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3.
Z Gastroenterol ; 58(4): 352-356, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32353887

RESUMO

Bouveret's syndrome is a rare complication resulting from gallstone disease. Both surgical and endoscopical procedures are performed, with the disease to be seen as strictly interdisciplinary. There are no well-established recommendations for this condition. In this paper, we want to describe our experience from 6 cases in 3 Swiss hospitals from 2015 to 2017 with emphasis on the endoscopic technique of electrohydraulic lithotripsy followed by balloon dilatation and propose a treatment algorithm.


Assuntos
Colelitíase/terapia , Obstrução Duodenal/etiologia , Obstrução Duodenal/terapia , Obstrução da Saída Gástrica/etiologia , Íleus/etiologia , Litotripsia/métodos , Colelitíase/diagnóstico , Obstrução Duodenal/patologia , Duodenoscopia , Obstrução da Saída Gástrica/cirurgia , Humanos , Masculino , Síndrome , Resultado do Tratamento
4.
Acta Chir Belg ; 120(1): 35-41, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30618322

RESUMO

Background: Prophylactic cholecystectomy has been proposed as a concomitant procedure during upper gastrointestinal surgery. This study evaluates the safety and the need of concurrent cholecystectomy during esophagectomy for cancer.Methods: All consecutive esophagectomies for esophageal cancer at the Center for Esophageal Diseases in Padova (Italy) between 1992 and 2011 were included. The safety of concurrent cholecystectomy was evaluated by surgical outcomes (length of stay, postoperative mortality and perioperative complications). The need for concurrent cholecystectomy was evaluated by occurrence of biliary duct stones and of cholelithiasis/cholecystitis after esophagectomy.Results: Cholecystectomy was performed during 67 out of 1087 esophagectomies (6.2%). Cirrhosis or chronic liver disease was associated with receiving cholecystectomy during esophagectomy (OR: 1.99, 95%C.I. 1.10-3.56). Patients receiving and those not receiving cholecystectomy showed similar length of stay (median 14 days, p = .87), postoperative mortality (3.0% vs. 2.5%, p = .68), intraoperative complication (4.5% vs. 7.1%, p = .62), early complications (52.2% vs. 44.6%, p = .25) and late complications (20.9% vs. 24.8%, p = .56). Cholelithiasis/cholecystitis after esophagectomy occurred in 61 (6.1%) patients, with only four requiring cholecystectomy during follow-up. The biliary stone occurrence was nil. Only pathologic stage III-IV (OR: 2.17, 95%C.I. 1.19-3.96) was associated with cholelithiasis/cholecystitis after esophagectomy.Conclusion: Routine prophylactic cholecystectomy during esophagectomy could be safe but unnecessary.


Assuntos
Carcinoma/cirurgia , Colecistectomia , Colelitíase/epidemiologia , Colelitíase/prevenção & controle , Neoplasias Esofágicas/cirurgia , Esofagectomia , Idoso , Carcinoma/complicações , Carcinoma/patologia , Colelitíase/diagnóstico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Feminino , Humanos , Itália , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (11): 37-41, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714528

RESUMO

OBJECTIVE: To develop a rational surgical strategy for acute biliary pancreatitis and its complications. MATERIAL AND METHODS: A 10-year follow-up enrolled 378 patients with acute biliary pancreatitis. Mild pancreatitis was diagnosed in 304 (80%) patients, moderate and severe course - in 74 (20%). Almost all patients with mild acute biliary pancreatitis underwent surgery within 3-7 days after the attack resolution. Patients with severe biliary pancreatitis had general and local complications that required differentiated treatment strategy. CONCLUSION: Strangulation of the calculus in the major duodenal papilla requires emergency endoscopic papillosphincterotomy. Choledocholithiasis, cholangitis and obstructive jaundice in acute biliary pancreatitis are indications for endoscopic papillosphincterotomy. Cholecystectomy should be performed after resolution of inflammatory changes in the gallbladder and pancreas in patients with severe biliary pancreatitis.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colelitíase/cirurgia , Pancreatite/cirurgia , Doença Aguda , Colelitíase/diagnóstico , Colelitíase/etiologia , Seguimentos , Humanos , Pancreatite/etiologia
6.
J Helminthol ; 94: e107, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31779732

