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Case Of Gallbladder Cancer With Extensive Lymphadenopathy Mimicking Klatskin Tumor. Practical Gastroenterology. 31(6): 83-85. June 2007.
This article presents a case report of a 58-year-old woman who presented with 3-week obstructive jaundice. She was found to have metastatic (stage IV) gallbladder adenocarcinoma, with a common bile duct (CBD) stricture mimicking Klatskin tumor. The authors present the differential diagnosis, along with the radiological images that make it a memorable case. Her symptoms include the triad of cholestasis, vague abdominal pain, and weight loss. The differential diagnosis included malignant CBD stricture, CBD stones, benign CBD strictures, primary sclerosing cholangitis, or compression of the CBD by either chronic pancreatitis or pancreatic cancer. They note that gallbladder cancer is an uncommon but highly fatal malignancy. The majority of cases are found incidentally in patients undergoing surgery for cholelithiasis; gallstones are present in 70 to 90 percent of patients with gallbladder cancer. 3 figures. 18 references.
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Catheter-Related Complications of Total Parenteral Nutrition. American Journal of Gastroenterology. 102: S97-S101. 2007.
This article describes the hepatobiliary complications that can occur with the use of total parenteral nutrition (TPN). The author reviews the background and incidence of TPN-associated liver disease; the risk factors associated with the development of TPN-associated liver disease; potential etiologies of TPN-associated liver disease including malnutrition, overnutrition, carnitine deficiency, choline deficiency, bacterial overgrowth, and methionine toxicity; and treatment options including medical treatment and nutritional treatment. Patients can only prevent hepatobiliary complications, including hepatic steatohepatitis, cirrhosis, and liver failure, if they eat. Eating allows the patient to preserve as much portal nutrient absorption as possible. A final section considers the problem of TPN-associated biliary disease, notably biliary tract stones and gallstones. 5 figures. 53 references.
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Endoscopy in Pregnancy. IN: Pregnancy in Gastrointestinal Disorders. 2nd ed. Bethesda, MD: American College of Gastroenterology. 2007. pp 10-17.
This chapter about endoscopy in pregnancy is from a monograph that presents updated information about pregnancy in women with gastrointestinal disorders. The authors stress that the spectrum of gastrointestinal diseases in the pregnant patient is virtually identical to that in nonpregnant women. However, options for evaluating pregnant patients are somewhat limited because barium studies and other radiographic techniques subject the fetus to the risks of radiation. However, endoscopy can play a crucial role in the diagnosis and treatment of various disorders in the pregnant patient. The chapter focuses on bringing readers up to date on the research in the area covered, the recommended treatments, and patient management concerns, notably issues of maternal and fetal safety. Topics include the use of upper endoscopy for diagnosing nausea, vomiting, esophagitis, ulcers, and gastritis; the use of lower endoscopy to evaluate rectal bleeding and inflammatory bowel disease (IBD); sigmoidoscopy and colonoscopy; endoscopic retrograde cholangiopancreatography (ERCP) used to evaluate gallstones; percutaneous endoscopic gastrostomy (PEG) placement to assist patients who cannot sustain adequate nutritional intake; and the use of sedation for endoscopic tests in women who are pregnant. The authors conclude that endoscopy appears to be safe in pregnancy. They recommend that procedures be performed after the first trimester if possible, following guidelines to minimize radiation and excessive sedation. Endoscopists are encouraged to consult with an obstetrician in challenging, complicated cases. 1 table. 17 references.
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Frequency of Gallstones After Renal Transplantation and Factors That Affect Gallstone Formation: A Comparative Study. Dialysis and Transplantation. 36(10): 533-542, 555. October 2007.
This article reports on a study of the frequency of gallstones in kidney transplant recipients, focusing on the effects of various factors on gallstone formation. The study included 182 patients who had undergone renal transplantation at the authors’ center in the last 12 years. Of these, 163 patients were followed up regularly; of these, 118 were using cyclosporine A (CsA). The median duration of patient follow-up was 36 months. All patients underwent abdominal ultrasonography and laboratory tests. Gallstones were diagnosed in five patients (3.1 percent). The frequency of gallstones was 3.4 percent in the CsA group and 2.2 percent in the non-CsA group. The CsA group had a significantly shorter gallstone-free follow-up period than the non-CsA group. The authors conclude that the use of CsA showed a trend toward increasing the risk of developing a gallstone sooner in the posttransplant period, particularly for young men. 1 figure. 4 tables. 24 references.
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Gallstones. Bethesda, MD: National Digestive Diseases Information Clearinghouse. July 2007. 8 p.
This fact sheet provides a wealth of information about gallstones, which are small, pebble-like substances that develop in the gallbladder. Gallstones form when liquid bile stored in the gallbladder hardens. Bile is made in the liver and stored in the gallbladder until the body needs it. The fact sheet describes the different types of gallstones, symptoms and complications of gallstones, the causes of gallstones, diagnostic tests that may be used to confirm the presence of gallstones, and treatment strategies including surgery and nonsurgical therapies such as oral dissolution therapy and contact dissolution therapy. Gallstones are more common among older adults; women; American Indians; Mexican Americans; people with diabetes; those with a family history of gallstones; people who are overweight, obese, or who undergo rapid weight loss; and those taking cholesterol-lowering drugs. Gallbladder attacks often occur after eating a meal, especially one high in fat. The symptoms of gallstones may mimic those of other problems, including a heart attack, so an accurate diagnosis is important. Laparoscopic surgery to remove the gallbladder is the most common treatment. A final brief section describes the research aims in this area. The fact sheet concludes with a list of resource organizations through which readers can obtain additional information, and a description of the goals and activities of the National Digestive Diseases Information Clearinghouse. 1 figure. 1 table. 3 references.
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Gastrointestinal Issues in the Assessment And Management Of the Obese Patient. Gastroenterology and Hepatology. 3(7): 559-569. July 2007.
This article outlines gastrointestinal issues in the assessment and management of the obese patient. The authors caution that as the obesity epidemic spreads, physicians of all specialties will be called on to participate in the management of obesity. Gastroenterologists should learn to recognize, prevent, and treat gastrointestinal disorders related to obesity, and they must have an understanding of the risks and benefits of various management strategies. They may also be called on to assist in the evaluation and management of liver and gastrointestinal problems that may develop after bariatric surgery. Specific topics include gastroesophageal reflux disease, obesity and esophageal adenocarcinoma, gallbladder disease, pancreatitis, liver disease, gastrointestinal cancer, the indications for bariatric surgery, the role of preoperative endoscopy, roux-en-Y gastric bypass, banded gastroplasty, the intragastric balloon, sleeve gastrectomy, biliopancreatic diversion, jejunoileal bypass, gallstones, vomiting, pulmonary embolism, wound infection, rhabdomyolysis, hemorrhage, weight gain, and cancer. The author notes that upper gastrointestinal endoscopy is an all-important tool in the assessment and therapy of the complications of obesity and related surgical techniques. 1 table. 149 references.
