scholarly journals Prevalence of pancreaticobiliary reflux in symptomatic cholelithiasis and its significance

2014 ◽  
Vol 9 (1) ◽  
pp. 1-6
Author(s):  
TP Bohara ◽  
A Parajuli ◽  
GR Bajracharya ◽  
MR Joshi
Keyword(s):  
Gall Bladder ◽  
Serum Amylase ◽  
Biliary Tree ◽  
Abdominal Ultrasound ◽  
Amylase Level ◽  
Bile Sample ◽  
Symptomatic Cholelithiasis ◽  
Study Materials ◽  
Calot’S Triangle ◽  
Functionally Impaired

Aims: Pancreaticobiliary reflux (PBR) is reflux of pancreatic enzymes into the biliary tree which occurs as a result of an anamoly of pancreaticobiliary junction (PBJ) or functionally impaired sphincter. PBR is associated with changes in biliary epithelium and is known to cause benign and malignant biliary pathology. Various authors have reported prevalence of PBR in patients with normal PBJ ranging from 20 % to 83.5 %. With aim to detect the prevalence of PBR in patients with symptomatic cholelithiasis in Nepalese population we conducted this study. Materials and methods: Thirty patients undergoing elective laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis were included in the study. History, physical findings and relevant investigations including liver function test, serum amylase and abdominal ultrasound were recorded. Bile sample for amylase was taken from gall bladder during LC percuatneously before manipulation of calot’s triangle and common bile duct. Bile amylase level above serum amylase level was considered positive for PBR. Results: Mean age of the patient was 37.27 (± 14.41) years. Out of 30, 6 (20 %) patients were male and 24 (80 %) were female. Mean BMI was 21.58 (± 3.2). PBR reflux was present in 66.7 % of patients out of which 2 were male and 18 were female that was not statistically significant (p = 1.41) when compared with patients without PBR. Conclusion: PBR occurs in patient with cholelithiasis and has role in pathogenesis of gallstones disease and gall bladder carcinoma. Long term surveillance would be required to ascertain the significance of detection of PBR after LC. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9666

scholarly journals Role of Biochemical Investigation in Prediction of Biliary Etiology in Acute Pancreatitis

2013 ◽  
Vol 52 (189) ◽  
pp. 229-232 ◽  
Author(s):  
Tanka Prasad Bohara ◽  
Anuj Parajuli ◽  
Mukund Raj Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Liver Function ◽  
Liver Function Test ◽  
Serum Amylase ◽  
Gall Stone ◽  
Abdominal Ultrasound ◽  
Stone Disease ◽  
Amylase Level ◽  
Biliary Pancreatitis ◽  
Function Test

Introduction: Acute pancreatitis is common clinical resentation. Gall stone disease and alcohol consumption are most common etiologies. Detection of biliary etiology is important in order to provide definite management in form of cholecystectomy to prevent further attacks. Sensitivity for abdominal ultrasound to detect cholelithiasis is decreased to 67–87% in presence of acute pancreatitis. Difference in biochemical investigations of acute biliary and non-biliary pancreatitis has been proposed to increase the suspicion of biliary etiology. Methods: Sixty patients admitted with diagnosis of acute pancreatitis from March 2012 to December 2012 were included in the study. The relation between etiology with age, sex, admission serum amylase and liver function test were evaluated. Results: Out of 60 patients 38 (63.33%) and 22 (36.66%) had biliary and non-biliary etiology respectively. Biliary pancreatitis was more common in females (25 vs. 3). Distribution of severity was comparable between both groups. Biliary pancreatitis group had significantly higher amylase level (3466.42 vs. 1987.5, p 0.003) whereas values of liver function test were higher in biliary pancreatitis though not statistically significant. Conclusions: A simple, rapid and accurate prediction of biliary etiology of acute pancreatitis can be provided by changes in biochemical parameters. Keywords: Acute Pancreatitis; Biliary Pancreatitis; Serum Amylase.  

