Biochemical Prediction of Acute Cholangitis and Symptomatic Bile Duct Stones by Gallstone Hepatitis

We have adopted the clinical concept of gallstone hepatitis indicated by marked serum transaminase elevation due to an acute inflammatory liver cell necrosis in the early stages of gallstone impaction in the bile duct as clinical and biochemical criteria for identifying high-risk patients for acute cholangitis or bile duct stones causing symptoms (symptomatic bile duct stones, SBDS).One hundred and fifty-eight (80.2%) of 197 patients with acute gallstone disease and concomitant elevation of serum transaminase (gallstone hepatitis) underwent emergency treatment, either surgery (138 patients) or percutaneous transhepatic biliary drainage (PTBD)/endoscopic sphincterotomy (ES) (20 patients). One hundred and forty-two (89.9%) and 67 (42.4%) were confirmed to have SBDS and acute cholangitis, respectively, in the early stage of the disease. The majority of the patients who had no bile duct stones identified at surgery had either biliary pancreatitis or multiple small stones in the gallbladder. They were assumed to have migrating stones or false negative operative cholangiograms.In conclusion, gallstone hepatitis indicates that SBDS and acute cholangitis are probable, and facilitates rapid selection of patients for urgent biliary tract exploration in patients with acute gallstone disease.

Download Full-text

Etiology and Pathogenesis of Marked Elevation of Serum Transaminase in Patients With Acute Gallstone Disease

HPB Surgery ◽

10.1155/1991/95059 ◽

1991 ◽

Vol 4 (2) ◽

pp. 95-107 ◽

Cited By ~ 11

Author(s):

Masatoshi Isogai ◽

Kitao Hachisuka ◽

Akihiro Yamaguchi ◽

Satoshi Nakano

Keyword(s):

Bile Duct ◽

Cell Injury ◽

Gallstone Disease ◽

Liver Cells ◽

High Serum ◽

Liver Histology ◽

Serum Transaminase ◽

Bile Duct Stones ◽

Biliary Surgery ◽

Marked Elevation

From 1980 through 1988, biliary surgery was performed in 197 patients with acute gallstone disease and concomitant elevation of serum glutamic oxalacetic transaminase (SGOT) or serum glutamic pyruvic transaminase (SGPT) of over 300 Karmen units. In 137 patients, anatomic inspection and liver biopsy were performed during the acute stage of the disease. Impacted and floating bile duct stones were found in 69 (50%) and in 43 (32%) of the 137 patients, respectively. The main liver histology was necrosis of liver cells. After surgery, high serum transaminase fell rapidly with immediate recovery in 99% of the patients. In the remaining 60 patients, their signs and symptoms settled soon after initial conservative treatment and surgery was performed after an average time of 21 days. At laparotomy, impacted bile duct stones were found in 2 (3%) and liver histology revealed regeneration of liver cells.These findings suggest that marked elevation of serum transaminase in patients with acute gallstone disease might be due to an acute inflammatory liver cell injury caused by impacted bile duct stones or migrating stones, which would be transient and reversible after early resolution of the bile duct obstruction.

Download Full-text

Gallstone disease

Current Surgical Guidelines ◽

10.1093/med/9780198794769.003.0042 ◽

2018 ◽

pp. 401-414

Author(s):

Abdullah Jibawi ◽

Mohamed Baguneid ◽

Arnab Bhowmick

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Obstructive Jaundice ◽

Gallstone Disease ◽

Acute Cholangitis ◽

Biliary Colic ◽

Ultrasound Scan ◽

Bile Duct Stones ◽

Clinical Presentations ◽

Laparoscopic Bile Duct Exploration

Gallstone disease is common with clinical presentations including biliary colic, cholecystitis, and obstructive jaundice. Acute cholangitis and pancreatitis are other complications. Ultrasound scan and MRCP as well as endoscopic ultrasound are investigation modalities. Medical treatment of gallstones with ursodeoxycholic acid is discussed as well as laparoscopic cholecystectomy with its risks and benefits. The prevalence of bile duct stones is around 10–20%. Strategies for investigation and management are discussed, including ERCP and laparoscopic bile duct exploration.