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Acute Pancreatitis. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 362-370.
This chapter on acute pancreatitis is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the mortality of acute pancreatitis; the role of gallstones and alcohol in cases of acute pancreatitis; diagnostic tests used to confirm acute pancreatitis, including serum amylase or lipase, or radiographic (X ray) evidence; determination of severity by Ranson's score, APACHE-II criteria, or CT scan; and the use of prophylactic antibiotics in patients with acute necrotizing pancreatitis. The chapter concludes with a lengthy list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 3 figures. 2 tables. 35 references.
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Biliary Fistula, Gallstone Ileus, And Mirizzi's Syndrome. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 239-251.
This chapter on biliary fistula, gallstone ileus, and related major complications is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. A separate section of this chapter covers Mirizzi’s syndrome, a special complication of gallstone disease characterized by an impacted gallstone in the cystic duct or the neck of the gallbladder that compresses the adjacent bile duct and results in complete or partial obstruction of the common hepatic bile duct. Gallstone ileus is a mechanical bowel obstruction that is caused by impaction of one or more gallstones within the lumen of the intestinal system. The authors discuss the different types of biliary fistulas, the clinical presentation of gallstone ileus and Mirizzi’s syndrome, the diagnostic imaging studies that may be used to confirm the presence of gallstone ileus and Mirizzi’s syndrome, and treatment options, notably surgical strategies. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 6 figures. 3 tables. 114 references.
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Biliary Tract Disease. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 371-376.
Biliary tract diseases comprise a range of disorders affecting the intrahepatic and extrahepatic bile ducts and the gallbladder. This chapter on biliary tract disease is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. The authors note that ductal obstruction is caused by gallstone impaction in more than 90 percent of cases and can lead to multiple conditions, including cholecystitis, choledocholithiasis, cholangitis, and pancreatitis. The authors focus on providing a framework for evaluating and treating diseases related to cholelithiasis. Specific topics covered in this chapter include the use of ultrasonography as the diagnostic imaging modality of choice for evaluating right upper quadrant pain and suspected gallstones; the symptoms that define cholangitis (biliary obstruction complicated by infection), including right upper quadrant tenderness, fever, and jaundice; treatment options for cholangitis, including emergency antibiotic therapy and biliary decompression; and acalculous cholecystitis as a cause of acute cholecystitis and occult fevers in the critically ill. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 1 figure. 1 table. 4 references.
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Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. 428 p.
This textbook provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The book was written by a multidisciplinary panel of international experts with extensive experience in this population of patients. The book offers 23 chapters in six sections: anatomy, pathophysiology, and epidemiology of the biliary system; diagnostic and therapeutic approaches for the biliary tree and gallbladder; specific conditions; the intrahepatic and extrahepatic bile ducts; intrahepatic cholestasis; and the pediatric population. Specific topics include noninvasive imaging, endoscopic diagnosis and treatment, percutaneous biliary imaging and intervention, radiation therapy, surgery, laparoscopic treatment, laparoscopic biliary injuries, treatment for biliary malignancies, the gallbladder, gallstones, acute cholangitis, cystic diseases of the biliary system, biliary complications of liver transplantation, primary sclerosing cholangitis, cholangiocarcinoma, primary biliary cirrhosis, and biliary disease in infants and children. Each chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. The book is illustrated with black-and-white photographs and line drawings; one section of color plates is included. The book concludes with the answers to the self-test study questions and a detailed subject index.
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Epidemiology of Diseases of the Bile Ducts And Gallbladder. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 58-68.
This chapter on epidemiology is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The author reviews the prevalence and incidence of gallstones, the risk factors for gallstone disease, the composition of gallstones, the complications of gallstone disease, the risk factors for gallbladder cancer, and the risk factors for cholangiocarcinoma. Specific topics include acalculous cholecystitis, cholesterolosis, adenomatosis, polyps of the gallbladder, extrahepatic biliary atresia, choledochal cysts, Caroli’s disease, cystic fibrosis, and primary sclerosing cholangitis. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 1 figure. 2 tables. 107 references.
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Epidemiology of Gallbladder Stone Disease. Best Practice & Research Clinical Gastroenterology. 20(6): 1017-1029. 2006.
This article brings readers up-to-date on the epidemiology of gallbladder stone disease, a common occurrence in the United States. The author notes that the burden of disease is epidemic in American Indians (60 to 70 percent); a corresponding decrease occurs in Hispanics/Latinos of mixed Indian origin. Ten to 15 percent of Caucasian adults in developed countries harbor gallstones. Frequency is further reduced in African Americans, East Asians, and sub-Saharan Africans. In developed countries, cholesterol gallstones predominate; 15 percent are black pigment gallstones. Risk factors for gallstones include female gender, increasing age, and ethnicity or family. Modifiable risk factors include obesity, the metabolic syndrome, rapid weight loss, certain diseases—including cirrhosis and Crohn's disease—and gallbladder stasis, which can happen from spinal cord injury or from drugs such as somatostatin. The only established dietary risk is a high caloric intake. The author concludes that protective factors include diets containing fiber, vegetable protein, nuts, calcium, vitamin C, coffee and alcohol, plus physical activity. 1 table. 144 references.
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Gallstone Disease: Primary and Secondary Prevention. Best Practice & Research Clinical Gastroenterology. 20(6): 1063-1073. 2006.
This article reviews the primary and secondary prevention of gallstone disease. The authors first explore several risk factors for cholesterol gallstone formation, including prolonged fasting, rapid weight loss, total parenteral nutrition (TPN), and somatostatin treatment. In both asymptomatic and symptomatic gallstone patients, it has been claimed that treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) reduces the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Prophylactic cholecystectomy may be beneficial in certain subgroups of asymptomatic gallstone carriers. The authors stress that randomized, double-blind, placebo-controlled trials that could support these contentions are lacking. However, in the general population, high fiber intake, low saturated fatty acid consumption, and nut consumption are associated with reduced risk of gallstones. Also, moderate physical activity appears to prevent gallstones. 3 tables. 95 references.
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Gallstone Ileus: A Review. Mount Sinai Journal of Medicine. 73(8): 1132-1134. December 2006.