scholarly journals Patients with Non-diagnostic Hyperamylasaemia Must be Investigated and Managed as per Acute Pancreatitis

2012 ◽  
Vol 3 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Huw G Jones ◽  
Nicky Jardine ◽  
Jeremy Williamson ◽  
Malcolm CA Puntis ◽  
Gareth J Morris-Stiff
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Epigastric Pain ◽  
Biliary Tree ◽  
University Hospital ◽  
Amylase Level ◽  
Median Serum ◽  
Drug History ◽  
Clinical Dilemma ◽  
Upper Abdominal

Objectives The identification of hyperamylasaemia insufficient to confidently diagnose acute pancreatitis in patients with epigastric pain poses a clinical dilemma. The aim of this study was to identify a cohort of such patients and review their presentation, investigation and outcome. Design Patients admitted through the emergency surgical intake during a 12-month period with serum amylase levels of 100–400 IU/L were identified and case notes reviewed to confirm those presenting with upper abdominal pain. Subsequent radiological and biochemical investigations were recorded. Participants A total of 25 patients with non-diagnostic hyperamylasaemia. Setting Ward patients in a University Hospital. Main outcome measures Amylase level, eventual diagnosis, drug history. Results Twenty-five patients were identified with a mean age of 46.7 years. The median serum amylase level was 230 IU/L (range 102–358 IU/L). Twenty-two patients underwent transabdominal ultrasound at presentation, with gallstones identified in nine cases. The remaining three had documented gallstones and were awaiting elective cholecystectomy. Of the 13 patients with no evidence of cholelithiasis, six were taking medications known to cause pancreatitis, seven patients underwent computed tomography (CT) scans that identified chronic pancreatitis in three, and were non-diagnostic in four cases. These four patients underwent endoscopic ultrasound (EUS) evaluation of the biliary tree identifying microlithiasis in one but no pathology in the remaining three cases. Conclusions Patients with hyperamylasaemia not diagnostic of pancreatitis should be carefully investigated, as gallstones will be identified in at least 50%. An accurate drug history is also invaluable.

Feline abdominal ultrasonography: what’s normal? what’s abnormal? The biliary tree

2019 ◽  
Vol 21 (5) ◽  
pp. 429-441 ◽  
Author(s):  
Sally Griffin
Keyword(s):  
Gall Bladder ◽  
Bile Ducts ◽  
Ultrasound Examination ◽  
Biliary Tree ◽  
Abdominal Ultrasound ◽  
Liver Parenchyma ◽  
Evidence Base ◽  
Vital Role ◽  
Abdominal Ultrasonography ◽  
Operator Experience

Practical relevance: Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. The biliary tree encompasses the liver, gall bladder and bile ducts, although only diseases affecting the latter two are discussed here. Diseases of the bile ducts and gall bladder are more common than those of the liver parenchyma and ultrasound plays an important role in their diagnosis. Clinical challenges: Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. In addition, a lack of pathological change does not necessarily rule out disease; for example, absence of gall bladder and/or extrahepatic biliary distension is not sufficient to exclude the possibility of biliary obstruction, and in many cases of cholangitis the liver and biliary tree are unremarkable on ultrasound examination. Equipment: Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. Aim: This review, part of an occasional series on feline abdominal ultrasonography, discusses the appearance of the normal and diseased biliary system. It is aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Percutaneous ultrasound-guided cholecystocentesis is also covered. Ultrasound examination of the liver was discussed in an article published in January 2019 and an upcoming article will cover hepatic vascular anomalies. Evidence base: Information provided in this article is drawn from the published literature and the author’s own clinical experience.

scholarly journals Pre-operative prediction of difficult laparoscopic cholecystectomy from clinical, hematological and radiological parameters

