scholarly journals Laproscopic cholecystectomy an analysis of 787 cases with reference to predictors on level of difficulty and the influence of early conversion to reduce IBDI and other complications

2017 ◽  
Vol 4 (9) ◽  
pp. 3034
Author(s):  
Suresh Kalyanasundar ◽  
Ashok Bhatnagar
Keyword(s):  
Average Rate ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Normal Liver Function ◽  
Careful Planning ◽  
Subtotal Cholecystectomy ◽  
History Of ◽  
Elective Surgical Procedure ◽  
The Right ◽  
Iatrogenic Bile Duct Injury

Background: Laparoscopic cholecystectomy is the most common major elective surgical procedure all over the globe. The complications associated with the procedure also become important for surgeons to manage well, strive to prevent them from occurring.Methods: The study was prospective and involved 787 cases in a period of 60 months starting from January 2013 to January 2017 which were diagnosed to have cholelithiasis sonologically, features to suggest acute cholecystitis and a normal CBD, with normal liver function tests, clinical examination did not reveal a palpable lump in the right hypochondrium and the history of acute pain was less than 72 hours.Results: The total number of cases 787 and 127 (16%) there were complications of which 0.2 % was biliary injuries and rest were nonbiliary. IBDI occurred in 02cases in this series which is 0.25% and 125 cases there was Nonbiliary complications. The incidence of iatrogenic bile duct injury (IBDI) in LC is 0.4%- 1.3 % compared to 0.2%- 0.3% for OC. 108 cases were converted to an open procedure (13%) and the average rate globally 5 % to 10%.Conclusions: LC should be planned in all cases of cholelithiasis, it is helpful to preoperatively and operatively grade the cases for the operative ease and cases which fall in the category of extreme it is better to resort to conversion early or even a planned open surgery. The low complication rate especially biliary is because of a careful planning preoperatively and operatively as per prediction scales which we used, a low tolerance to conversion and because of adopting the practice of subtotal cholecystectomy.

Persistently raised aspartate aminotransferase (AST) due to macro-AST in a rheumatology clinic

Diagnosis ◽  
2015 ◽  
Vol 2 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Wycliffe Mbagaya ◽  
Joanne Foo ◽  
Ahai Luvai ◽  
Claire King ◽  
Sarah Mapplebeck ◽  
...  
Keyword(s):  
Liver Function ◽  
Aspartate Aminotransferase ◽  
Normal Liver ◽  
Abdominal Ultrasound ◽  
Liver Function Tests ◽  
Analytical Investigation ◽  
Normal Liver Function ◽  
Rheumatology Clinic ◽  
History Of ◽  
Liver Biopsies

AbstractMacrocomplexes between immunoglobins and aspartate aminotransferase (macro-AST) may result in persistently increased AST concentration. The presence of macro-AST in patients has been implicated in unnecessary investigations of abnormal liver function tests. We report the case of a 44-year-old female who presented to the rheumatology clinic with a 12-months’ history of constant widespread pain affecting her limbs and was found to have an elevated AST concentration. Further information from her GP revealed a 14-years’ history of elevated AST with otherwise normal liver function. Previous abdominal ultrasound and two liver biopsies carried out 2 years apart were normal. This prompted further analytical investigation by the biochemistry department which identified macro-AST as the cause. This case illustrates that persistently raised isolated AST concentration with no other abnormal indices may warrant macroenzyme analysis potentially avoiding unnecessary invasive investigations.

Management of Obscurely Dilated Common Bile Duct with Normal Liver Function Tests: A Pragmatic Approach

2021 ◽  
Author(s):  
Sundeep Singh Saluja ◽  
Vaibhav Kumar Varshney ◽  
Vidya Sharada Bhat ◽  
Phani Kumar Nekarakanti ◽  
Asit Arora ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Liver Function ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Pragmatic Approach ◽  
Normal Liver Function ◽  
Function Tests

scholarly journals Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Fahri Yetişir ◽  
Akgün Ebru Şarer ◽  
Hasan Zafer Acar ◽  
Omer Parlak ◽  
Basar Basaran ◽  
...  
Keyword(s):  
Laparoscopic Resection ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Mirizzi Syndrome ◽  
Intermittent Fever ◽  
Subtotal Cholecystectomy ◽  
Type V ◽  
First Time ◽  
Cholecystocolic Fistula