This article reviews the pathophysiology, clinical presentation, radiological findings, and treatment options of gallstone ileus. Gallstone ileus is usually preceded by an attack of acute cholecystitis, causing inflammation and adhesions in the area of the gallbladder bed. The adhesions and inflammation facilitate the formation of a fistula with the small or large intestine; the gallstone then moves through the fistula and has the potential of forming an obstruction (ileus). Gallstone ileus is a disease of the elderly, causing up to one-fourth of non-strangulation intestinal obstructions in patients older than 65 years. Radiological features on plain x rays include features of intestinal obstruction and pneumobilia and an aberrant gallstone. Treatment depends on the site of the impacted stone, but surgery is needed in many cases. The authors conclude that early diagnosis and treatment improve the outcome. 31 references.
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Gallstones: Common, But Not to Be Ignored. Mayo Clinic Health Letter. 24(1): 1-3. January 2006.
This article reviews basic information about gallstones, a common condition that can cause painful attacks and lead to more serious complications. The author first reviews the anatomy and function of the gallbladder, which is part of the biliary system that helps break down fats and remove waste products from the body. Two common types of gallstones are cholesterol stones and pigment stones. The author reviews the risk factors for gallstone formation, which include gender (women are at higher risk), overweight, the use of certain weight-loss diets, age, family history, and ethnicity. The author covers symptoms that should prompt a visit to a health care provider, diagnostic tests that will be used to confirm the presence of a gallstone, and treatment options, including removal of the gallbladder. One sidebar briefly reviews gallbladder cancer, a very rare but invasive form of cancer. 2 figures.
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Hepatobiliary Complications of Inflammatory Bowel Disease. Practical Gastroenterology. 30(8): 19-33. August 2006.
This article outlines the hepatobiliary complications that may be associated with inflammatory bowel disease (IBD, including Crohn’s disease and ulcerative colitis). The author notes that the prevalence of hepatobiliary abnormalities in IBD range from 5 percent to 15 percent. Common hepatobiliary manifestations of IBD can include chronic active hepatitis, cirrhosis, steatosis, and primary sclerosing cholangitis. The author outlines a recommended initial approach to the patient, then discusses primary sclerosing cholangitis (PSC), differential diagnosis, autoimmune hepatitis, cholelithiasis (gallstones), chronic viral hepatitis, and medication-induced hepatotoxicity (including that due to 5-ASA drugs, thiopurines, infliximab, and methotrexate). A final section considers some of the more rare hepatic complications of IBD, including liver abscess, and hepatic amyloidosis. The author concludes that PSC is the classic IBD-related liver disease and occurs most often in patients with ulcerative colitis. Readers are cautioned that patients with IBD are as likely as other patients to develop non-IBD-related liver disorders, so a diligent search for common causes of any hepatobiliary disease should be performed. 1 figure. 2 tables. 34 references.
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Liver Disease and IBD. New York, NY: Crohn's and Colitis Foundation of America.. 2006. 2 p.
Some of the complications of inflammatory bowel disease (IBD, including Crohn’s disease and ulcerative colitis) are related to the liver and the biliary system, both of which are closely linked to the intestine. This fact sheet reviews the different types of liver disease that may be encountered in people with IBD, including fatty liver disease (hepatic steatosis), primary sclerosing cholangitis (PSC), gallstones, pancreatitis, and chronic active hepatitis. For each condition, the fact sheet explains why it might develop and offers basic suggestions for treatment. Low energy and fatigue tend to be the most common symptoms of IBD-related liver diseases. Symptoms of more advanced liver disease include itching, jaundice, fluid retention, fatigue, and a feeling of fullness in the upper abdomen. The treatments for these conditions in people with IBD are the same as in those people without IBD. Serious liver disease involving the liver affects only about 5 percent of people with IBD.
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Natural History And Pathogenesis of Gallstones. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 219-228.
This chapter on the natural history and pathogenesis of gallstones is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The author focuses on the recent major advances in the understanding of gallstone pathogenesis and the improvements and availability of imaging studies, both of which have improved the understanding of the epidemiology and natural history of cholelithiasis. Topics include the pathogenesis of gallstone formation, the different risk factors of gallstone formation, the natural history of asymptomatic and symptomatic gallstones, and current medical treatment options for patients with symptomatic gallstone disease. Treatment options described include oral gallstone dissolution therapy, extracorporeal shock wave lithotripsy, and topical dissolution therapy. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 2 figures. 1 table. 70 references.
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Sex-Based Differences in Pancreatic and Biliary Disease. Practical Gastroenterology. 30(04): 49-67 p. April, 2006.
This article reviews the sex-based differences in pancreatic and biliary disease. The authors discuss algorithms for expediting diagnosis and treatment based on gender differences. The authors consider the hypotheses that anatomic, physiologic, and hormonal factors may contribute to sex-based differences in pancreatic and biliary diseases. Benign processes such as gallstones and gallbladder disease, choledochal cysts, and sphincter of Oddi dysfunction are significantly more common in females. Cystic neoplasia of the pancreas with malignant potential is also seen predominantly in females—more than 80 percent. By comparison, males are more commonly afflicted by primary sclerosing cholangitis (PSC), acalculous cholecystitis, and intraductal papillary mucinous neoplasms. Alcohol and gallstones account for approximately 70 percent of all cases of pancreatitis. The relative risk of developing acute pancreatitis due to gallstones is greater in men; however, there is a higher prevalence of gallstones in women, and gallstone pancreatitis is more common in women. 4 tables. 7 references.
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Smoking And Your Digestive System. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2006. 4 p.
This fact sheet reminds readers of the interrelationship between smoking and the digestive system. Smoking can harm all parts of the digestive system, contributing to common disorders such as heartburn and peptic ulcers. Smoking increases the risk of Crohn’s disease, a type of inflammatory bowel disease, and may be a contributor to gallstones. Smoking also damages the liver. The fact sheet reviews each of these connections, describing the symptoms of these disorders and the physiological role of smoking. The fact sheet concludes that some of the effects of smoking on the digestive system appear to be of short duration. The effects of smoking on how the liver handles drugs disappear when a person stops smoking. However, people who no longer smoke still remain at risk for Crohn’s disease. Readers are referred to the Office on Smoking and Health at the National Center for Chronic Disease Prevention and Health Promotion at 1–800–232–1311 or www.cdc.gov/tobacco. A final section offers a brief description of the National Digestive Diseases Information Clearinghouse (NDDIC), a Federal Government agency that provides information about digestive diseases to people with digestive disorders and their families, health care professionals, and the public.
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Symptoms and Diagnosis of Gallbladder Stones. Best Practice & Research Clinical Gastroenterology. 20(06): 1017-1029. 2006.