2018 ◽  
Vol 5 (12) ◽  
pp. 3807
Author(s):  
Hardik Parmar ◽  
Sahdevsinh Chauhan ◽  
R. Arun ◽  
Akshay Sutaria
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Serum Amylase ◽  
Leukocyte Count ◽  
Open Cholecystectomy ◽  
The Other ◽  
Patient Counselling ◽  
Abdominal Tenderness ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy

Background: The aim of study was to formulate a scoring system to predict difficult laparoscopic cholecystectomy (LC) pre-operatively; depending on the specific parameters of an individual patient.Methods: We have included 100 patients who underwent LC from July 2010 to December 2012. Conversion to open cholecystectomy in relation with age, sex, attack of acute cholecystitis, fever, abdominal tenderness, serum amylase and LDH level, status of GB and GB wall thickness, number of stone, leukocyte count and CBD diameter were assessed.Results: The most important reason for conversion was adhesions at Calot's triangle (60%), followed by contracted gall bladder (15%). The other reasons of conversion were empyema of the gall bladder (15%), stone at Hartmann's pouch (10%), bleeding during dissection (5%).Conclusions: This study will surely help the surgical fraternity in the future to plan the particular patients for appropriate mode of surgery, pre-operative preparation, patient counselling and most importantly to predict the score for the difficult interval Laparoscopic Cholecystectomy.

scholarly journals A prospective observational study to study and correlate the clinical and microbiological profile of bile cultures in patients with symptomatic cholelithiasis

2020 ◽  
Vol 7 (5) ◽  
pp. 1566
Author(s):  
Ramakrishnan Shankaran ◽  
Chaminda Amarasekara
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Gallstone Disease ◽  
Significant Proportion ◽  
Antibiotic Sensitivity ◽  
Klebsiella Species ◽  
Duration Of Symptoms ◽  
Symptomatic Cholelithiasis ◽  
Bile Culture ◽  
Symptomatic Gallstone Disease

Background: Biliary infection has been reported in a significant proportion of patients developing gallstones. Many studies have found biliary microflora in 20% to 46% patients with a post-operative infection rate of 7% to 20% in those who undergo cholecystectomy for symptomatic gallstone disease. Various antibiotics are also used empirically as prophylaxis against post-operative infection. The study was conducted in order to determine the bacteriology and to test its sensitivity to commonly used antibiotics of aspirated bile samples taken during laparoscopic cholecystectomy, and to correlate it with the clinical profile recorded in patients with symptomatic cholelithiasis.Methods: A total of 266 patients who underwent laparoscopic cholecystectomy were included in the study over a two year period. Intra operatively, bile was aspirated from gall bladder and sent for culture and antibiotic sensitivity testing.Results: 14.66% (39 out of 266) patients had positive growth with Escherichia coli most commonly isolated in 9.77% (26/266) patients, followed by the Klebsiella species in 4.89% (13 out of 266) patients. All the cultures were sensitive to amikacin and meropenem, 97.44% to imipenem, and only 43.39% were sensitive to ampicillin. A statistically significant correlation was observed between a positive bile culture with the duration of symptoms (p=0.01874) and gall bladder thickness (p<0.0001). No correlation was seen between bile culture and history of acute cholecystitis, number or size of calculi.Conclusions: The results of this study can help develop local guidelines and recommendations based on Indian data to ensure the rational use of prophylactic antibiotics in patients with symptomatic cholelithiasis.

scholarly journals Secrets, puzzles and mysteries of macroamylasemia

2020 ◽  
Vol 46 (1) ◽  
pp. 12-22
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevich ◽  
T. L. Mozhyna
Keyword(s):  
Serum Amylase ◽  
Amylase Activity ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Normal Serum ◽  
Amylase Level ◽  
Clearance Ratio ◽  
Urine Amylase ◽  
Classical Constant

