Accuracy of Ultrasound and Magnetic Resonance Cholangiopancreatography Findings in the Diagnosis of Biliary System Stones

This study aimed to evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and Ultrasound (US) images for the diagnosis of biliary system stones, as well as to assess the consistency between MRCP and US findings. The study sample included 200 cases (90 males and 110 females) with symptomatic biliary system stones between 14 and 82 years. All cases underwent both the US and MRCP imaging for biliary system diagnosis. The study revealed that the most prominent age group with symptoms of biliary system stones was the 33-60-year-old group. It also found that the accuracy of US and MRCP in detecting gallbladder (GB) stones compared with the final diagnosis was 94% and 91%, respectively, with moderate conformity between their results. The accuracy of US and MRCP images in detecting common bile duct (CBD) stones was 61% and 98%, respectively, with fair conformity between their results. In addition, there is a significant agreement between the MRCP and US results in detecting the GB and CBD stones with an agreed percentage of 74% and 71%, respectively. The study concluded that US is the preferred imaging technique for patients with symptomatic gallbladder stones, whereas MRCP is a trustworthy investigation for common bile duct stones.

Іmmunological disorders and colonic dysbiosis in patients with biliary lesions in type 2 diabetes mellitus and obesity

Background. The microbiome plays a crucial role in maintaining homeostasis. The purpose of the research was to study the peculiarities of changes in immunological status and their relationship with colonic dysbiosis in patients with biliary lesions on the background of type 2 diabetes mellitus (DM) and obesity. Materials and methods. The study included 54 patients with type 2 DM and obesity of varying severity, who underwent a comprehensive examination. Two groups of those examined for type 2 DM and obesity were formed, depending on the type of lesion of the biliary system. Thus, group I included 24 patients with chronic acalculous cholecystitis, and group II consisted of 30 patients with gallstone disease. Results. The results of the analysis of the quantitative and qualitative composition of the colonic microflora indicate dysbiotic changes in patients with type 2 DM, obesity, and lesions of the biliary system. More pronounced disorders in the quantitative and qualitative composition of colonic microflora were diagnosed in patients of group II (with type 2 DM and obesity in combination with gallstone disease). The patients of group II significantly more often developed an increase in the number of Enterobacter (14.2 %; p < 0.05), Citrobacter (31.8 %; p < 0.01), Staphylococcus (16.7 %; p < 0.05), and Clostridium (11.8 %; p < 0.05) compared with the data of group I. More pronounced increase in all immunoglobulin parameters was found in patients with gallstone disease associated with type 2 DM and obesity. At the same time, the increase in IgA and IgG levels, which is indisputable evidence of activation of the humoral part of the body’s immunocompetent system, was found in patients with biliary lesions and type 2 DM and obesity. Conclusions. In patients with type 2 DM and obesity in combination with lesions of the biliary system (mainly gallstone disease), changes in the quantitative and qualitative composition of the colonic microflora (a decrease in the number of Bifidobacterium and Lactobacillus and an increase in the concentration of Clostridium, Staphylococci, Proteus, and Klebsiella) were detected. Impairment of immunological status in patients with type 2 DM and obesity in combination with lesions of the biliary tract was diagnosed, which manifested in increased levels of IgA, IgG, IgM, IgG and a decrease in serum C3 and C4 in patients with gallstone disease. The increase in IgA and IgG directly depends on the change in the number of Bifidobacterium and Lactobacillus, Staphylococcus, Clostridium, Proteus in the microbiological examination of feces in patients with type 2 DM and obesity in combination with the biliary system (mainly gallstone disease).

Bilobed gallbladder: a rare congenital anomaly of the biliary system

Duplication of the gallbladder is a rare congenital anomaly, which Boyden first illustrated in 1926. No additional risk of cholelithiasis or malignancy with this congenital anomaly was documented. However, this congenital anomaly is associated with more risk for complications during and after laparoscopic cholecystectomy. So, preoperative diagnosis is essential in identifying anatomical abnormalities to avoid biliary injuries at the time of surgery or the performance of an incomplete operation. The removal of an asymptomatic double gallbladder remains controversial. Here, we are reporting a case of the incidentally detected duplex gallbladder in a teenager and review the literature that will enrich the reader’s knowledge regarding this rare congenital anomaly.