This article reviews the symptoms and diagnosis of gallstones, including the natural history of silent gallstones, the risk of developing symptoms, and complications of the disease. The authors highlight the importance of colic-like pain as a specific gallstone symptom and discuss the role of laboratory tests and differential diagnosis. They describe the diagnostic features of gallstone disease, including indications, sensitivity, specificity, and limitations of different test investigations under special circumstances. The authors conclude that in the majority of cases, gallstone patients remain asymptomatic during their life. Once pain has appeared, gallstone patients are at high risk for pain recurrence in the following year. The clinical presentation of gallstone disease might also depend on ongoing complications, such as cholecystitis or pancreatitis; thus, both medical history and ancillary investigations are essential to avoid misdiagnoses. The most accurate diagnostic tool to detect gallstones is transabdominal ultrasonography. 3 tables. 115 references.
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Acute And Chronic Cholecystitis. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 229-238.
This chapter on acute and chronic cholecystitis is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The authors discuss the pathogenesis of acute and chronic cholecystitis; the clinical presentation of gallbladder infection, including infection due to gallstones; the diagnostic tests that may be used to confirm cholecystitis; complications of acute and chronic cholecystitis; surgical and nonsurgical treatment options; and recommendations for cholecystectomy in patients with acute cholecystitis. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 4 figures. 53 references.
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Gallbladder and Bile Ducts. IN: Digestive Disorders 2005. Palm Coast, FL: Medletter Associated. pp 24-29. 2005.
This chapter on the gallbladder and bile ducts is from a White Paper on digestive disorders, including conditions that affect the esophagus, stomach, gallbladder, bile ducts, small intestine, and large intestine. This chapter covers normal anatomy of the gallbladder and bile ducts, and the causes, symptoms, diagnosis, and treatment of gallstones. Risk factors for gallstones include genetics, age older than 50, obesity, pregnancy, use of some medications, rapid weight loss, prolonged total intravenous nutrition, and diseases of the terminal ileum. Between 70 and 80 percent of gallbladder stones produce no symptoms and are discovered incidentally during imaging studies or postmortem examinations. Abdominal ultrasound is the easiest way to diagnose stones inside the gallbladder. Asymptomatic gallstones do not require treatment. Treatment options for patients with symptoms include cholecystectomy (removal of the gallbladder), or gallstone dissolution with shockwave therapy. One chart summarizes the potential use of probiotics, or friendly bacteria, for a variety of digestive disorders, including infectious diarrhea, antibiotic-associated diarrhea, pouchitis, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). One sidebar considers a new research study that supports the hypothesis that dietary fiber may protect against the development of gallstones.
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Is It IBS or Something Else?. Digestive Health Matters. 14(2): 4-5. Summer 2005.
This article focuses on how irritable bowel syndrome (IBS) is diagnosed and distinguished from other disorders. Although physicians can usually identify IBS from the patient's symptoms, sometimes with the addition of routine blood tests and a colon evaluation, patients can worry if they are not familiar with the diagnosis of IBS. Typical patterns of abdominal discomfort or pain, bowel habit disturbance, and bloating point to a diagnosis of IBS. The article includes a table of the Manning and Rome criteria for IBS symptoms. The author discusses the conditions that may be investigated as part of an IBS diagnosis, including colorectal cancer, gallstones, inflammatory bowel disease (IBD, including ulcerative colitis and Crohn's disease), celiac disease (gluten intolerance), and gynecological disorders. The author concludes by reminding readers that sometimes IBS is present along with another disorder that can also cause bowel habit disturbance or abdominal pain. 7 references.
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Gallbladder and Biliary Disease. IN: U.S. Department of Health and Human Services. Action Plan for Liver Disease Research. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2004. pp. 145-152.
Diseases of the gallbladder and biliary tree include gallstones, acute cholecystitis, acalculous cholecystitis, primary sclerosing cholangitis (PSC), biliary atresia, choledochal cysts, gallbladder cancer, and cholangiocarcinoma. These serious diseases can cause considerable morbidity and mortality. This chapter on gallbladder and biliary disease is from the Action Plan for Liver Disease Research that was developed to advance research on liver and biliary diseases. The Action Plan was undertaken to identify areas of scientific opportunity to help direct research resources at the National Institutes of Health (NIH) toward practical goals in the prevention, diagnosis, and management of liver and biliary diseases. In this chapter, the authors first note that gallstones are by far the most common cause of gallbladder disease. They review the epidemiology, development, and risk factors for gallstones, then outline recent research advances in the areas of understanding gallstone formation, and the management of patients with gallbladder and biliary disease. The authors provide specific research goals in the areas of the pathogenesis and diagnosis of gallstones, the pathogenesis and management of PSC, gallbladder cancer, and biliary tract and gallbladder imaging. A final section considers the steps that would assist in achieving these research goals. One chart summarizes the short (0 to 3 years), intermediate (4 to 6 years), and long-term (7 to 10 years) goals of research on these topics. 2 figures. 1 table.
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Gallstones. [Calculos en La Vesicula]. Arlington, VA: American College of Gastroenterology. 2004. 2 p.
This brief patient education fact sheet, from a series on common gastrointestinal (GI) and medical problems in women, reviews gallstones. Gallstones are solid clumps of cholesterol crystals and other substances that may be of variable size. The fact sheet reviews the common causes or triggers of gallstones, the gallbladder and its role in digestion, the formation of gallstones, the different types of gallstones, symptoms of gallstones, diagnostic considerations, and treatment options, including surgery, laparoscopic surgery, and dissolution therapy. The fact sheet is available in English or Spanish. 2 tables.
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Acute Pancreatitis. Boston, MA: The National Pancreas Foundation. 2003. 4 p.
This brochure describes acute pancreatitis, a sudden inflammation of the pancreas that is usually associated with severe upper abdominal pain. The most common cause of acute pancreatitis is gallstones. The brochure first reviews the anatomy and physiology of the pancreas, then discusses the causes of acute pancreatitis, clinical signs, diagnostic strategies, and treatment options. Treatment for acute pancreatitis depends on the severity of the condition. Sometimes the patient needs hospitalization with administration of intravenous fluids to help restore blood volume. Antibiotics are often prescribed if infection occurs and pain medications are often used to provide relief. Surgery is sometimes needed when complications such as infection, cysts, or bleeding occur. The brochure includes the contact information for the National Pancreas Foundation (www.pancreasfoundation.org) and a tear-off mailer form for joining or donating to the National Pancreas Foundation. 1 figure.
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Cholecystectomy (With or Without Clips). In: Schier, F. Laparoscopy in Children. Heidelberg, Germany: Springer-Verlag. 2003. p.48-55.
Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical approach. This section on laparoscopic cholecystectomy (removal of the gallbladder) is from a book that describes the differences and characteristic aspects of laparoscopy in small children. The book is an atlas of numerous drawings, accompanied by textual descriptions. Technical guidelines are given on how to perform the laparoscopic cholecystectomy safely, with or without clips, even in small children. Illustrations depict trocar placement, the instruments used, the technique of locating and isolating the gallbladder, ligation techniques, and the use of laparoscopy to remove gallstones (without removing the gallbladder). The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children. 11 figures.
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Cholecystitis. In: PDxMD. PDxMD Gastroenterology. St. Louis, MO: Elsevier Science. 2003. p. 74-100.
Calculous cholecystitis is defined as acute or chronic inflammation of the gallbladder due to cystic duct obstruction secondary to the presence of gallstones (bile duct stricture or neoplasm may also be causative). Acalculous cholecystitis is defined as acute inflammation of the gallbladder in the absence of gallstones. This chapter on cholecystitis is from a book on gastroenterology that offers concise, action-oriented recommendations for primary care medicine. The chapter covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Specific topics covered include the ICD9 code, urgent action, synonyms, cardinal features, causes (etiology), epidemiology, differential diagnosis, signs and symptoms, associated disorders, investigation of the patient, appropriate referrals and consultations, diagnostic considerations, clinical tips, treatment options, patient management issues, drug therapies, prognosis, complications, and how to prevent recurrence. The information is provided in outline and bulleted format for ease of accessibility. The final section of the chapter offers resources, including related associations, key references, and the answers to frequently asked questions (FAQs). 18 references.
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Gallbladder Surgery Book: Understanding Gallbladder Symptoms, Their Most Common Cause, and Your Treatment Options.. San Bruno, CA: Krames Communications. 2003. 11 p.
This booklet provides patients with a readable guide to gallbladder surgery. No one knows for sure what causes gallbladder problems, but those at risk include women, often in their forties; women who have been pregnant; people who are overweight; people who eat large amounts of dairy products, animal fats, and fried foods; and people with a family history of gallbladder problems. This pamphlet uses full-color illustrations to discuss the symptoms of gallstones; prevention; the anatomy of the gallbladder; the types of gallstones; and evaluation and diagnosis. The booklet also reviews treatment options, including open cholecystectomy (removing the gallbladder through an incision in the abdomen), laparoscopic cholecystectomy, medications, and ERCP (endoscopic retrograde cholangiopancreatography). Other topics include preparation for surgery, what happens during surgery, and recovery in the hospital and at home. The booklet reassures readers that after surgery they should be able to live full and healthy lives.
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Gallstones. In: Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 2177-2200.
Over 20 million Americans have gallstones, and more than 700,000 cholecystectomies (gallbladder removal) are performed annually in the United States. Gallstone-related symptoms and complications are among the most common gastroenterological disorders requiring hospitalization, at an estimated annual cost of almost $6.5 billion. This chapter on gallstones is from a comprehensive gastroenterology textbook that provides an encyclopedic discussion of virtually all the disease states encountered in a gastroenterology practice. In this chapter, the authors cover epidemiology, etiology (cause), clinical manifestations, differential diagnosis, clinical course and complications, treatment, acalculous cholecystitis (inflamed gallbladder without the presence of stones), and recurrent pyogenic cholangitis (bile duct inflammation). The chapter is illustrated with black-and-white radiographs and drawings. 6 figures. 4 tables. 307 references.
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Pancreatitis. In: PDxMD. PDxMD Gastroenterology. St. Louis, MO: Elsevier Science. 2003. p. 407-431.
Pancreatitis is inflammation of the pancreas, with symptoms of moderate to severe midepigastric pain, anorexia (lack of appetite), nausea, and vomiting. Eighty percent of all cases of pancreatitis are caused by either obstructive gallstone pathology or heavy alcohol use. Recurrence rates of up to 50 percent occur without resolution of the causative factors. This chapter on pancreatitis is from a book on gastroenterology that offers concise, action-oriented recommendations for primary care medicine. The chapter covers summary information and background on the condition, and comprehensive information on diagnosis, treatment, outcomes, and prevention. Specific topics covered include the ICD9 code, urgent action, synonyms, cardinal features, causes (etiology), epidemiology, differential diagnosis, signs and symptoms, associated disorders, investigation of the patient, appropriate referrals and consultations, diagnostic considerations, clinical tips, treatment options, patient management issues, drug therapies, prognosis, complications, and how to prevent recurrence. The information is provided in outline and bulleted format for ease of accessibility. The final section of the chapter offers resources, including related associations, key references, and the answers to frequently asked questions (FAQs). 5 references.
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Pancreatitis: Understanding This Painful Condition. San Bruno, CA: StayWell Company. 2003. [2 p.].
This brochure describes acute pancreatitis (irritated or inflamed pancreas), a condition most often caused by gallstones. Acute pancreatitis is very painful and emergency medical treatment is usually needed. Symptoms include severe pain in the upper abdomen (that goes through to the back), nausea and vomiting, abdominal swelling and tenderness, fever, rapid pulse, and shallow, fast breathing. Blood tests are used to determine whether the symptoms are due to acute pancreatitis; health history and physical exam can help confirm the diagnosis. Other tests used include ultrasound (to confirm gallstones), CT scan (computed tomography, used to show how much the pancreas is inflamed), and ERCP (endoscopic retrograde cholangiopancreatography, which examines the common bile duct for gallstones). The brochure briefly describes the treatment for acute pancreatitis, which can include resting the pancreas (nutrition and fluids are given through an intravenous line), medications for the pain, and dietary modifications (after leaving the hospital). The brochure emphasizes the importance of avoiding alcohol. One sidebar describes chronic pancreatitis, which is most often due to continued drinking of alcohol. Another section describes the anatomy and function of the pancreas. The brochure is illustrated with full color drawings. 6 figures.
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Supporting Cast: Disorders of the Liver, Pancreas, and Gallbladder. In: Bonci, L. American Dietetic Association Guide to Better Digestion. Hoboken, NJ: John Wiley and Sons, Inc. 2003. p. 201-228.
While medical treatments and prescriptions can offer relief from gastrointestinal problems, one of the most important ways patients can help themselves is in their dietary choices. This chapter on disorders of the liver, pancreas, and gallbladder is from a book that describes how patients can self-manage their digestive disorders through dietary choices. The author reviews these disorders, focusing on the role of diet as a part of comprehensive treatment plans. Topics include gallstones, pancreatitis, and liver disease. For each, the author reviews symptoms, diagnosis, treatment, the impact of diet in causing disease, and the role of food choices in treating the condition. The author also considers the potential impact of dietary or herbal supplements on these conditions. Food charts and sample food diaries are also provided. 11 figures.