Physiological features of amylase synthesis and excretion are considered in the article, presence of other sources of amylase synthesis different from pancreas and salivary glands is emphasized. Definitions of hyperenzymemia and macroamylasemia (MAE) are given. MAE is a state characterized by presence of circulating complexes of normal serum amylase with protein or carbohydrates in blood. There are 3 types of MAE: first — classical (constant hyperamylasemia, decreased amylase level in urine, high blood concentration of macroamylase complexes); second — hyperamylasemia with slightly decreased amylase activity in urine, macroamylase/normal amylase ratio is less than in the first type; third — normal blood and urine amylase activity, low macroamylase/normal amylase ratio. Pathogenesis is explained by connection of blood amylase and acute phase protein in different inflammatory, infectious diseases, malabsorption. MAE clinical manifestations could be absent, sometimes abdominal pain is possible. Hyperamylasemia and reduced urine amylase activity are typical. MAE diagnostics means determination of macroamylase complexes in blood (chromatography, calculation of the clearance ratio of amylase and creatinine). The article presents clinical cases describing extra-pancreatic MAE in women with malignant ovarian lesions. The question of expediency of thorough diagnostic examination in asymptomatic MAE is raised, which may turn out to be a symptom of cancer. The lack of specific treatment for MAE is emphasized.

scholarly journals Arthralgia and Osteolytic Lesions Associated with Traumatic Pancreatitis in a 10-Year-Old Girl

2009 ◽  
Vol 2009 ◽  
pp. 1-3
Author(s):  
Masayuki Obatake ◽  
Yusuke Yamane ◽  
Takayuki Tokunaga ◽  
Yasuaki Taura ◽  
Yukio Inamura ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Joint Pain ◽  
Serum Amylase ◽  
Knee Joints ◽  
Pancreatic Pseudocysts ◽  
Amylase Level ◽  
Serum Amylase Level ◽  
Osteolytic Lesions ◽  
Pseudocyst Drainage ◽  
Traumatic Pancreatitis

A case of traumatic pancreatitis with subsequent joint pain and osteolytic lesions is presented. A 10-year-old girl was admitted to our hospital with abdominal pain caused by blunt epigastric injury. She was diagnosed with traumatic pancreatitis, and multiple pancreatic pseudocysts subsequently developed. Two weeks after admission, she complained of joint pain, and MR revealed osteolytic lesions of both knee joints. On the 58th day, endoscopic transgastric pseudocyst drainage was performed. Joint pain and osteolytic lesions resolved rapidly, in parallel with the decrease in serum amylase level and pseudocyst size.

Frequency of gall bladder carcinoma in cholecystectomies for symptomatic cholelithiasis

2020 ◽  
pp. 1-4
Author(s):  
Muhammad Amar Qudeer ◽  
Syed Asghar Naqi ◽  
Muhammad Zeeshan Sarwar ◽  
Hafiza Amina Mujahid ◽  
Admin
Keyword(s):  
Survival Rate ◽  
Gall Bladder ◽  
Gall Bladder Carcinoma ◽  
Stone Size ◽  
Gastrointestinal Malignancies ◽  
Gallbladder Polyps ◽  
Symptomatic Cholelithiasis ◽  
Carcinoma Gall Bladder ◽  
Gall Stones ◽  
Carcinoma Gallbladder

It was a Letter to the Editor to find out the frequency of carcinoma gall bladder in patients which were presented with symptomatic cholelithiasis. Carcinoma of the gallbladder is a rear malignancy with 5 year survival rate of 5%. Carcinoma gall bladder is the most common billiary tract malignancy, it is also 5th most common in gastrointestinal malignancies 1. In Pakistan the incidence of carcinoma gallbladder among patients having symptomatic cholelithiasis is 6 to 28%2. Patients with symptomatic gall stones had more risk for developing carcinoma gallbladder as compared to asymptomatic gall stones. Large stones in cholelithiasis are more dangerous than small stones as stone size reaches >3cm risk increases upto 10 fold. Gallbladder polyps >10mm, calcified(porcelain) gallbladder, choledochal cyst, seclerosing cholangitis, anomalous pancreaticobillary junctions and exposure to carcinogens are other risk factors3. Continuous...

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