RESUMO

The association between eosinophil count and cholelithiasis among people with Clonorchis sinensis infection is still uncertain. We conducted a cross-sectional study to investigate the associations among Clonorchis sinensis infection, eosinophil count and cholelithiasis. The study included 4628 participants from January to December 2018. The levels of eosinophil count were divided into four groups according to the quartiles of eosinophil count. Spearman's rank correlation was performed to assess the association between eosinophil counts and Clonorchis sinensis egg counts. Multiple regression analysis was performed to evaluate the relationships among C. sinensis infection, eosinophil count and cholelithiasis after adjusting for three models. The prevalence of C. sinensis infection was 38.72% (1792/4628), and the prevalence of cholelithiasis was 6.03% (279/4628). The infection rate of C. sinensis was higher in the cholelithiasis group than in the non-cholelithiasis group (63.08% vs. 37.16%, P < 0.001). Significant differences were found among various eosinophil count quartiles for C. sinensis infection, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyltranspeptidase (γ-GT), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine (CRE), blood urea nitrogen (BUN), uric acid (UA) and non-alcoholic fatty liver disease (NAFLD) (all P < 0.001). A significant positive correlation was found between eosinophil count and log-transformed C. sinensis egg count (r = 0.9477, P < 0.001). Multiple logistic regression analysis revealed that light and moderate intensities of C. sinensis infection were associated with cholelithiasis (P < 0.01 and P < 0.001, respectively), and C. sinensis infection with eosinophil count ranging from 0.05 to 0.5 × 109/l were associated with cholelithiasis (P < 0.05). In conclusion, our findings suggest that the light and moderate infections of C. sinensis with eosinophil count ranging from 0.05 to 0.5 × 109/l may be associated with a higher risk of cholelithiasis.


Assuntos
Colelitíase/diagnóstico , Clonorquíase/diagnóstico , Eosinófilos/citologia , Adulto , Animais , China/epidemiologia , Colelitíase/epidemiologia , Colelitíase/parasitologia , Clonorquíase/epidemiologia , Clonorchis sinensis , Estudos Transversais , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Contagem de Ovos de Parasitas , Prevalência , Fatores de Risco , Estatísticas não Paramétricas
7.
PLoS One ; 14(9): e0221720, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513631

RESUMO

Artificial intelligence (AI) tools have been applied to diagnose or predict disease risk from medical images with recent data disclosure actions, but few of them are designed for mobile terminals due to the limited computational power and storage capacity of mobile devices. In this work, a novel AI diagnostic system is proposed for cholelithiasis recognition on mobile devices with Android platform. To this aim, a data set of CT images of cholelithiasis is firstly collected from The Third Hospital of Shandong Province, China, and then we technically use histogram equalization to preprocess these CT images. As results, a lightweight convolutional neural network is obtained in a constructive way to extract cholelith features and recognize gallstones. In terms of implementation, we compile Java and C++ to adapt to the application of deep learning algorithm on mobile devices with Android platform. Noted that, the training task is completed offline on PC, but cholelithiasis recognition tasks are performed on mobile terminals. We evaluate and compare the performance of our MobileNetV2 with MobileNetV1, Single Shot Detector (SSD), YOLOv2 and original SSD (with VGG-16) as feature extractors for object detection. It is achieved that our MobileNetV2 achieve similar accuracy rate, about 91% with the other four methods, but the number of parameters used is reduced from 36.1M (SSD 300, SSD512), 50.7M (Yolov2) and 5.1M (MobileNetV1) to 4.3M (MobileNetV2). The complete process on testing mobile devices, including Virtual machine, Xiaomi 7 and Htc One M8 can be controlled within 4 seconds in recognizing cholelithiasis as well as the degree of the disease.


