Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0149520 (acute cholecystitis)
 2,784 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

99mTc-HIDA is concentrated by the hepatocytes and excreted into the biliary system; the gallbladder, common bile duct, and early accumulation in the duodenum are visualized within 30 minutes of intravenous administration. The authors studied the utility of 99mTc-HIDA imaging in both acute and chronic cholecystitis and hepatobiliary disease in the presence of jaundice: (a) all normal gallbladders exhibited filling, (b) absence of visualization indicated gallbladder disease and/or cystic duct obstruction, (c) visualization of the gallbladder after cholecystokinin-induced emptying excluded an obstructed cystic duct and acute cholecystitis, and (d) a definitive diagnosis of hepatocellular disease, partial and complete obstruction, is possible in jaundiced patients with hyperbilirubinemias up to 5 mg%. Beyond that level, 99mT-HIDA imaging was of qualified value. The technique is useful in assessing biliary drainage in jaundiced patients with surgically altered biliary tract anatomy.
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PMID:Diagnosis of hepatobiliary disease by 99mTc-HIDA cholescintigraphy. 62

Cholescintigraphy with N-substituted iminodiacetic acid (HIDA) labelled with technetium-99m is a new noninvasive technique for evaluation of the hepatobiliary system. The significance of nonvisualization of the gallbladder by this method in comparison with standard radiologic examinations was studied. In 43 healthy subjects the gallbladder was visualized by the two methods. By contrast, all 27 patients in whom the gallbladder was not visualized by cholescintigraphy had cholecystitis. When visualization failed to occur, a repeat cholescintigraphic study after an injection of cholecystokinin demonstrated the status of the cystic duct. Visualization excludes cystic duct obstruction and acute cholecystitis, whereas persistent nonvisualization indicates cystic duct obstruction.
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PMID:Nonvisualization of the gallbladder by 99mTc-HIDA cholescintigraphy as evidence of cholecystitis. 63 Apr 97

A procedure was devised to quickly and reliably determine the patency of the cystic duct in patients suspected of having acute cholecystitis. First the gallbladder was stimulated to empty by a cholecystokinin injection. Thirty minutes later a radiolabeled biliary marker, either 150 muCi 131-I rose bengal or 2 mCi 99-mTc dihydrothioctic acid, was injected, and the accumulation of radioactivity in the liver and gallbladder regions was monitored by external gamma emission imaging and recording devices. The images of diagnostic importance were obtained between 60 and 90 minutes after injection of the tracer. Thirty-nine patients with acute abdominal pain were studied. Ten patients who had acute cholecystitis failed to show gallbladder accumulation of radioactivity, reflecting the cystic duct obstruction that initiates this disease. Twenty-nine patients having a variety of other diseases all showed gallbladder accumulation of activity, indicating in each patient that the cystic duct was patent. No significant adverse effects were noted. We conclude that the procedure is a useful adjunct to the clinical and roentgenographic evaluation of patients with acute abdominal pain.
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PMID:A test for patency of the cystic duct in acute cholecystitis. 111 65

Recent publications continue to refine the technique and interpretation of hepatobiliary scanning. Studies related to the evaluation of suspected acute cholecystitis have shown that morphine-augmented hepatobiliary imaging may not overcome the problem of false-positive study results in severely ill patients and the criterion for a normal study should be gallbladder visualization within 30 rather than 60 minutes. In patients with suspected acute cholecystitis, nonvisualized extrahepatic activity despite good hepatic uptake is highly predictive of acute cholecystitis, usually with biliary obstruction. The limitations of cholecystokinin-hepatobiliary imaging studies in patients with abdominal pain syndromes were defined and its use in evaluating common bile duct dynamics, and duodenogastric reflux was explored. Unusual findings and less-common uses of hepatobiliary scanning were reported, including assessment of conjoined twins, liver transplantation, primary biliary cirrhosis, gallbladder perforation, and persistent splenic visualization.
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PMID:Hepatobiliary imaging. 175 Dec 94

