sonography was able to detect the cause of the right upper quadrant pain in 21%. Patients with acute right upper quadrant pain should first be screened with sonography. If cholescintigraphy is subsequently used for suspected acute cholecystitis, positive results should be interpreted with caution before surgery is planned.
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PMID:Evaluation of acute right upper quadrant pain: sonography and 99mTc-PIPIDA cholescintigraphy. 697 66

To define the role of ultrasound in evaluating acute right upper quadrant pain, a prospective study was performed on 52 patients having clinically suspected acute cholecystitis. Ultrasonographic determination of acute or chronic cholecystitis, or diagnosis of a normal gallbladder, was based on analysis of location of tenderness, calculi, sludge, and wall thickness. The diagnosis of acute cholecystitis (34.6% of patients) was based on the highly significant observations of focal gallbladder tenderness and calculi. Sludge and wall thickening were also statistically significant, but to a lesser degree. Cholelithiasis allowed differentiation of patients with chronic cholecystitis (32.7%) from patients with normal gallbladders (32.7%). Neither of these two groups had significant focal gallbladder tenderness, sludge, or thickened walls. Because acute cholecystitis is found in the minority of patients with acute right upper quadrant pain, and because ultrasound is rapid, accurate, and noninvasive, it should be the initial modality used to evaluate these patients.
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PMID:Ultrasonic evaluation of patients with acute right upper quadrant pain. 725 22

Sixty patients were evaluated for acute abdominal pain using technetium-99m PIPIDA hepatobiliary imaging. The sensitivity of the test was 90.6 percent in all patients and the accuracy was 93.3 percent. In the evaluation of acutely ill patients with right upper quadrant pain, fever, nausea and vomiting, hepatobiliary imaging with PIPIDA is the preferred test for diagnosing acute cholecystitis. If the test is positive, disease of the gallbladder and probably acute cholecystitis are present. Early operation can proceed if desirable. If the test is negative and the bilirubin level is less than 5.0 mg/dl, acute cholecystitis is not present. In such cases conservative treatment is appropriate, and follow-up tests should be performed to evaluate the possibility of chronic cholecystitis. When the bilirubin level exceeds 5.0 mg/dl, the test is often indeterminate.
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PMID:Diagnosis of acute cholecystitis using hepatobiliary scan with technetium-99m PIPIDA. 728 23

A positive sonographic Murphy sign, the presence of maximal tenderness elicited over a sonographically localized gallbladder, has been reported to be a helpful adjunctive finding in patients with proven acute cholecystitis who are evaluated with ultrasonography. We evaluated 200 patients with right upper quadrant pain, thought to be acute cholecystitis. Results of ultrasound examinations and subsequent follow-up were tabulated. The sensitivity of the sonographic Murphy sign in acute cholecystitis was 86% with a specificity of 35%, positive predictive value of 43%, and negative predictive value of 82%. The sensitivity of the sonographic findings, including stones, gallbladder wall edema, and pericholecystic fluid collections, was 93%, a specificity of 53%. The combination of the Murphy sign accompanied by gallstones yielded a specificity of 77%. The large number of false positives, and only moderate improvement in specificity when accompanied by gallstones, makes this sign unreliable in separating acute from chronic cholecystitis.
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PMID:Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis. 773 Apr 62