Assuntos
Colelitíase/diagnóstico , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Algoritmos , Aprendizado Profundo , Humanos , Aplicativos Móveis , Processamento de Linguagem Natural , Redes Neurais de Computação , Tomografia Computadorizada por Raios X
8.
Orv Hetil ; 160(38): 1510-1513, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31537097

RESUMO

Gallbladder agenesis is a rare congenital malformation due to an embryological defect of the biliary system. In most cases it is asymptomatic, but it can also mimic biliary colic. We report the case of a 72-year-old Caucasian woman with a medical history of cardiovascular disease and hypercholesterolemia, under cholesterol-lowering and hypotensive treatment, who presented symptoms suggesting biliary colic. She underwent laparoscopic surgery that confirmed the final diagnosis. We present our approach in this rare case as well as a brief review of medical literature. The surgeon should decide intraoperatively whether to continue and search for a possible ectopic gallbladder or investigate further with imaging studies. Gallbladder agenesis is a rare condition that the surgeon must be aware of. In the cases of inconclusive or indirect signs of cholelithiasis, the best approach is complementary imaging investigations such as magnetic resonance cholangiopancreatography in order to avoid surgery. Orv Hetil. 2019; 160(38): 1510-1513.


Assuntos
Anormalidades Congênitas/cirurgia , Vesícula Biliar/anormalidades , Laparoscopia , Adulto , Idoso , Colecistectomia Laparoscópica , Colelitíase/diagnóstico , Diagnóstico Diferencial , Feminino , Vesícula Biliar/cirurgia , Humanos
9.
BMC Gastroenterol ; 19(1): 139, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382888

RESUMO

BACKGROUND: Endoscopic transpapillary cannulation of the gallbladder is useful but challenging. This study aimed to investigate cystic duct anatomy patterns, which may guide cystic duct cannulation. METHODS: A total of 226 patients who underwent endoscopic transpapillary cannulation of the gallbladder were analyzed retrospectively. RESULTS: According to the cystic duct take-off, 226 cystic duct patterns were divided into 3 patterns: Type I (193, 85.4%), located on the right and angled up; Type II (7, 3.1%), located on the right and angled down; and Type III (26, 11.5%), located on the left and angled up. Type I was further divided into three subtypes: Line type, S type (S1, not surrounding the common bile duct; S2, surrounding the common bile duct), and α type (α1, forward α; α2, reverse α). Types I and III cystic ducts were easier to be cannulated with a higher success rate (85.1 and 86.4%, respectively) compared with Type II cystic duct (75%) despite no statistically significant difference. The reasons for the failure of gallbladder cannulation included invisible cyst duct take-off, severe cyst duct stenosis, impacted stones in cyst duct or neck of the gallbladder, sharply angled cyst duct, and markedly dilated cyst duct with the tortuous valves of Heister. CONCLUSION: Classification of cystic duct patterns was helpful in guiding endoscopic transpapillary gallbladder cannulation.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colecistite/prevenção & controle , Colelitíase/cirurgia , Ducto Cístico/anatomia & histologia , Vesícula Biliar/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo , Criança , Colecistite/etiologia , Colelitíase/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esfinterotomia Endoscópica , Adulto Jovem
10.
Heart Surg Forum ; 22(3): E229-E233, 2019 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-31237549

RESUMO

BACKGROUND: There are limited data about the results of simultaneous coronary revascularization, either with coronary artery bypass grafting (CABG) surgery or percutaneous coronary intervention (PCI), and cholecystectomy operations. Here we present clinical outcomes of the patients who underwent simultaneous laparoscopic cholecystectomy (LC) and coronary revascularization at the same session. PATIENTS AND METHODS: We included a total of 19 patients who underwent simultaneous LC and CABG or PCI. Thirteen of them had been hospitalized because of acute cholecystitis prior to coronary angiography. Simultaneous CABG and LC were performed in 10 patients (group I). LC was performed immediately after CABG surgery at the same session. PCI (group II) was performed in 9 patients. In the PCI group, LC was performed under general anesthesia 2 or 3 days after PCI. RESULTS: No mortality was seen after the procedures. In the CABG group, the mean number of bypass grafts was 3.4 ± 1.9. The mean extracorporeal circulation and the total operation times were 95 ± 13.5 minutes and 259 ± 18.9 minutes, respectively; the mean intubation duration was 17 ± 4.8 hours. In the PCI group, the mean number of stents per patient was 2.1 ± 0.7; LC was performed 2 or 3 days after the PCI without the cessation of clopidogrel and acetylsalicylic acid. The mean operation times for LC were 56.5 ± 15.6 minutes and 51.3 ± 17.6 minutes in the CABG and PCI groups, respectively (P = .86). In the CABG group, the mean durations of ICU and hospital stays were 3.1 ± 1.4 and 14.2 ± 3.7 days, respectively. In the PCI group, the mean durations of ICU stay and hospitalization were 1.7 ± 0.4 and 7.4 ± 2.2 days, respectively. Significant differences were found between the 2 groups in terms of the intubation time, duration of ICU stay, and hospitalization periods (P =.001, P =.0001, and P =.001, respectively). No intra-abdominal complications or bleeding was encountered in any group. Postoperative complications of the abdominal wall or mediastinitis were not seen in the setting of concomitant procedures in the CABG group. CONCLUSION: Simultaneous CABG or PCI with LC may be performed safely in patients with cholecystitis. The durations of postcholecystectomy ICU stay and the intubation time were significantly lower in the PCI group. According to our results, PCI may be the first choice of revascularization procedure in selected patients requiring cholecystectomy prior to discharge.