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely.

scholarly journals Rumpel-Leede Phenomenon: A Case Report

1970 ◽  
Vol 9 (4) ◽  
Author(s):  
Rehman HU, MBBS, FRCPC ◽  
Kambo J, MD
Keyword(s):  
Complete Blood Count ◽  
Vital Signs ◽  
Liver Function Tests ◽  
Left Hand ◽  
Lower Base ◽  
Associated Symptoms ◽  
Chest Auscultation ◽  
History Of ◽  
Artery Disease ◽  
The Right

A 72-year-old woman presented with a one-week history of fever, non-productive cough, and three unwitnessed syncopal episodes, with no other associated symptoms. She had poor recollection of the episodes, but denied urinary/fecal incontinence, tongue biting, numbness, parasthesias, or weakness. Her medical history was significant for hypertension, dyslipidemia, leg ulcers, psoriasis, stress incontinence, and gastroesophageal reflux disease. She did not have diabetes, coronary artery disease, or peripheral vascular disease. Her medications included Atorvastatin, Enalapril, Hydrochlorothiazide, Lansoprazole, and Calcium. She did not smoke or drink. On examination, her vital signs were stable and she was afebrile. Chest auscultation revealed crackles in the right lower base. She developed an erythematous, lacy sharply demarcated rash on her left hand that lasted for 3–4 hours after her blood pressure was taken on the same arm (Figures 1 and 2). Blood tests were unremarkable and included glucose, complete blood count, electrolytes, urea, creatinine, liver function tests, and coagulation studies.

scholarly journals Bilirubin Metabolism — Preliminary Investigation

1976 ◽  
Vol 3 (4) ◽  
pp. 365-372 ◽  
Author(s):  
A. Barbeau ◽  
G. Breton ◽  
B. Lemieux ◽  
R.F. Butterworth
Keyword(s):  
Liver Function ◽  
Membrane Transport ◽  
Total Bilirubin ◽  
Preliminary Investigation ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Bimodal Distribution ◽  
Secondary Component ◽  
Normal Liver Function ◽  
Bilirubin Metabolism

SUMMARY:In our studies, high total bilirubin values in the plasma were noted in cases of Friedreich's ataxia. A bimodal distribution of the values indicated the possible presence of two subgroups of patients. In these kindred, we demonstrated an elevation in unconjugated bilirubin with features similar to those reported in Gilbert's syndrome: normal liver function tests, elevation after fasting and day to day variability. We also report preliminary experiments indicating that bilirubin levels may be taurine dependent. We postulate that the defect could be a secondary component of the ataxic disease, possibly indicating a defect in membrane transport.

scholarly journals Fatal Nonhepatic Hyperammonemia in ICU Setting: A Rare but Serious Complication following Bariatric Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Gyanendra Acharya ◽  
Sunil Mehra ◽  
Ronakkumar Patel ◽  
Simona Frunza-Stefan ◽  
Harmanjot Kaur
Keyword(s):  
Bariatric Surgery ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Ammonia Level ◽  
Gastric Bypass Procedure ◽  
History Of ◽  
Serum Ammonia Level ◽  
Pedal Edema ◽  
Serum Ammonia

Bariatric surgery is well established in reducing weight and improving the obesity-associated morbidity and mortality. Hyperammonemic encephalopathy following bariatric surgery is rare but highly fatal if not diagnosed in time and managed aggressively. Both macro- and micronutrients deficiencies play a role. A 42-year-old Hispanic female with a history of Roux-en-Y Gastric Bypass Procedure was brought to ED for progressive altered mental status. Physical exam was remarkable for drowsiness with Glasgow Coma Scale 11, ascites, and bilateral pedal edema. Labs showed elevated ammonia, low hemoglobin, low serum prealbumin, albumin, HDL, and positive toxicology. She remained obtunded despite the treatment with Narcan and flumazenil and the serum ammonia level fluctuated despite standard treatment with lactulose and rifaximin. Laboratory investigations helped to elucidate the etiology of the hyperammonemia most likely secondary to unmasking the functional deficiency of the urea cycle enzymes. Hyperammonemia in the context of normal liver function tests becomes diagnostically challenging for physicians. Severe hyperammonemia is highly fatal. Early diagnosis and aggressive treatment can alter the prognosis favorably.

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