A Clonorchis Sinensis in the Gallbladder: A Rare Case in Kuwait

Clonorchis Sinensis is an important foodborne pathogen. It is actively transmitted in far-East countries and Asia, especially in China. It enters the biliary system via ingestion of infected cysts. It is exceedingly rare to encounter such a presentation in the Middle East, particular in Kuwait. The presence of liver fluke in the biliary system may lead to adverse complications. We are presenting a case report describing quite an unusual gallbladder finding in a 55-year-old Chinese lady.

Hepatic artery pseudoaneurysm secondary to a cholangitic abscess and its spontaneous thrombosis

Hepatic artery pseudoaneurysm (HAP) is mostly encountered secondary to trauma or iatrogenic causes. HAP associated with cholangitic liver abscess is a rare complication. We present a case of gallstone disease and choledocholithiasis who developed moderate cholangitis and a liver abscess. A small HAP was detected incidentally on a biphasic CT done to evaluate the biliary system. Repeat CT after management with endoscopic retrograde cholangiopancreatography and antibiotics showed resolution of cholangitic abscess with spontaneous thrombosis of HAP.

The biliary continuum: an up-to-date look at biliary tract diseases

In the structure of gastrointestinal diseases, the pathology of the hepatobiliary system currently ranks second in frequency of occurrence. The stages of diseases of the biliary system can be combined into the so-called “biliary continuum”, when one patient has a consistent development of pathogenetically related diseases of the biliary tract. The progressive course of functional motility disorders of the biliary tract gradually leads to the development of organic pathology, including chronic cholecystitis, the subsequent development of gallstone disease and possible postcholecystectomy complications. Among the diseases of the biliary system, one of the most frequently used diagnoses is chronic cholecystitis. The development of chronic cholecystitis is associated with repeated attacks of acute inflammation or prolonged irritation of large gallstones. The clinical aspects of chronic cholecystitis and other pathologies included in the the «biliary continuum» largely depends on concomitant dyskinesia. There are several directions for the treatment of pathologies of the biliary system: diet therapy, medication, endoscopic and surgical treatment. According to the latest guidelines, the most important direction in modern therapy of diseases of the biliary system is the restoration of the motility of the biliary tract and the normalization of the physicochemical properties of bile. The central place in the treatment of diseases of the “biliary continuum” is given to antispasmodic drugs. The administration of antispasmodics is recommended in order to relieve biliary pain and dyspeptic symptoms caused by spasm of smooth muscles, as well as to control the inflammatory process due to a decrease in the release of pro-inflammatory substances. This article describes in detail the importance of the recovery of the biliary tract motor activity and the improvement of the physico-chemical properties of bile acids.

Self-Organogenesis from 2D Micropatterns to 3D Biomimetic Biliary Trees

Background and Aims: Globally, liver diseases account for 2 million deaths per year. For those with advanced liver disease the only curative approach is liver transplantation. However, less than 10% of those in need get a liver transplant due to limited organ availability. To circumvent this challenge, there has been a great focus in generating a bioengineered liver. Despite its essential role in liver functions, a functional biliary system has not yet been developed. In this framework, exploration of epithelial cell self-organogenesis and microengineering-driven geometrical cell confinement allow to envision the bioengineering of a functional biomimetic intrahepatic biliary tract. Approach: three-dimensional (3D) bile ducts were built in vitro by restricting cell adhesion to two-dimensional (2D) patterns to guide cell self-organization. Tree shapes mimicking the configuration of the human biliary system were micropatterned on glass slides, restricting cell attachment to these areas. Different tree geometries and culture conditions were explored to stimulate self-organogenesis of normal rat cholangiocytes (NRCs) used as a biliary cell model, either alone or in co-culture with human umbilical endothelial cells (HUVECs). Results: Pre-seeding the micropatterns with HUVECs promoted luminogenesis with higher efficiency to yield functional branched biliary tubes. Lumen formation, apico-basal polarity, and preservation of the cholangiocyte phenotype were confirmed. Moreover, intact and functional biliary structures were detached from the micropatterns for further manipulation. Conclusion: This study presents physiologically relevant 3D biliary duct networks built in vitro from 2D micropatterns. This opens opportunities for investigating bile duct organogenesis, physiopathology, and drug testing.