Assuntos
Colecistectomia Laparoscópica , Colelitíase/cirurgia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea , Idoso , Colelitíase/complicações , Colelitíase/diagnóstico , Estudos de Coortes , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento
11.
J Laparoendosc Adv Surg Tech A ; 29(9): 1185-1191, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31199700

RESUMO

Background: This study aimed to review our 25-year experience with pediatric laparoscopic cholecystectomy (LC) to assess its long-term outcome. Materials and Methods: The records of 215 children (127 girls and 88 boys) who underwent LC for the past 25 years (1993-2018) were retrospectively reviewed. All patients had a symptomatic cholelithiasis. The cholelithiasis was idiopathic in 185 patients (86%) and secondary in 30 patients (14%). A four-trocar technique was always adopted and cystic duct and cystic artery were clipped using 10-mm clips in the first 35 cases (16.3%) and 5-mm clips in the following 180 patients (83.7%). In the last 15 cases, indocyanine green (ICG)-enhanced fluorescence was adopted intraoperatively for a better identification of the anatomy of gallbladder and biliary tree. Results: The average operative time was 69 minutes and fell down to 52 minutes after introduction of ICG fluorescence (P = .001). Fifteen anatomic anomalies (6.9%), involving bile duct in 5 cases and cystic artery in 10 cases, were recorded. Technical problems were reported intraoperatively in 6 cases (2.8%). We recorded 4 postoperative Clavien IIIb complications (1.9%): 1 bleeding from the cystic artery, 1 dislocation of the clips on the cystic duct, and 2 iatrogenic injuries to the main bile duct managed with choledojejunostomy in 1 case and suture of the choleducus over a stent in the second case. We also recorded 3 umbilical granulomas (1.4%) (Clavien II). Conclusions: LC is a standardized and effective procedure to perform in children. Our 25-year experience showed that major complications (Clavien IIIb) can occur even in experienced surgeons' hands. Age, weight, and preoperative cholecystitis were significantly associated with the risk of bile duct injury in our series. Considering its versatility and safety, we believe that ICG fluorescence technology may be adopted in every LC to ease the dissection and reduce the likelihood of complications.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite/cirurgia , Colelitíase/cirurgia , Verde de Indocianina/farmacologia , Adolescente , Criança , Pré-Escolar , Colelitíase/diagnóstico , Corantes/farmacologia , Feminino , Seguimentos , Previsões , Humanos , Incidência , Itália/epidemiologia , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Instrumentos Cirúrgicos
12.
Pan Afr Med J ; 32: 91, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223382

RESUMO

After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination.


Assuntos
Colecistectomia Laparoscópica/métodos , Doenças da Vesícula Biliar/diagnóstico , Esquistossomose/diagnóstico , Colelitíase/diagnóstico , Colelitíase/cirurgia , Feminino , Doenças da Vesícula Biliar/parasitologia , Doenças da Vesícula Biliar/cirurgia , Humanos , Pessoa de Meia-Idade , Esquistossomose/cirurgia , Tunísia
13.
Ter Arkh ; 91(2): 48-51, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-31094171