Because of the high diagnostic yield, its widespread availability and the possibility of bedside examinations, US has become the imaging modality of choice in patients with acute right upper quadrant pain caused by inflammatory disorders such as liver abscesses, acute cholangitis and acute cholecystitis. Computed tomography (CT) can be reserved for more complex cases. US, often in combination with fluoroscopy, is also widely used to control interventions. In patients with liver abscesses the therapeutic strategy is determined by the size of the abscess, its uni- or multifocal presentation and the causative micro-organisms cultured after diagnostic percutaneous aspiration. Small-sized pyogenic abscesses (< 3 cm), most fungal and amoebic abscesses can be treated medically. Large-sized pyogenic abscesses should be drained percutaneously and can be cured in 75-90%. Surgery should be restricted to patients with prolonged sepsis after percutaneous drainage and patients with infected pre-existing hepatic lesions. In patients with acute cholangitis drainage of the infected bile is essential. Invasive imaging such as percutaneous or endoscopic cholangiography procedures such as nasobiliary drainage, stent placement and sphincterotomy has decreased mortality rates dramatically. Percutaneous drainage should be considered in patients in whom endoscopic procedures fail. Surgery may have a place in the treatment of bile duct obstruction which causes cholangitis. In patients with suspected acute cholecystitis, imaging modalities such as cholescintigraphy and CT can be reserved for patients with inconclusive sonographic studies and more complex cases. The contribution of percutaneous gallbladder aspiration and culture to diagnose acute cholecystitis seems limited. Percutaneous cholecystostomy is an effective procedure with a low morbidity and mortality for high-risk patients. The drainage catheter in the gallbladder does not interfere with cholecystectomy at a later stage in patients with calculous cholecystitis. In most patients with acalculous cholecystitis, percutaneous cholecystectomy provides a definitive treatment.
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PMID:Imaging and intervention in patients with acute right upper quadrant disease. 777 13

Laparoscopic cholecystectomy was performed in 467 patients between November 1989 and April 1991. Fifty-four patients (12%) had acute inflammatory changes. These were divided into three different groups: group 1-13 patients who admitted having an attack of right upper quadrant pain within 24-48 h of their scheduled elective laparoscopic cholecystectomy; group 2-23 patients who had a history of acute cholecystitis treated 4-6 weeks before their elective laparoscopic cholecystectomy; group 3-18 patients who were admitted to the hospital and were diagnosed with acute cholecystitis; they had laparoscopic cholecystectomy performed in the same admission. All patients had a successful laparoscopic removal of their gallbladder except 2 in group 3 who had to be converted to an open procedure. Analysis of the operative time, complications, and hospital stay showed that after adequate experience is gained in performing laparoscopic cholecystectomy, acute cholecystitis is not a contraindication. The procedure is faster and safer if performed in the first 24-48 h of the onset of the symptoms. Different technical maneuvers are needed due to the nature of the disease.
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PMID:Timing of laparoscopic cholecystectomy in acute cholecystitis. 817 20

Diabetic gastroparesis is a common problem in diabetics, especially insulin-dependent diabetics. The diagnosis usually is suggested on plain radiographs and confirmed on either upper gastrointestinal barium series or radionuclide gastric emptying studies. The clinical diagnosis is not always easy and some patients may present atypically with right upper quadrant pain simulating acute cholecystitis. In these patients, hepatobiliary scintigraphy may be the initial investigation performed and may first demonstrate unsuspected gastroparesis. Therefore, it is useful for the nuclear medicine physician to be aware of this entity to ensure early diagnosis and prompt treatment. The authors report one such case of diabetic gastroparesis that was diagnosed initially on a Tc-99m hepatobiliary scan.
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PMID:Diagnosis of diabetic gastroparesis on Tc-99m hepatobiliary scintigraphy. 843 57

A 70-year old male patient was admitted to hospital with fever and right upper quadrant pain. Ultrasonography and cholecystography revealed acute cholecystitis associated with multiple stones not only in the gallbladder but also in the common bile duct. Percutaneous trans-gallbladder drainage (PTGBD) was performed because of his persisting complaints and severe inflammatory change of the gallbladder. Operation was not considered due to his cardiac problem, so we tried direct dissolution treatment of the gallstones by using Methyl tert butyl ether (MTBE) through the percutaneous transhepatic catheter. Following maximal aspiration of the gallbladder contents, same amount of MTBE was infused into and the patient was kept in the right-side-down position for an hour. After 30 times of MTBE treatment, all stones in the gallbladder were thoroughly dissolved without any side effect. A residual stone in the common bile duct was easily taken out by endoscopic sphincterotomy.
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PMID:[Cholecystolithiasis and choledocholithiasis cured by methyl tert butyl ether (MTBE) combined with EST]. 844


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