Noninvasive Imaging Prior to Biliary Interventions

Noninvasive imaging is a crucial and initial step in the diagnostic algorithm of patients with suspected biliary pathology and directs the subsequent diagnostic and therapeutic workup, including the endoluminal and percutaneous biliary interventions. This article reviews the current noninvasive imaging methods for the evaluation of biliary system and further discusses their roles in the diagnostic workup of different biliary disease.

Functional state of the digestive organs in patients with celiac desease associatedFunctional state of the digestive organs in patients with celiac desease associated with connective tissue dysplasia with connective tissue dysplasia

The article presents the results of our own research devoted to the study of the functional characteristics of the digestive system in patients with celiac disease associated with connective tissue dysplasia (CTD).Materials and methods. The study included 90 patients from the register of adults with celiac disease. To assess CTD, patients underwent clinical and laboratory- instrumental examination, including ultrasound of the abdomen organs, kidneys and heart, EGDS. The assessment of the functional state of the gastrointestinal tract was carried out according to the ultrasound data of the abdomen organs, coprogram and PEGEG.Results. The results of the study showed that all patients had signs of CTD with involvement of at least two organ systems. The most common visceral stigmas of dysplasia were MVP (66.7%), gallbladder anomalies (53.3%), tracheobronchial dyskinesia (35.6%) and signs of nephroptosis (30.0%). Anomalies of the gallbladder included single bends in the body area — 26 people (28.9%) and in the neck area –5 people (5.6%), and double bend — S-shaped gallbladder — 17 people (18.9%). At the same time, an increase in the proportion of gallbladder anomalies was revealed as the severity of CTD increased, with significant differences in the groups in patients with an S-shaped gallbladder (p<0.05), which correlated with biliary sludge and signs of maldigestion. According to PEGEG data, an increase in tonic activity (Pi / Ps) at the frequency of the duodenum with an increase in the degree of CTD was revealed, with the maximum values in group 3 patients being 3.84 ± 1.03, which reflects the presence of hypertensive dysfunction.Conclusion. The functional state of the digestive system in celiac patients with signs of CTD is characterized by disorders of the gastroduodenal complex and the biliary system. A high degree of CTD in celiac disease patients should be considered as an independent risk factor for motor disorders of the upper gastrointestinal tract and biliary system, which must be taken into account when carrying out therapeutic and prophylactic measures.

Forward genetics combined with unsupervised classifications identified zebrafish mutants affecting biliary system formation.

Impaired formation of the biliary network can lead to congenital cholestatic liver diseases; however, the genes responsible for proper biliary system formation and maintenance have not been fully identified. Combining computational network structure analysis algorithms with a zebrafish forward genetic screen, we identified 24 new zebrafish mutants that display impaired intrahepatic biliary network formation. Complementation tests suggested that these 24 mutants affect 24 different genes. We applied unsupervised clustering algorithms to classify the recovered mutants into three classes unbiasedly. Further computational analyses revealed that each of the recovered mutations in these three classes shows a unique effect on node subtype composition and connection property distribution of the intrahepatic biliary network. Besides, we found that most recovered mutations are viable. In those mutant fish, biliary network phenotypes persist into adulthood, which themselves are good animal models to study chronic cholestatic liver diseases. Altogether, this study provides unique genetic and computational toolsets that advance our understanding of the molecular pathways leading to biliary system malformation and cholestatic liver diseases.