RESUMO

AIM: Сomparative studying of changes in the spectrum of bile acids in bile in patients with nonalcoholic fatty liver disease and cholelithiasis. MATERIALS AND METHODS: 140 patients were included in the survey: 50 - with nonalcoholic fatty liver disease and 90 - with cholelithiasis. The diagnosis of nonalcoholic fatty liver disease was established on the basis of ultrasound examination of the liver, the elasticity and fibrosis of liver by using the sonoelastography and liver biopsy. The prestone stage of cholelithiasis was established on the basis of ultrasound examination of the gallbladder and biochemical examination of bile. The level of total cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, total bilirubin, alkaline phosphatase and gamma glutamyl transpeptidase were studied using the analyzer "Labsystems" (Finland). The spectrum of bile acids in bile is studied by mass spectrometry on AmazonX apparatus (Bruker Daltonik GmbH, Bremen, Germany). RESULTS: Biochemical blood test revealed increase of cholesterol, triglycerides, cytolysis markers, and cholestasis, the most pronounced in patients with nonalcoholic fatty liver disease. Biochemical study of bile showed increase of cholesterol, decrease the total amount of bile acids and cholatecholesterol coefficient in the vesicle and hepatic bile in patients with nonalcoholic fatty liver disease and cholelithiasis. Mass spectrometry showed decrease the total amount of free bile acids (choloidal, chenodeoxycholic, deoxycholic) and increase the content of conjugated bile acids (glycocholic, glycodesoxycholic, taurocholic, taurodeoxycholic, ursodeoxycholic), the most pronounced in patients with nonalcoholic fatty liver disease. CONCLUSION: Unidirectional changes in the spectrum of bile acids in nonalcoholic fatty liver disease and cholelithiasis give reason to believe that the trigger mechanism in the disturbance of bile acids metabolism is the liver. Reduction of primary bile acids, imbalance of phospholipids and cholesterol disrupt the stabilization of bile, resulting in unfavorable conditions in the bile ducts to form stones.


Assuntos
Ácidos e Sais Biliares/sangue , Bile/química , Colelitíase/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Biópsia , Colelitíase/diagnóstico , Técnicas de Imagem por Elasticidade , Vesícula Biliar/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/diagnóstico
14.
J Visc Surg ; 156(4): 319-328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30922600

RESUMO

Low-Phospholipid Associated Cholelithiasis (LPAC) is a genetic disease responsible for the development of intrahepatic lithiasis. It is associated with a mutation of the ABCB4 gene which codes for protein MDR3, a biliary carrier. As a nosological entity, it is defined by presence of two of the three following criteria: age less than 40 years at onset of biliary symptoms, recurrence of biliary symptoms after cholecystectomy, and intrahepatic hyperechogenic foci detected by ultrasound. While the majority of clinical forms are simple, there also exist complicated forms, involving extended intrahepatic lithiasis and its consequences: lithiasis migration, acute cholangitis, intrahepatic abscess. Chronic evolution can lead to secondary sclerosing cholangitis or secondary biliary cirrhosis. In unusual cases, degeneration into cholangiocarcinoma may occur. Treatment is built around ursodeoxycholic acid, which yields dissolution of biliary calculi. Complicated forms may call for interventional, radiological, endoscopic or surgical treatment. This synthetic review illustrates and summarizes the different aspects of this entity, from simple gallbladder lithiasis to cholangiocarcinoma, as well as secondary biliary cirrhosis requiring liver transplant, on the basis of clinical cases and the iconography of patients treated in our ward.


Assuntos
Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Colelitíase , Fosfatidilcolinas/deficiência , Adulto , Fatores Etários , Bile/química , Neoplasias dos Ductos Biliares/etiologia , Colagogos e Coleréticos/uso terapêutico , Colangiocarcinoma/etiologia , Colangite/etiologia , Colangite Esclerosante/etiologia , Colecistectomia , Colelitíase/complicações , Colelitíase/diagnóstico , Colelitíase/genética , Colelitíase/terapia , Códon sem Sentido , Diagnóstico Diferencial , Feminino , Cálculos Biliares/diagnóstico , Cálculos Biliares/etiologia , Cálculos Biliares/terapia , Humanos , Litíase/complicações , Litíase/diagnóstico por imagem , Litíase/terapia , Abscesso Hepático/etiologia , Cirrose Hepática Biliar/etiologia , Hepatopatias/complicações , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Mutação , Gravidez , Complicações na Gravidez/etiologia , Recidiva , Síndrome , Ultrassonografia , Ácido Ursodesoxicólico/uso terapêutico
16.
J Midwifery Womens Health ; 64(3): 289-297, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30908805