Download Full-text

Comparative study of ultrasonographic findings with the operative findings of biliary surgery

Journal of Surgical Sciences ◽

10.3329/jss.v22i1.44011 ◽

2020 ◽

Vol 22 (1) ◽

pp. 25-29

Author(s):

Zubayer Ahmad ◽

Mohammad Ali ◽

Kazi lsrat Jahan ◽

ABM Khurshid Alam ◽

G M Morshed

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Imaging Modality ◽

False Positive Rate ◽

Gallstone Disease ◽

False Negative ◽

False Negative Rate ◽

Biliary Disease ◽

Biliary Surgery ◽

Operative Findings

Background: Biliary disease is one of the most common surgical problems encountered all over the world. Ultrasound is widely accepted for the diagnosis of biliary system disease. However, it is a highly operator dependent imaging modality and its diagnostic success is also influenced by the situation, such as non-fasting, obesity, intestinal gas. Objective: To compare the ultrasonographic findings with the peroperative findings in biliary surgery. Methods: This prospective study was conducted in General Hospital, comilla between the periods of July 2006 to June 2008 among 300 patients with biliary diseases for which operative treatment is planned. Comparison between sonographic findings with operative findings was performed. Results: Right hypochondriac pain and jaundice were two significant symptoms (93% and 15%). Right hypochondriac tenderness, jaundice and palpable gallbladder were most valuable physical findings (respectively, 40%, 15% and 5%). Out of 252 ultrasonically positive gallbladder, stone were confirmed in 249 cases preoperatively. Sensitivity of USG in diagnosis of gallstone disease was 100%. There was, however, 25% false positive rate detection. Specificity was, however, 75% in this case. USG could demonstrate stone in common bile duct in only 12 out of 30 cases. Sensitivity of the test in diagnosing common bile duct stone was 40%, false negative rate 60%. In the series, ultrasonography sensitivity was 100% in diagnosing stone in cystic duct. USG could detect with relatively good but less sensitivity the presence of chronic cholecystitis (92.3%) and worm inside gallbladder (50%). Conclusion: Ultrasonography is the most important investigation in the diagnosis of biliary disease and a useful test for patients undergoing operative management for planning and anticipating technical difficulties. Journal of Surgical Sciences (2018) Vol. 22 (1): 25-29

Download Full-text

The role of 99mTc mebrofenin hepatobiliary scanning in predicting common bile duct stones in patients with gallstone disease

Nuclear Medicine Communications ◽

10.1097/00006231-200403000-00012 ◽

2004 ◽

Vol 25 (3) ◽

pp. 285-289 ◽

Cited By ~ 5

Author(s):

Mohammed Iqbal ◽

Sandeep Aggarwal ◽

Rakesh Kumar ◽

Pramod Kumar Garg ◽

Suman Bandhu ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Gallstone Disease ◽

Common Bile Duct Stones ◽

Bile Duct Stones

Download Full-text

Bile Duct Stones Predict a Requirement for Cholecystectomy in Older Patients

World Journal of Surgery ◽

10.1007/s00268-019-05241-2 ◽

2019 ◽

Vol 44 (3) ◽

pp. 721-729 ◽

Cited By ~ 1

Author(s):

Yoichi Matsui ◽

Satoshi Hirooka ◽

Tatsuma Sakaguchi ◽

Masaya Kotsuka ◽

So Yamaki ◽

...

Keyword(s):

Bile Duct ◽

Older Patients ◽

Bile Duct Stone ◽

Elective Surgery ◽

Gallstone Disease ◽

Therapeutic Options ◽

Bile Duct Stones ◽

History Of ◽

Wait And See ◽

Elective Cholecystectomy

Abstract Background The requirement for elective cholecystectomy in older patients is unclear. To determine predictors for requiring elective cholecystectomy in older patients, a prospective cohort study was performed. Methods All patients with gallstone disease who presented to our department from 2006 to 2018 were included if they met the following criteria: (1) age 75 years or older, (2) presentation for elective cholecystectomy, and (3) preoperative diagnosis of cholecystolithiasis. Two therapeutic options, elective surgery and a wait-and-see approach, were offered at their initial visit. Enrolled patients were assigned to one arm of the study according to their choice of the therapeutic options. The primary endpoint was the incidence of gallstone-related complications. The endpoint was compared between patients who underwent cholecystectomy (CH group) and those who chose a wait-and-see approach (No-CH group). Results During the study period, there were 344 patients in the CH group and 161 in the No-CH group. Among patients with a history of bile duct stones, the incidence of gallstone-related complications in the No-CH group was significantly higher (45% within 3 years, including two gallstone-related deaths) than that in the CH group (RR 2.66, 95% confidence interval 1.50–4.77, p = 0.0009). Among patients with no history of bile duct stones, the incidence of gallstone-related complications in the No-CH group reached only 10% over the 12 years. Conclusion Cholecystectomy is recommended for older patients with both histories of cholecystolithiasis and bile duct stones, whereas a wait-and-see approach is preferable for patients with no bile duct stone history. A history of bile duct stones is a good predictor for cholecystectomy in older patients.

Download Full-text