Ultrasonography of the Gallbladder in Acute Pancreatitis

1989 ◽  
Vol 30 (4) ◽  
pp. 403-406 ◽  
Author(s):  
M. Soiva
Keyword(s):  
Acute Pancreatitis ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Gallbladder Wall ◽  
Sonographic Appearance ◽  
Significant Difference ◽  
Local Tenderness ◽  
The Mean ◽  
Fluid Collections

The sonographic appearance of the gallbladder in 52 patients with acute pancreatitis (AP) was evaluated and compared with the findings in acute cholecystitis (AC) and in normal gallbladders (N). The mean gallbladder wall thickness in the AP group, 3.2 mm, was significantly different from the thickness in the N group, 2.3 mm (p<0.001), and from that in the AC group, 5.2 mm (p<0.001). Wall edema, distension, tenderness (sonographic Murphy sign) and pericholecystic fluid collections were occasional findings in AP, and were not seen in normal gallbladders. A significant difference between the AP and AC groups was found in the prevalence of maximal local tenderness of the gallbladder (in only 2/52 in AP, but in 28/31 in AC).

scholarly journals Sonographic gallbladder wall thickness in normal adult population in Nigeria

2010 ◽  
Vol 14 (4) ◽  
pp. 84 ◽  
Author(s):  
S Mohammed ◽  
A Tahir ◽  
A Ahidjo ◽  
Z Mustapha ◽  
Franza O
Keyword(s):  
Wall Thickness ◽  
Adult Population ◽  
Clinical History ◽  
Gallbladder Wall ◽  
Normal Adult ◽  
Chi Square ◽  
Normal Ranges ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Mean

Aim. The aim of the study was to determine the ultrasonic gallbladder wall thickness in normal adult Nigerians so as to create standards for defining gallbladder abnormalities in Nigerians. Method. Four hundred adults comprising 228 (57%) women and 172 (43%) men aged 16 - 78 years, who had normal clinical history and physical findings, were recruited. The gallbladder wall thickness was obtained in the supine, prone and right anterior oblique positions. Differences in gallbladder wall thickness were determined using the chi-square test, while the relationship between the ultrasound-measured gallbladder wall thickness and the subjects’ age, sex, height and weight were analysed using the Pearson product moment correlation. Normal ranges and related statistics were estimated and tabulated according to age group and sex. Results. The mean age of the subjects was 32±13.2 years. The mean gallbladder wall thickness range was 1.8 - 2.8 mm±0.5mm. The thickness range for females was 1.7 - 2.7 mm±0.5 mm, and that for males was 1.9 - 2.9 mm±0.5 mm. There was a statistically significant difference (p

Ultrasonography in Acute Gallbladder Perforation

1988 ◽  
Vol 29 (1) ◽  
pp. 41-44 ◽  
Author(s):  
M. Soiva ◽  
M. Pamilo ◽  
M. Päivänsalo ◽  
M. Taavitsainen ◽  
I. Suramo
Keyword(s):  
Acute Cholecystitis ◽  
Peritoneal Fluid ◽  
Gallbladder Wall ◽  
Control Group ◽  
Gallbladder Perforation ◽  
University Hospitals ◽  
Fluid Collections ◽  
Free Peritoneal Fluid

The files of patients with acute cholecystitis from two large university hospitals from the years 1978–1985 were employed to find the cases with acute gallbladder perforation for this study. Only those patients (n=9) were selected for the analysis of sonographic signs of acute gallbladder perforation who had less than 48 hours of symptoms before sonography, and were operated upon within 24 hours of the sonography. Patients (n=10) with non-complicated acute cholecystitis and identical in regard to the duration of the symptoms and the timing of the sonography and the operation formed a control group. The sonographic findings in patients with gallbladder perforation were pericholecystic fluid collections, free peritoneal fluid, disappearance of the gallbladder wall echoes, focal highly echogenic areas with acoustic shadows in the gallbladder, and an inhomogeneous, generally echo-poor gallbladder wall.

scholarly journals Early enteral nutrition in acute pancreatitis - how beneficial is it?