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When Gallstones Are to Blame for Your Pain. Mayo Clinic Women's Healthsource. 7(7): 4-5. July 2003.
Gallbladder disease is common, especially in women. This article, from a women's health newsletter, reviews gallstones and the pain they can cause. The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. The main function of the gallbladder is to store bile, a greenish-brown fluid that helps to digest fats. Bile is produced in the liver and travels to the gallbladder and small intestine through thin tubes (the bile ducts). If bile within the gallbladder becomes chemically unbalanced, it can form into hardened particles that eventually grow into stones. Topics include gallstone formation, risk factors for gallstones, gallstone movement, diagnostic tests that can confirm the presence of gallstones, and treatment options. Readers are encouraged to reduce their risks of gallstones by maintaining a healthy body weight, exercising regularly, and eating a low-fat, high-fiber diet plentiful in fresh fruits, vegetables, and whole grains. 1 figure.
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Abdominal Pain. In: Reisman, A.B.; Setevens, D.L., eds. Telephone Medicine: A Guide for the Practicing Physician. Philadelphia, PA: American College of Physicians. p. 107-122.
This chapter on abdominal pain is from a reference book for practicing physicians who are providing information for their patients over the telephone. The author notes that abdominal pain is one of the more challenging medical complaints to evaluate over the telephone. The chapter summarizes key points, then outlines an approach to acute abdominal pain and to chronic abdominal pain that has acutely changed in the adult patient. Topics include epidemiology, utility of early diagnosis, early diagnosis in the elderly, the general approach to the telephone evaluation, determining whether the patient requires emergency evaluation, small bowel obstruction, acute appendicitis, acute cholecystitis (gallbladder infection, often due to gallstones), ectopic pregnancy, dyspepsia, biliary colic, what to tell the patient, and what to document. The author stresses that the telephone physician should have a lower threshold for in-person evaluation of elderly patients with any acute abdominal pain because older patients are more likely to present late in the course of their illness and to have a poor clinical outcome. Abdominal pain in the setting of significant bleeding, trauma, or recent abdominal surgery should prompt a referral to the emergency room without delay. For patients in whom the disposition is not clear, the physician should consider calling back within a few hours to reassess the symptoms for resolution or progression. A patient care diagnostic algorithm is provided. 1 figure. 38 references.
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Acalculous Cholecystitis, Cholesterolosis, Adenomyomatosis, and Polyps of the Gallbladder. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1116-1130.
Although gallstones (cholelithiasis) and their complications account for most cholecystectomies (gallbladder removal), a persistent 15 percent of these operations are performed in patients without gallstones. In general, one of two clinically distinct syndromes occur in these patients: acalculous biliary pain or acute acalculous cholecystitis. This chapter on acalculous cholecystitis, cholesterolosis, adenomyomatosis, and polyps of the gallbladder is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. For each condition, the author considers a definition, epidemiology, pathogenesis, clinical manifestations, diagnostic considerations, and treatment options. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 5 figures. 5 tables. 201 references.
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Acute Pancreatitis. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 913-941.
This chapter on acute pancreatitis is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include incidence and definition; pathology; pathogenesis; pathophysiology; predisposing conditions, including gallstones, biliary sludge and microlithiasis, other causes of mechanical ampullary obstruction, alcohol, hypertriglyceridemia, hypercalcemia, drugs, infections and toxins, trauma, pancreas divisum, vascular disease, pregnancy, post-ERCP (endoscopic retrograde cholangiopancreatography), postoperative pancreatitis, hereditary pancreatitis, structural abnormalities, and idiopathic (of unknown cause) pancreatitis; clinical presentation; laboratory diagnosis; radiologic diagnosis; differential diagnosis of acute pancreatitis; distinguishing alcoholic from gallstone pancreatitis; predictors of severity of pancreatitis, including scoring systems, obesity, chest radiography, organ failure, and local complications; treatment for mild and severe pancreatitis, gallstone pancreatitis, and experimental agents; complications, including infection, pancreatic pseudocyst, pancreatic abscess, and systemic complications; and prognosis. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 5 figures. 7 tables. 260 references.
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Diagnosis of Acute Cholecystitis: Sensitivity of Sonography, Cholescintigraphy, and Combined Sonography-Cholescintigraphy. Journal of the American College of Surgeons. 193(6): 609-613. December 2001.
The radiographic diagnosis of acute cholecystitis (gallbladder inflammation) can be established using ultrasound (US), cholecystoscintigraphy (HIDA), or both. Although both modalities have been effective in diagnosis acute cholecystitis (AC), physicians from the emergency department and admitting surgeons continue to request both tests in an attempt to increase the diagnostic accuracy of AC. This article reports on the institutional experience of a large tertiary care health care facility, with respect to the sensitivity of US, HIDA, and combined US and HIDA. The authors conducted a retrospective review of 132 patients diagnosed with AC who underwent laparoscopic cholecystectomy during the same hospitalization. Group 1 (n = 50) included patients who underwent US alone; group 2 (n = 28) included patients who underwent HIDA scan alone; and group 3 (n = 54) included patients who underwent both tests. Results showed sensitivity for US was 24 of 50 patients (48 percent); for HIDA 24 of 28 patients (86 percent); and 49 of 54 patients (90 percent) for the combination of tests. The authors conclude that HIDA scan is a more sensitive test than US in diagnosing patients with AC. Based on their results, the authors recommend that HIDA scan should be used as the first diagnostic modality in patients with suspected acute cholecystitis; US should be used to confirm the presence of gallstones rather than to diagnose AC. 1 figure. 2 tables. 12 references.
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Diseases of the Liver and Biliary System, Eleventh Edition. Malden, MA: Blackwell Science, Inc. 2002. 706 p.