The authors assessed the influence of cholecystokinin (CCK), administered before cholescintigraphy, on the biliary-to-bowel transit time (BBTT) of technetium-99m disofenin. Fourteen healthy volunteers underwent two separate cholescintigraphic studies with and without CCK treatment. BBTT was less than 1 hour in all 14 studies of subjects not treated with CCK. In 14 subjects treated with CCK, there was no tracer activity in the bowel up to 2 hours in seven (50%) (P = .006). Eighty-three cholescintigrams obtained in patients with suspected acute cholecystitis were also retrospectively analyzed. In 53 of 83 patients in whom the gallbladder was visualized within 1 hour, significantly delayed BBTT was found in 14 of 29 (48%) who received CCK, compared with the BBTT in one of 24 patients (4%) who did not receive CCK (P less than .001). In the 30 patients in whom the gallbladder was never visualized (n = 28) or was visualized after 1 hour (n = 2), BBTT was less than 30 minutes, regardless of whether patients were treated with CCK. Results show that CCK treatment causes significantly delayed BBTT in many cases, and this finding should not be interpreted as abnormal.
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PMID:Delayed biliary-to-bowel transit in cholescintigraphy after cholecystokinin treatment. 236 44

The gallbladder volume was measured on abdominal ultrasonography in 115 patients consisting of three population groups, before and after ingestion of a fatty meal and/or intravenous administration of cholecystokinin. The variation in volume, estimated as a percentage, was used to assess gallbladder contraction. The first group, consisting of 40 normal individuals without gallstones or impaired gallbladder or hepatic function, can be considered to constitute a control group. In this population, gallbladder contraction exceeded 50% in every case. The second group consisted of 40 cases of acute cholecystitis, including 30 cases with acute gallstones and 10 cases of stone-free acute cholecystitis proven surgically (7 cases) or by guided aspiration (3 cases). Gallbladder contraction was less than 15% in every case. Lastly, a third group of 35 patients with uncomplicated gallstones discovered on routine ultrasonography, demonstrated gallbladder contraction of between 10 and 85%. In this last group, 12 patients with vague gastrointestinal symptoms and gallbladder contraction less than 15% were operated: the histological results demonstrated severe lesions of chronic gallstone cholecystitis. The authors believe that absent or weak gallbladder contraction after endogenous stimulation is a supplementary sign to be taken into consideration in a context suggestive of the diagnosis of acute stone-free cholecystitis and to suggest, in the presence of gastrointestinal symptoms not directly related to the gallbladder, the hypothesis of chronic gallstone cholecystitis.
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PMID:[Echographic study of gallbladder contraction: normal and pathologic aspects. Apropos of 115 patients]. 266 30

Prolonged fasting (NPO) and total parenteral nutrition (TPN) have been reported to result in an unacceptable number of false-positive hepatobiliary scintigrams for acute cholecystitis. Based on these reports, the clinical usefulness of the hepatobiliary scan in diagnosing acute cholecystitis in the critically ill postoperative patient who has been NPO or on TPN has been questioned. Patients who were either on prolonged fasting or total parenteral nutrition and who had no history of hepatobiliary disease were prospectively studied to assess the value of the Tc-99m diisopropyl-iminodiacetic acid (DISIDA) scan without pretreatment with cholecystokinin (CCK) in such a setting. Of the 17 persons studied, nine had been on total parenteral nutrition for at least five days and eight had been fasting for at least five days prior to imaging. Seven of the nine individuals on TPN (78%) and six of the eight individuals who were NPO (75%) had normal hepatobiliary scintigraphy. The results suggest that hepatobiliary imaging with Tc-99m DISIDA has a lower false-positive rate in individuals on TPN or NPO than previously has been reported and that it has clinical efficacy in ruling out the diagnosis of acute cholecystitis in these individuals.
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PMID:The effect of prolonged fasting and total parenteral nutrition on hepatobiliary imaging with technetium-99m DISIDA. 310 68