2021 ◽  
Author(s):  
Shruthikamal Venkat ◽  
Rajesh Subramaniam ◽  
Vijai Raveendran
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Pain Score ◽  
Tamil Nadu ◽  
Early Enteral Nutrition ◽  
Medical College ◽  
Severe Pancreatitis ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

Background: Acute pancreatitis is an inflammatory disease of pancreas and is one of the leading cause of acute abdomen requiring hospital admission. Nutritional support plays a crucial role in this hypercatabolic state in not only providing calories but also in preventing complications and decreasing recovery time.Methods: This prospective study was done among 120 patients with acute moderate and severe pancreatitis who got admitted in department of general surgery at Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India between 2018 and 2019.Results: 67 (55.8%) patients were in early enteral and 53 (44.2%) were in parenteral/delayed enteral group. Maximum number of patients were in 30-40 years age group. The mean of patient age was 40.33. Mean duration of hospital stay in enteral group was 7.06 and in parenteral/delayed enteral group it was 14.09 (p<0.001). Mean pain score in enteral group was 2.69 and in parenteral group it was 6.51 (p<0.001).Conclusions: There was significant (p<0.001) decrease in hospital stay duration and pain score in early enteral group compared to parenteral/delayed enteral group. Infections related to feeding route was found high in parenteral group. No significant difference found in complications of acute pancreatitis. Hence early enteral feeding is more beneficial in terms of shortened hospital stay, decreased pain score leading to reduction in usage of analgesics and reducing the recovery time and less nutrition related complications in management of acute moderate and severe pancreatitis.

scholarly journals To Estimate the Importance of Wharton’s Jelly in the Growth of the Foetus – A Light Microscopic Study

2021 ◽  
Vol 10 (35) ◽  
pp. 3024-3029
Author(s):  
Sreekumar Rajasekharan ◽  
UmesanKannanvilakom Govindapillai ◽  
Manju Madhavan C. ◽  
Suja R. S. ◽  
Swapna T ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Wall Thickness ◽  
Umbilical Artery ◽  
Umbilical Vein ◽  
Wharton’S Jelly ◽  
External Diameter ◽  
Single Umbilical Artery ◽  
Wharton's Jelly ◽  
Significant Difference ◽  
The Mean

BACKGROUND Human umbilical cord contains two arteries and one vein with their tunica intima and tunica media layers. The role of tunica adventitia is fulfilled by Wharton’s jelly, a mucoid connective tissue. The function of Wharton’s jelly is to prevent the vessels from compression and torsion which is essential for foetal development. The purpose of the study was to estimate the importance of Wharton’s jelly in the growth of the foetus. METHODS Umbilical cord tissue collected from each case was immediately put in 10 % formalin for fixation. Slides were then stained with Haematoxylin and Eosin. These slides were then read under light microscopy and measurements were taken using a photomicrograph. Wharton’s jelly area was calculated by subtracting the total vessel area from the umbilical cord area. RESULTS The histological measurements of umbilical vessels include the external diameter, lumen diameter, wall thickness, thickness of tunica intima and tunica media, and the area. The mean area of the umbilical cord was 35.73 ±23.04 mm2 (Mean ± SD) and the mean area of the Wharton’s jelly was 29.74 ± 19.26 mm2. There was a significant difference in the external diameter and wall thickness of the umbilical artery. Analyses showed that there was a significantly (P < 0.01) increased external diameter and wall thickness of umbilical artery in normal cases, compared to single umbilical artery cases. CONCLUSIONS There was a significant positive correlation between the gestational age and the external diameter of the umbilical cord. There was a significant difference in the external diameter of the umbilical cord between SUA cases (4.45 mm) and the other foetuses with normal umbilical cord (6.53 mm). There was a significantly increased external diameter, lumen diameter, wall thickness and area of umbilical vein in normal cases, compared to single umbilical artery cases. There was a significantly increased area of umbilical cord and area of Wharton’s jelly in normal umbilical cord foetuses than foetuses with a single umbilical artery. KEY WORDS Foetus, Umbilical Cord, Wharton’s Jelly, Umbilical Artery, Umbilical Vein, Light Microscopy

Significance of Preoperative Ultrasound Measurement of Gallbladder Wall Thickness

2007 ◽  
Vol 73 (9) ◽  
pp. 926-929 ◽  
Author(s):  
James Majeski
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Acalculous Cholecystitis ◽  
Gallbladder Wall ◽  
Chronic Cholecystitis ◽  
Entire Series ◽  
Calculous Cholecystitis ◽  
Gallbladder Ultrasound

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (≥3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure.