RESUMO

Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy's sign. Referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting are also frequently reported by persons with cholelithiasis. Cholelithiasis can result in complications, including cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). Lack of physical examination findings does not rule out a diagnosis of cholelithiasis. Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist the clinician in diagnosing cholelithiasis; however, ultrasonography is the gold standard for diagnosis. Management is dependent on severity and frequency of symptoms. Lifestyle and dietary modifications combined with medication management, such as use of gallstone dissolution agents, may be recommended for persons who have a single symptomatic episode. If symptoms become severe and/or are recurrent, laparoscopic cholecystectomy is recommended. It is recommended that individuals with an established diagnosis of cholelithiasis be referred to a surgeon and/or gastroenterologist within 2 weeks of initial presentation regardless of severity or frequency of symptoms.


Assuntos
Colelitíase/diagnóstico , Colelitíase/terapia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Colelitíase/fisiopatologia , Feminino , Humanos , Masculino , Gravidez , Complicações na Gravidez/fisiopatologia , Gestantes , Fatores de Risco , Ultrassonografia
17.
Taiwan J Obstet Gynecol ; 58(2): 177-182, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910134

RESUMO

Pregnancy can be complicated with different surgical emergencies which may potentially endanger the mother as well as foetus. In the modern era of advanced diagnostics and treatments, neither of them in response to a surgical emergency in a pregnant woman should be delayed. Appropriate early intervention is essential to decrease the morbidity and mortality. Following article encompasses common surgical emergencies that can arise in a pregnant woman and tries to suggest the approach that may be taken to reduce the burden of morbidity and mortality.


Assuntos
Emergências , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/cirurgia , Doença Aguda , Apendicite/diagnóstico , Apendicite/cirurgia , Colangite/diagnóstico , Colangite/cirurgia , Colelitíase/diagnóstico , Colelitíase/cirurgia , Diagnóstico por Imagem/efeitos adversos , Diagnóstico por Imagem/métodos , Diagnóstico Precoce , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Pancreatite/diagnóstico , Pancreatite/cirurgia , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/cirurgia , Gravidez , Ruptura Uterina/diagnóstico , Ruptura Uterina/cirurgia
18.
Biomed Res Int ; 2019: 7604939, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30834274

RESUMO

Background: In inflammatory bowel disease (IBD) patients there are reports of the occurrence of hepatobiliary manifestations, so the aim of this study was to evaluate the hepatobiliary manifestations in patients with Crohn's disease (CD) and ulcerative colitis (UC) from an IBD reference center. Methods: Cross-sectional study in an IBD reference center, with interviews and review of medical charts, between July 2015 and August 2016. A questionnaire addressing epidemiological and clinical characteristics was used. Results: We interviewed 306 patients, and the majority had UC (53.9%) and were female (61.8%). Hepatobiliary manifestations were observed in 60 (19.6%) patients with IBD. In the greater part of the patients (56.7%) hepatobiliary disorders were detected after the diagnosis of IBD. In UC (18.2%) patients, the hepatobiliary disorders identified were 11 (6.7%) non-alcoholic fatty liver disease, 9 (5.5%) cholelithiasis, 6 (3.6%) primary sclerosing cholangitis (PSC), 3 (1.8%) hepatotoxicity associated with azathioprine, 1 (0.6%) hepatitis B, and 1 (0.6%) hepatic fibrosis. In CD (21.3%) patients, 11 (7.8%) had cholelithiasis, 11 (7.8%) non-alcoholic fatty liver disease, 4 (2.8%) PSC, 3 (2.1%) hepatotoxicity, 1 (0.7%) hepatitis B, (0.7%) hepatitis C, 1 (0.7%) alcoholic liver disease, and 1 (0.7%) autoimmune hepatitis (AIH). There was one case of PSC/AIH overlap syndrome. Conclusion: The frequency of hepatobiliary disorders was similar in both forms of IBD in patients evaluated. The most common nonspecific hepatobiliary manifestations in IBD patients were non-alcoholic liver disease and cholelithiasis. The most common specific hepatobiliary disorder was PSC in patients with extensive UC or ileocolonic CD involvement; this was seen more frequently in male patients.


