Acute biliary pancreatitis: a prospective observational hospital-based study

Background: Acute biliary pancreatitis (ABP) is one of the most serious complications of gall stone disease with a high risk of morbidity and mortality. Hence accurate diagnosis and prompt management of ABP is very crucial. Different management strategies exist regarding indications and timing for interventions, endoscopic retrograde cholangio-pancreaticography (ERCP) and cholecystectomy.Methods: Ours is a prospective observational study of the different clinical presentations and management strategies and their respective outcomes in our hospital. All cases of ABP admitted over a period of one year were included in the study. The clinical presentation, severity and course of the disease, imaging studies, duration of ICU and hospital stay and timing of ERCP and cholecystectomy were studied.Results: A total of 56 cases were included in the study. Average age was 45 years. Pain abdomen was the most common symptom at presentation. About 82% patients had mild to moderate disease while the rest had severe disease. The mean duration of intensive care unit stay was 8 days. ERCP was done in 6 cases. Cholecystectomy during the same admission was dine in 20 cases. There were 2 deaths during the course of the study.Conclusions: Early intervention definitely reduces morbidity, mortality and recurrent admissions in cases of acute biliary pancreatitis. Same admission laparoscopic cholecystectomy is preferable in mild ABP. All cases of severe ABP must undergo early ERCP irrespective of biliary obstruction. This also helps in reducing readmissions due to pancreatic-biliary complications and is cost-effective.

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A one-year study of cholelithiasis at a tertiary care hospital of South India

International Surgery Journal ◽

10.18203/2349-2902.isj20182502 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2444

Author(s):

Ramalinga Reddy Rachamalla ◽

Kishore Kumar Markapuram ◽

Sreeram Satish

Keyword(s):

Gall Stone ◽

Stone Disease ◽

Hormonal Contraceptives ◽

Care Hospital ◽

Mixed Diet ◽

Female Ratio ◽

Gall Stones ◽

Increased Risk ◽

Gall Stone Disease ◽

One Year

Background: Gall stone disease is a chronic recurrent disease of hepatobiliary system characterised by formation of gall stones due to impaired metabolism of bile acids, cholesterol and bilirubin. The prevalence of cholelithiasis is variable and has been reported as 2-29% in India with differences in interstate and interregions. The objective of the present study was mainly focuses on the total clinical study with surgical management and their outcome.Methods: A prospective study for a period of one year was done after approval from ethical committee. The socio-demographic factors, clinical history, physical examination, laboratory investigations with ultrasound abdomen were done in all the cases. Surgical repair by Laparoscopic and open cholecystectomy was done.Results: Females were more predominant with male: female ratio of 1:1.97. Mean age of study population was 34.12±6.2 years and was more common during 5th decade of life. Pain in the hypochondrium was most common sign. Mixed stones were most common and mostly observed in cases of mixed diet. Laparoscopic cholecystectomy was most commonly performed with zero conversion rate. Wound infection was the most common post-operative complication in both the types of repair.Conclusions: To conclude, from the present study females were more commonly affected by cholelithiasis than males with a ratio of 1:1.97. Females are more prone during fertile age and reasons are multifactorial due to hormones, parity and hormonal contraceptives. Gall stone disease is more common during fourth and fifth decade of life in both males and females. Mixed diet (non-vegetarian) is associated with increased risk of developing gall stones than vegetarian diet.

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Pathophysiology and causes of jaundice in the critically ill

10.1093/med/9780199600830.003.0192 ◽

2016 ◽

Author(s):

Anand D. Padmakumar ◽

Mark C. Bellamy

Keyword(s):

Critically Ill ◽

Management Strategies ◽

Gall Stone ◽

Elevated Serum ◽

Stone Disease ◽

Bilirubin Metabolism ◽

Gall Stone Disease ◽

Underlying Causes ◽

Icu Physicians ◽

Enzymatic Pathways

Critically-ill patients develop jaundice for a variety of reasons. A good understanding of bilirubin metabolism can help the clinician to diagnose and treat jaundice. Intensive care unit (ICU) physicians commonly encounter elevated serum bilirubin in severely-ill patients, which can be associated with increased morbidity and mortality. A complex interaction of enzymatic pathways leads to safe excretion of bilirubin. This fine homeostasis is often disturbed and leads jaundice, which can be broadly classified into three main categories—prehepatic, hepatic, and post-hepatic. Common examples include sepsis, cardiac failure, drug toxicity, hepatic ischaemia, gall stone disease, etc. Management strategies directed towards the underlying causes aim to improve outcome. The aetiology can be often multifactorial and difficult to treat. This chapter provides a brief overview of bilirubin metabolism and aetiopathogenesis of jaundice. We also provide key recommendations to develop a systematic diagnostic approach, provide guidance on ordering appropriate investigations and on interpreting their results.