Intraperitoneal Chemotherapy by Ultrasound-Guided Direct Puncture in Recurrent Ovarian Cancer: Feasibility, Compliance, and Complications

2012 ◽  
Vol 22 (6) ◽  
pp. 1069-1074 ◽  
Author(s):  
Pierluigi Benedetti-Panici ◽  
Giorgia Perniola ◽  
Claudia Marchetti ◽  
Milena Pernice ◽  
Cristina Donfrancesco ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Abdominal Wall ◽  
Wall Thickness ◽  
Recurrent Ovarian Cancer ◽  
Pain Scale ◽  
Direct Puncture ◽  
Significant Difference ◽  
The Mean ◽  
Chemotherapy Patients ◽  
Ultrasonographic Guidance

ObjectiveThis prospective pilot study investigated the feasibility, complications, and compliance of the administration of intraperitoneal (IP) chemotherapy by direct puncture under ultrasonographic guidance performed on consecutive patients with recurrent ovarian cancer (ROC).MethodsPatients were evaluated to undergo secondary cytoreduction and/or to receive IP chemotherapy. Patients received standard intravenous therapy for ROC plus IP administration by direct puncture needle, under ultrasonographic guidance.ResultsFrom January 2008 to January 2011, 38 patients were enrolled. A total of 402 IP procedures were performed, with a mean of 10.5 procedures per patient. The feasibility rate was 97.4%. In 237 cases (98.8%) of subgroup 1 (abdominal wall thickness ⩽6 cm), the procedure was performed after 1 attempt, meanwhile in 6% of cases of subgroup 2 (abdominal wall thickness >6 cm), more than 1 attempt was necessary (P < 0.01). The mean procedure time was 10 minutes (range, 5–30 minutes). We recorded a total of 2.25% mild intraprocedure complications. No significant difference was identified for the complication rate according to the abdominal wall thickness or according to the number of previous laparotomies. A total of 5 procedures (1.2%) were not performed as a result of patients’ noncompliance. The mean pain score according to the visual analog pain scale was moderate at the first evaluation (after 3 minutes) and mild at the final evaluation (after 10 minutes).ConclusionsThe administration of IP chemotherapy with a direct puncture, under ultrasound guidance, for patients with ROC, is a safe and feasible method, with a high acceptance from patients.

scholarly journals Changes in the management of patients with severe acute pancreatitis

2008 ◽  
Vol 45 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Tercio De Campos ◽  
Candice Fonseca Braga ◽  
Laíse Kuryura ◽  
Denise Hebara ◽  
José Cesar Assef ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Apache Ii ◽  
Specific Approach ◽  
Severe Pancreatitis ◽  
Group A ◽  
The Mean ◽  
Fluid Collections ◽  
Group B

BACKGROUND: Severe acute pancreatitis is present in up to 25% of patients with acute pancreatitis, with considerable mortality. Changes in the management of acute pancreatitis in the last 2 decades contributed to reduce the mortality. AIM: To show the evolution in the management of severe acute pancreatitis, comparing two different approaches. METHODS: All patients with severe acute pancreatitis from 1999 to 2005 were included. We compared the results of a retrospective review from 1999 to 2002 (group A) with a prospective protocol, from 2003 to 2005 (group B). In group A severe pancreatitis was defined by the presence of systemic or local complications. In group B the Atlanta criteria were used to define severity. The variables analyzed were: age, gender, etiology, APACHE II, leukocytes, bicarbonate, fluid collections and necrosis on computed tomography, surgical treatment and mortality. RESULTS: Seventy-one patients were classified as severe, 24 in group A and 47 in group B. The mean APACHE II in groups A and B were 10.7 ± 3.5 and 9.3 ± 4.5, respectively. Necrosis was seen in 12 patients (50%) in group A and in 21 patients (44.7%) in group B. Half of the patients in group A and two (4.3%) in group B underwent to pancreatic interventions. Mortality reached 45.8% in group A and 8.5% in group B. CONCLUSION: A specific approach and a prospective protocol can change the results in the treatment of patients with severe acute pancreatitis.

scholarly journals Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3354
Author(s):  
Mohanapriya Thyagarajan ◽  
Balaji Singh ◽  
Arulappan Thangasamy ◽  
Shobana Rajasekar
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Gallbladder Wall ◽  
Related Factors ◽  
Previous Episode ◽  
Factors Influencing