Assuntos
Eliminação Hepatobiliar , Doenças Inflamatórias Intestinais/diagnóstico , Fígado/fisiopatologia , Adulto , Azatioprina/efeitos adversos , Colelitíase/diagnóstico , Colelitíase/fisiopatologia , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/fisiopatologia , Doença de Crohn/diagnóstico , Doença de Crohn/fisiopatologia , Estudos Transversais , Feminino , Hepatite B/diagnóstico , Hepatite B/fisiopatologia , Hepatite C/diagnóstico , Hepatite C/fisiopatologia , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/fisiopatologia , Humanos , Doenças Inflamatórias Intestinais/classificação , Doenças Inflamatórias Intestinais/fisiopatologia , Hepatopatias/classificação , Hepatopatias/patologia , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Adulto Jovem
19.
Expert Rev Gastroenterol Hepatol ; 13(2): 157-171, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30791781

RESUMO

INTRODUCTION: Cholesterol gallstone disease have relationships with various conditions linked with insulin resistance, but also with heart disease, atherosclerosis, and cancer. These associations derive from mechanisms active at a local (i.e. gallbladder, bile) and a systemic level and are involved in inflammation, hormones, nuclear receptors, signaling molecules, epigenetic modulation of gene expression, and gut microbiota. Despite advanced knowledge of these pathways, the available therapeutic options for symptomatic gallstone patients remain limited. Therapy includes oral litholysis by the bile acid ursodeoxycholic acid (UDCA) in a small subgroup of patients at high risk of postdissolution recurrence, or laparoscopic cholecystectomy, which is the therapeutic radical gold standard treatment. Cholecystectomy, however, may not be a neutral event, and potentially generates health problems, including the metabolic syndrome. Areas covered: Several studies on risk factors and pathogenesis of cholesterol gallstone disease, acting at a systemic level have been reviewed through a PubMed search. Authors have focused on primary prevention and novel potential therapeutic strategies. Expert commentary: The ultimate goal appears to target the manageable systemic mechanisms responsible for gallstone occurrence, pointing to primary prevention measures. Changes must target lifestyles, as well as experimenting innovative pharmacological tools in subgroups of patients at high risk of developing gallstones.


Assuntos
Bile/metabolismo , Colelitíase/prevenção & controle , Colesterol/metabolismo , Fármacos Gastrointestinais/uso terapêutico , Prevenção Primária/métodos , Comportamento de Redução do Risco , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Animais , Colelitíase/diagnóstico , Colelitíase/epidemiologia , Colelitíase/metabolismo , Dieta Saudável , Exercício Físico , Fármacos Gastrointestinais/efeitos adversos , Humanos , Fatores de Proteção , Fatores de Risco , Resultado do Tratamento
20.
BMJ Case Rep ; 12(2)2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30798279

RESUMO

Bouveret's syndrome is a rare form of small bowel obstruction caused by a large biliary stone entering the lumen of the duodenum or the stomach through a bilioenteric fistula. Treatment options include various surgical techniques. However, recent advances in endoscopy also allow non-surgical endoscopic treatment options. We report a 68-year-old man, with a disseminated small intestinal neuroendocrine tumour, presenting with Bouveret's syndrome without any previously reported biliary disease. He experienced a number of symptoms 1 month prior to his admittance, which were difficult to differentiate from other infectious diseases and complications due to his neuroendocrine tumour. Abdominal CT showed a biliary stone impacted in the duodenal bulb, small bowel obstruction, pneumobilia and a bilioenteric fistula. The patient was treated with endoscopic electrohydraulic lithotripsy to fragment the large gallstone in smaller retractable pieces. The patient avoided major surgery and was discharged the following day.


Assuntos
Colelitíase/diagnóstico , Colelitíase/terapia , Obstrução Duodenal/etiologia , Obstrução Duodenal/terapia , Litotripsia , Idoso , Obstrução Duodenal/patologia , Duodenoscopia , Humanos , Litotripsia/métodos , Masculino , Síndrome , Resultado do Tratamento
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