Designed to serve practicing physicians, surgeons and pathologists, as well as clinical students, this textbook presents a comprehensive and up-to-date account of diseases of the liver and biliary system. The text offers 38 chapters: anatomy and function; the assessment of liver function; biopsy of the liver; the hematology of liver disease; ultrasound, computed tomography (CT scan) and magnetic resonance imaging (MRI); hepatocellular failure; hepatic encephalopathy; acute liver failure; ascites (fluid accumulation); the portal venous system and portal hypertension; the hepatic artery and hepatic vein, and the liver in circulatory failure; jaundice; cholestasis; primary biliary cirrhosis (PBC); sclerosing cholangitis; viral hepatitis, including general features, hepatitis A, hepatitis E, and other viruses; hepatitis B virus and hepatitis Delta virus; hepatitis C virus; chronic hepatitis, its general features and autoimmune chronic disease; drugs and the liver; hepatic cirrhosis (scarring); alcohol and the liver; iron overload states; Wilson's disease; nutritional and metabolic liver diseases; the liver in infancy and childhood; the liver in pregnancy; the liver is systemic disease, granulomas, and hepatic trauma; the liver in infections; nodules and benign liver lesions; malignant liver tumors; the role of interventional radiology and endoscopy in imaging of the biliary tract; cysts and congenital biliary abnormalities; gallstones and inflammatory gallbladder diseases; benign stricture of the bile ducts; diseases of the ampulla of Vater and the pancreas; tumors of the gallbladder and bile ducts; and hepatic transplantation. The text includes full-color and black-and-white illustrations and photographs. A detailed subject index concludes the volume.
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Don't Accept Gallbladder Disease as a Fact of Life. Digestive Health and Nutrition. p. 8-11. November-December 2002.
This article explores the causes of gallstones (cholelithiasis) and offers strategies for preventing their recurrence. Topics include the symptoms of a typical gallstone attack, dietary risk factors, how gallstones form, the epidemiology of gallstones, the role of genetics, strategies for preventing gallstones through diet, the importance of weight loss, diagnostic tests used to confirm gallstones, and treatment strategies, including surgical removal, and laparoscopic removal of the gallbladder (cholecystectomy). The author stresses that healthy, slow weight loss along with a balanced diet and moderate exercise is the key. The article concludes with two web site addresses through which readers can obtain more information.
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Epidemiology of the American Indians' Burden and Its Likely Genetic Origins. Hepatology. 36(4 Part 1): 781-791. October 2002.
Gallstones are now found in epidemic proportions in 13 diverse American Indian tribes and communities living in Arizona, Oklahoma, and the Dakotas. In this article, the authors speculate that this predisposition is polygenic involving 'thrifty' genes that conferred survival advantages when Paleo-Indians migrated from present-day Siberia to the Americas during the last Great Ice Age approximately 50,000 to 10,000 years ago. A reasonable hypothesis is that functioning of these genes promoted more efficient calorie utilization and storage in the form of adipose tissue. Beneficial results would have been operative during the isolation of Paleo-Indians in the Bering Strait land bridge (Beringia) when thrifty genes would have ensured sufficient fat reserves for survival of prolonged winters, successful pregnancy outcomes, and extended lactation periods. The authors' conjoint work on genetics of experimental cholesterol cholelithiasis (gallstones) in inbred mice may help in pinpointing orthologous genetic loci (LITH genes) in the human genome. Moreover, the shared environments and homogeneity of American Indian tribes and communities should facilitate discovery of the ensembles of their common and more rare cholesterol gallstone genes. 2 figures. 1 table. 69 references.
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Ethnic Variation in Gallstone Disease. Practical Gastroenterology. 26 (6): 33-34, 36, 39-40, 42-43, 47-48. June 2002.
Gallstone disease (GSD) is a major cause of morbidity (illness) worldwide. This article considers the epidemiologic data that are now available from a large number of European and American studies demonstrating a marked variation in overall gallstone prevalence among different ethnic groups. These studies have revealed a much higher prevalence of GSD in Native Americans (especially Pima Indians), Chileans, and Mexican Americans, while Japanese and non Hispanic black populations have some of the lowest prevalence of GSD. For example, in women older than 65, the prevalence of GSD among Pima Indians is 89.5 percent, 44.1 percent among Mexican Americans, 16.4 percent among Caucasians, and only 9.5 percent among Japanese. Although the reasons behind this ethnic variation are not well understood, it is important that health care providers be aware that certain ethnic groups are at higher risk for gallstone disease so that appropriate evaluation and timely treatment can be rendered. 4 tables. 36 references.
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Gallbladder Polyps: Epidemiology, Natural History and Management. Canadian Journal of Gastroenterology. 16(3): 187-194. March 2002.
This article discusses polypoid lesions of the gallbladder, which affect approximately 5 percent of the adult population. Most affected individuals are asymptomatic, and their gallbladder polyps are detected during abdominal ultrasound performed for unrelated conditions. Although the majority of gallbladder polyps are benign, most commonly cholesterol polyps, malignant transformation (to cancer) is a concern. The differentiation between benign and malignant lesions can be challenging. Several features, including patient age, polyp size and number, and rapid growth of polyps, are important discriminating features between benign and malignant polyps. Based on the evidence highlighted in this article, the authors recommend resection in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, greater than 10 millimeters in diameter, or associated with gallstones or polyp growth on serial ultrasonography. New imaging techniques, including endoscopic ultrasound and enhanced computed tomography (CT scan), may aid in the differential diagnosis of these lesions and permit better patient management. A brief patient care algorithm is provided. 3 figures. 3 tables. 66 references.
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Gallstone Disease and Its Complications. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1065-1090.
Gallbladder removal (cholecystectomy) is the most common elective abdominal operation in the United States and is overwhelmingly necessitated by the presence of gallstones. This chapter on gallstone disease and its complications is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include epidemiology, risk factors, pathogenesis, and natural history of gallstones (cholelithiasis); and clinical manifestations of gallstone disease, including imaging studies of the biliary tract, biliary colic and chronic cholecystitis, acute cholecystitis, choledocholithiasis (bile duct stones), cholangitis (bacterial cholangitis), and uncommon complications of gallstone disease. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 5 figures. 5 tables. 201 references.
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Gallstones and Inflammatory Gallbladder Diseases. In: Sherlock, S.; Dooley, J. Diseases of the Liver and Biliary System. Malden, MA: Blackwell Science, Inc. 2002. p.597-628.
This chapter on gallstones and inflammatory gallbladder diseases is from a textbook that presents a comprehensive and up-to-date account of diseases of the liver and biliary system. The chapter covers the composition of gallstones and of bile; factors in cholesterol gallstone formation; pigment gallstones; radiology of gallstones; the natural history of gallstones, including silent gallstones; treatment of gallstones in the gallbladder, with cholecystectomy or laparoscopic cholecystectomy; non-surgical treatment of gallstones in the gallbladders, including dissolution therapy, direct solvent dissolution, and shock-wave therapy; and percutaneous cholecystolithotomy; acute cholecystitis; empyema of the gallbladder; perforation of the gallbladder; emphysematous cholecystitis; chronic calculous cholecystitis; acalculous cholecystitis, including acute, chronic, typhoid cholecystitis and acute cholecystitis in AIDS; other gallbladder pathology, including cholesterolosis of the gallbladder, xanthogranulomatous cholecystitis, adenomyomatosis, and porcelain gallbladder; post-cholecystectomy problems; sphincter of Oddi dysfunction; gallstones in the common bile duct (choledocholithiasis); management of common duct stones, including acute obstructive suppurative cholangitis and acute cholangitis; common duct stones without cholangitis, including patients with gallbladder in situ, acute gallstone pancreatitis, large common duct stones, trans T-tube tract removal of stones, intra-hepatic gallstones, and Mirizzi's syndrome; biliary fistulae, external and internal; gallstone ileus; hemobilia; bile peritonitis; and the association of gallstones with other diseases, including colorectal and other cancers, and diabetes mellitus. 16 figures. 4 tables. 206 references.
