A Prospective Observational Study of Clinicopathological and Biochemical Profile of Patients with Cholecystitis Visiting a Teaching Tertiary Care Centre of Haryana

Introduction Gallstone diseases constitute a major part of patients visiting hospitals, and more than 50% of operation theaters are occupied by it or diseases related to it. It also imposes significant financial burden on health resources. The 21st century has opened with an improved foundation to our understanding of the basis of bile formation by defining the key transporters of the lipids in bile and the responsible genes. The specter of obesity as an epidemic in developed countries, and the recent recognition of the metabolic syndromes and their links to gallstone formation, emphasize the expectation of a rise in the frequency of cholesterol cholelithiasis. Materials and Methods Data pertaining to patients who were admitted/received surgery for a diagnosis of gallstone diseases at the Department of General Surgery of BPS GMC Khanpur Kalan was collected.The collected data was entered in a Microsoft Excel spreadsheet. Mean ± standard deviation (SD) was calculated for quantitative data, using Student’s “t” test/Kruskal test. Chi-square test was used to find out the association for categorical data. Results and Discussion Most of the patients were experiencing right hypochondriac pain (79.23%) as presenting complaints, with the most common age range being 31 to 40 years, followed by 41 to 50 years, that is, 31.85% and 20.74%, respectively. Females were most commonly affected, approximately 90%, and only 10% of patients with gallstones visiting our hospital were males. Maximum patients had chronic cholecystitis (80%) on histopathological examination, followed by cholesterosis (6.15%). As much as 82.6% of patients presented with mixed gallstones, followed by cholesterol stones, that is, 10.43%. All types of stones are more common in patients with abdominal adiposities, that is, having waist-to-hip ratio more than 0.85, and these findings are statistically significant. Conclusion Our study concluded that gallstones were more common in females of younger population (31–40 years) with right hypochondriac pain as presenting complaints. The most common histopathology was chronic cholecystitis with mixed types of stones, which is associated with increased waist-to-hip ratio. All biochemical markers were within normal range.

Biliary disorders

This chapter covers core curriculum topics relating to disorders of the biliary tract including physiology and biochemistry of bile formation and the pathogenesis of gallstones; complications of gallstones disease including biliary colic, acute cholecystitis, biliary obstruction, and cholangitis, and options for operative and non-operative management. Material is also provided on conditions of the gallbladder including adenomyomatosis, gallbladder polyps, and porcelain gallbladder; primary sclerosing cholangitis and other causes of cholangitistumours of the bile duct, gall bladder, and ampulla; indications and complications of endoscopic and radiological treatment of biliary disease including endoscopic retrograde choalngiopancreatography, cholangioscopy, and Percutaneous transhepatic cholangiography. There is also discussion on the diagnosis and management of biliary complications after liver transplantation. Additional curriculum material regarding disorders of the biliary tract will also be covered in the mock examination chapter.

Cholesterol and its esters in the bile of rats in tetracyclineinduced hepatosis and under the using of milk phospholipids

The increase of disorders of the cholesterol metabolism and the bile formation determines the need of the search for possible substances correcting the cholesterol metabolism in the liver. It is found that, in laboratory rats with an experimental drug form of steatosis, the excretion of cholesterol and, especially, cholesterol esters to the bile ducts is inhibited, and their ratio in bile is significantly impaired. The use of bioadditive “FLP-MD” made on milk phospholipids has a corrective effect on the concentration of cholesterol and its esters in bile of rats with tetracycline-induced steatosis. This allows us to recommend bioadditive “FLP-MD” made on milk phospholipids to improve the cholesterol metabolism in patients with clinical cases of drug-induced liver damage.

AGE RELATED FEATURES OF THE BOMBESIN EFFECT ON HEPATIC BILE FORMATION

Hepatic bile formation under bombesin action (1 µg/100 g body weight, intraportally) was examined in acute experiments on 30 male rats of three age categories: juvenile (body weight 130-175 g), adult (200-250 g) and elder (more than 300 g). Changes in the bile flow rate were recorded and the amount of various bile acids (BA) was detected using thin layer chromatography/densitometry. Bombesin caused the increase of the bile flow rate in juvenile and adult rats without any effect on it in old animals. The concentration of free bile acids increased in juvenile and adult rats and decreased in old animals. This peptide stimulated secretion of taurocholic and glicocholic acids in adult and aged rats but had no effect on the secretion of tauroconjugated dihydroxycholates. Secretion of dihydroxy bile salts conjugated with glycine was more potently enhanced by bombesin in adult rats but in the elder group this parameter dropped below the control. Bombesin had a lower effect on the BA secretion in aged rats but its influence on the juvenile animals was bidirectional. In this group the peptide stimulates free bile salts formation and, without affecting de novo synthesis, inhibits BA conjugation with amino acids in aged group. Bombesin activated classic pathway of BA biosynthesis in juvenile rats and suppressed it in aged animals. The data obtained demonstrate that different effect of bombesin on bile acids content in rats of different age could change biliary lipid-solubilizing capacity under age related damage of the gut with impairment of normal bombesin release.

Hepatic bile formation: bile acid transport and water flow into the canalicular conduit

Advances in molecular biology identifying the many carrier-mediated organic anion transporters and advances in microscopy that have provided a more detailed anatomy of the canalicular conduit make updating the concept of osmotically determined canalicular flow possible. For the most part water flow is not transmembrane but via specific pore proteins in both the hepatocyte and the tight junction. These pores independently regulate the rate at which water flows in response to an osmotic gradient and therefore are determinants of canalicular bile acid concentration. Review of the literature indicates that the initial effect on hepatic bile flow of cholestatic agents such as Thorazine and estradiol 17β-glucuronide are on water flow and not bile salt export pump-mediated bile acid transport and thus provides new approaches to the pathogenesis of drug-induced liver injury. Attaining a micellar concentration of bile acids in the canaliculus is essential to the formation of cholesterol-lecithin vesicles, which mostly occur in the periportal region of the canalicular conduit. The other regions, midcentral and pericentral, may transport lesser amounts of bile acid but augment water flow. Broadening the concept of how hepatic bile flow is initiated, provides new insights into the pathogenesis of canalicular cholestasis.