In eight patients without a history of gallbladder disease, cholecystostomy was performed for acute pancreatitis (four patients) and blunt abdominal trauma (four patients). In one case only, acute cholecystitis developed after discontinuation of the cholecystostomy. Six patients were followed for a mean period of 3.9 years, after which the gallbladder function was evaluated. Cholecystography and ultrasonography demonstrated good visualisation of the gallbladder without signs of gallstones. The contraction of the gallbladder produced by cholecystokinin varied. This could be due to adhesions impairing the motility of the gallbladder. After cholecystostomy in a previously normal gallbladder, its function will become normal in most patients. If no signs of gallbladder disease develop within the first year after cholecystostomy, the risk of late complications is minimal.
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PMID:Long-term effects of cholecystostomy on gallbladder function. 650 82

Two tests of cystic duct patency were compared in 37 patients with suspected acute cholecystitis. Ultrasound (US) measurement of gallbladder contraction induced by 40 Ivy dog units of cholecystokinin (CCK) was followed by the radionuclide (RN) test for cystic duct patency. In all 13 patients in whom US showed significant gallbladder contraction after CCK, the cystic duct was proved to be patent by the RN test. The gallbladder did not contract significantly in 24 patients. Eleven of these patients had acute cholecystitis, with evidence of cystic duct obstruction, and 12 had patent cystic ducts and final diagnoses other than acute cholecystitis. The measurement of contraction of the gallbladder in response to CCK is a valuable improvement over simple US when cystic duct obstruction is excluded; failure of contraction is not specific, and independent evaluation of cystic duct patency is required.
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PMID:Ultrasound measurement of contraction response of the gallbladder: comparison with the radionuclide test for cystic duct patency. 706 Mar 6

Pharmacological intervention with either cholecystokinin-8 (CCK-8) or morphine during 99mTc- hepatoiminodiacetic acid (HIDA) cholescintigraphy is required primarily for the assessment of the diseases affecting the gallbladder, the common bile duct, or the sphincter of Oddi. For imaging, the patient should be prepared by an overnight fast, or with 4 hours of minimum fast. Pre-emptying with CCK-8 is probably undesirable and should either be avoided or one should wait for at least 4 hours after CCK-8 to begin the 99mTc-HIDA study to achieve higher specificity of the test for acute cholecystitis. When he gallbladder is not observed by 60 mins in a clinical setting of acute cholecystitis, a dose of 0.04 mg/kg of morphine is administered intravenously and imaging continued for an additional 30 mins. Nonvisualization of the gallbladder by 90 mins with morphine in an appropriate clinical setting is diagnostic for acute cholecystitis. When the gallbladder is not observed by 60 min but is seen with morphine administered after 60 mins, a positive diagnosis of abnormal gallbladder function can be made. When the gallbladder is observed in a clinical setting of biliary pain or chronic calculous or acalculous cholecystitis, CCK-8 at a dose rate of 3.3 ng/kg/min is infused intravenously for 3 mins (10 ng/kg/3 min) for the measurement of the ejection fraction. An ejection fraction value of less than 35% is indicative of calculous or acalculous chronic cholecystitis. The gallbladder emptying is directly related to the total number of cholecystokinin receptors in the smooth muscle. The ejection fraction can be controlled to any desired level simply by controlling the dose rate or the duration of infusion of CCK-8. Morphine and other opiate metabolites circulate for many hours in blood and act on the sphincter of Oddi and decrease the gallbladder ejection fraction. Careful drug history, especially that of opiates, is very critical in all subjects with a low ejection fraction before assigning an abnormality to the gallbladder motor function.
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PMID:Cholecystokinin and morphine pharmacological intervention during 99mTc-HIDA cholescintigraphy: a rational approach. 862 48


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