Background: Gall stone disease is a common disease affecting human beings. Over the past two decades, laparoscopic cholecystectomy has become gold standard for the surgical treatment of gallbladder disease. The advantages of laparoscopic cholecystectomy over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses. This study was planned to identify the circumstances and the risk factors influencing the conversion of laparoscopic cholecystectomy to open procedure.Methods: This is a Prospective study conducted over a period of 24 months. A total of 50/500 patients who were electively posted for laparoscopic cholecystectomy and got converted into open cholecyctectomy were included in the study. The Factors recorded and analysed were Age and Sex of the patient, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, presence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness and presence of pericholecystic fluid.Results: In our study, it has been observed that Patient Related Factors - Age >50yrs, Male gender, Presence of Diabetes Mellitus, Obesity, previous Abdominal surgeries and Disease Related Factors - previous episode of Acute Cholecystitis, presence of Acute Cholecystitis, Gallbladder wall thickness >4mm, presence of Pericholecystic fluid were found to be significant risk factors in conversion of laparoscopic to open cholecystectomy.Conclusions: These risk factors help to predict the difficulty of the procedure and this would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.

scholarly journals Utility of pre-operative abdominal ultrasound to predict conversion to open cholecystectomy

2021 ◽  
Vol 8 (10) ◽  
pp. 3007
Author(s):  
Reetesh Sharma ◽  
Ramesh Dumbre ◽  
Arun Fernandese ◽  
Deepak Phalgune
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Wall Thickness ◽  
Open Cholecystectomy ◽  
Fluid Collection ◽  
Biliary Tree ◽  
Gallbladder Wall ◽  
Significant Difference ◽  
Conversion To Open Cholecystectomy

Background: Many factors like unclear Calot triangle anatomy, intensely inflamed and thick gallbladder, dense adhesions in the operative area, obscure biliary tree anatomy, local inflammation like pancreatitis contribute to the conversion of laparoscopic cholecystectomy to open cholecystectomy. The aim of the present study was to find the utility of abdomen sonography parameters that predict the conversion from laparoscopic to open cholecystectomy.Methods: Ninety patients aged between 20 and 75 years with the diagnosis of cholelithiasis/cholecystitis were included in this observational study. Every patient underwent ultrasonography (USG). The USG findings such as gallbladder wall thickness, presence or absence of stones, number of calculi, size of the calculi, presence of abdominal adhesions, size of the common bile duct was recorded. If feasible, laparoscopic cholecystectomy was done. If not, the procedure was converted to open cholecystectomy. Association of USG findings was correlated with conversion to open cholecystectomy. The comparison of the qualitative variables was done using Fisher’s exact test. Results: Of 90 patients, 7 (7.8%) had a conversion to open cholecystectomy. There was no statistically significant difference of USG parameters studied such as gallbladder wall thickness >4 mm, pericholecystic fluid collection, common bile duct diameter >7 mm, presence of calculus, number of calculi, size of calculus >6 mm and adhesions/fibrosis in patients who required conversion to open cholecystectomy and who were operated laparoscopically.Conclusions: Pre-operative USG parameters did not predict conversion to open cholecystectomy.

Ultrasonography and Gallbladder Perforation in Acute Cholecystitis

1988 ◽  
Vol 29 (2) ◽  
pp. 203-205 ◽  
Author(s):  
L. Forsberg ◽  
R. Andersson ◽  
E. Hederström ◽  
K.-G. Tranberg
Keyword(s):  
Early Diagnosis ◽  
Acute Cholecystitis ◽  
Fluid Collection ◽  
Gallbladder Wall ◽  
Gallbladder Perforation ◽  
Free Fluid ◽  
Patients At Risk ◽  
Common Sign ◽  
Fluid Collections ◽  
Gallbladder Fossa

A group of 24 patients with perforated gallbladder operated upon between 1980 and 1987 was compared with a group of 21 patients operated upon in 1982 due to uncomplicated acute cholecystitis in order to find out whether it was possible to use some specific sonographic signs to find the patients at risk of perforation. Free fluid and fluid collections close to the gallbladder fossa were found in 9 patients. The patients with perforated gallbladders tended to have a slightly thicker gallbladder wall—7 mm (range 3–20 mm)—when compared with the uncomplicated cases of acute cholecystitis—5.3 mm (range 2–13 mm). Localized fluid collection in the wall of a gallbladder was seen in a patient just prior to the perforation. It was, however, not possible to find a common sign characteristic for imminent perforation. The study showed, however, that the combination of early diagnosis with ultrasound together with aggressive surgery reduced the mortality at gallbladder perforation to none in the last 9-year-period compared with 10 per cent in the previous 9-year-period.

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