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CHOLEDOCHOLITHIASIS

The Professional Medical Journal ◽

10.29309/tpmj/2016.23.03.1469 ◽

2016 ◽

Vol 23 (03) ◽

pp. 257-261

Author(s):

Shabab Hussain ◽

Viqar Aslam ◽

Sajjad Muhammad Khan ◽

Waqar Alam Jan

Keyword(s):

Primary Repair ◽

Open Cholecystectomy ◽

Gall Stone ◽

Bile Leak ◽

Stone Disease ◽

Tube Placement ◽

Cbd Stones ◽

Gall Stone Disease ◽

Symptomatic Gallstones ◽

One Year

Objectives: To determine the frequency of choleducholethiasis in patientswith symptomatic gall stone disease and evaluation of primary closure of common bile ductwithout T-Tube placement after open exploration as a treatment modality in its management.Study Design: Prospective (descriptive) study. Setting: Surgical Unit of Postgraduate MedicalInstitute, Lady Reading Hospital, Peshawar. Period: One year from 15-03-2013 to 15-03-2014. Subjects and methods: Total 0f 206 patients of symptomatic gallstones disease wereincluded in the study to find out frequency of choledcholithias and patients with common bileduct (CBD) stones were subjected to open choledochotomy and primary choledochorrhaphy,and follow up of patients was done to find out any post operative complication. Results: Atotal of 206 patients underwent open cholecystectomy during the study period. The age ofthe patients ranged from 17 to 70 years with mean of 44.24±1.23 years. Most of the patientswith symptomatic gall stones disease were female in the age range of 41-50 years. Frequencyof choledocholethiasis was 24 out of 206 constituting 11.65%. Among the patients with CBDstones 4 were male constituting 16.6% and 20 were female that is 83.33% with male to femaleratio of 1:4 respectively. Mean hospital stay of the patients in which open CBD explorationand primary repair was performed was 7.25±1.45 days. Complications developed in only 4patients constituting 16.66%. Complications were wound infection in 2 (8.33%) patients, intraabdominalpus collection in 1 (4.16%) patient and bile leak in 1 (4.16%). One patient lost fromfollow up. In none of the patients retained CBD stones and stricture observed. Conclusions:There should be low

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Investigation of the Lith1 candidate genes ABCB11 and LXRA in human gall stone disease

Zeitschrift für Gastroenterologie ◽

10.1055/s-2006-950845 ◽

2006 ◽

Vol 44 (08) ◽

Author(s):

C Schafmayer ◽

J Tepel ◽

JH Egberts ◽

A Franke ◽

S Buch ◽

...

Keyword(s):

Candidate Genes ◽

Gall Stone ◽

Stone Disease ◽

Gall Stone Disease

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Early experience of laparoscopic cholecystectomy in acutely inflamed gallbladder

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1283 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Ali Abdul Hussein Handoz ◽

Ahmed Kh Alsagban

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Gall Stone ◽

The Elderly ◽

Stone Disease ◽

Definitive Treatment ◽

Adjacent Structures ◽

Common Causes ◽

Gall Stone Disease ◽

Male To Female

Gallstones are now among the most important disease in the era of surgery. Definitive treatment of gall stone disease remains cholecystectomy. One of the common causes of emergency surgical referral is acute cholecystitis of which 50-70% cases are seen in the elderly patients.50 patients were treated with laparoscopic cholecystectomy from October 2013 to October 2015. The patient’s age was from 20 to 65 years old with a mean age of 34 ±3 years old. The patients received in the emergency unit and their attack not more than 72 hrs of acute gall stone inflammation were included in this study.From the 50 patients,15 were males (34%) and females were 35 (74%) so the ratio of 1:2of male to female. Problems and complications that facing in this study at time of laparoscopy were mainly adhesions to the adjacent structures like stomach, colon, and omentum. Adhesion into CBD also considered.Early intervention for acute cholecystitis of calculus type by laparoscopy now regarding safe and gold standard approach that should be kept in mind when dealing with such cases.

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