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Gallstones: What to Do?. Digestive Health Matters. 4(1): 1-3. Spring 2002.
This article helps readers who are diagnosed with gallstones determine their own best course of action. Although gallstones are present in 20 percent of women and 8 percent of men over the age of 40, most people are unaware of their presence and the consensus is that if they are not causing trouble, they should be left in place. Nevertheless, gallbladder removal (cholecystectomy) is one of the most common surgical procedures. The author reviews gallstones and their development, the prognosis of gallstones, how gallstones can cause symptoms, the symptoms they cause, other digestive tract symptoms that are not due to gallstones, complications of gallstones, diagnostic tests that may be used to confirm the presence or type of gallstones, and treatment options. 2 figures. 6 references.
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Nonsurgical Management of Gallstone Disease. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1107-1115.
The treatment of gallstones (cholelithiasis) without surgery has long been a goal of medical therapy. This chapter on the nonsurgical management of gallstone disease is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include general aspects; oral bile acid dissolution therapy, including pathophysiologic considerations and rationale, therapeutic regimens, patient selection, efficacy, safety, and side effects; extracorporeal shock wave lithotripsy (ESWL), including background and rationale, physical and technical aspects of shock waves, procedure, patient selection, efficacy, safety, and side effects; ESWL used for bile duct stones, including the procedure, patient selection, efficacy, safety, and side effects; recurrence of gallstones; and choice of treatment. The author stresses that nonsurgical approaches represent a long term solution only for patients in whom the disturbance that led to the formation of gallstones is transient. Gallstones recur within approximately five years in 30 to 50 percent of the patients whose stones are eliminated nonsurgically. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 3 figures. 3 tables. 58 references.
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Right Upper Quadrant Pain: Gallbladder Disease and its Complications. In: Edmundowicz, S.A., ed. 20 Common Problems in Gastroenterology. New York, NY: McGraw-Hill, Inc. 2002. p. 233-253.
Right upper quadrant pain is a common problem that accounts for many elective and emergency room visits. Although the list of causes is extensive, one of the most common is cholelithiasis (gallstones) and its associated complications. This chapter on gallbladder disease and its complications is from a book that focuses on the most common gastroenterological problems encountered in a primary practice setting. The chapter is organized to support rapid access to the information necessary to evaluate and treat most patients with this problems. Topics include incidence and background; the principal diagnoses, including types of gallstones and the risk factors for developing gallstones; complications of gallstone disease, including symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, choledocholithiasis, cholangitis, gallstone pancreatitis, Mirizzi's syndrome, postcholecystectomy syndrome, malignancy, and motility disorders; the typical presentation and key history; physical examination and ancillary tests, including sonography, cholescintigraphy, oral cholecystography, computed tomography (CT) and magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and blood tests; treatment options, including cholecystectomy (removal of the gallbladder), percutaneous cholecystostomy, dissolution therapy, and extracorporeal shock wave lithotripsy (ESWL); patient education; common errors in diagnosis and treatment; controversies, including the role of Helicobacter pylori in gallstone disease; and emerging concepts. The chapter includes an outline for quick reference, the text itself, a diagnostic and treatment algorithm, and selected references. 7 figures. 1 table. 34 references.
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Short Bowel Syndrome. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1807-1816.
Short bowel syndrome is a malabsorption syndrome that results from extensive intestinal resection (surgical removal). Intestinal failure is a functional definition of the syndrome that denotes the inability of the remnant intestine to maintain nutritional balance. This chapter on short bowel syndrome is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include etiology, incidence and prevalence, pathophysiology, clinical manifestations (symptoms), diagnostic considerations, treatment options, complications (cholesterol gallstones, oxalate kidney stones, delta lactic acidosis, reoperations), intestinal transplantation, treatment with growth factors, and prognosis. The chapter includes a mini-outline with page citations, illustrations, and extensive references. 4 figures. 4 tables. 76 references.
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Sorting out the most Common GI Complaints. Patient Care. 36(3): 21-22, 25-26, 28, 31. February 15, 2002.
Millions of patients have gastrointestinal (GI) symptoms including belching (burping), intestinal gas (flatulence), abdominal distension, and indigestion, among others. Most of these do not signal the presence of a serious illness, but the practitioner's advice on preventing and treating nuisance symptoms can be enormously valuable to patients. This article helps primary care providers sort out the most common GI complaints. The authors stress that even trivial GI complaints deserve careful attention in the history and physical. Ominous symptoms include anemia, dysphagia (swallowing difficulties), bleeding, and weight loss. Once a potentially serious GI disorder has been ruled out, prevention and treatment efforts against the patient's most troublesome complaints can be initiated. Alpha-D-galactosidase may reduce gas associated with bean consumption; patients should be encouraged to incorporate these valuable foods in their diets. Sorbitol containing products may cause excessive gas production, even diarrhea. Patients should not increase their fiber consumption without increasing their fluid intake. Heartburn is usually well managed with H2 receptor antagonists and proton pump inhibitors. The authors caution that testing for gallstones is not indicated, unless the patient has the characteristic severe pain associated with this condition. And eradicating Helicobacter pylori in a patient with nonulcer dyspepsia usually does not reduce the symptoms. 1 figure. 1 table. 6 references.
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Surgical Management of Gallstone Disease and Postoperative Complications. In: Feldman, M.; Friedman, L.S.; Sleisenger, M.H. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 2002. p. 1091-1105.
Gallbladder removal (cholecystectomy) is the most common elective abdominal operation in the United States and is overwhelmingly necessitated by the presence of gallstones. Laparoscopic cholecystectomy has become the standard method for the elective treatment of patients with biliary colic and complications of gallstone disease, such as acute cholecystitis, gallstone pancreatitis, and choledocholithiasis (common bile duct stones). This chapter on the surgical management of gallstone disease and postoperative complications is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include open cholecystectomy (gallbladder removal) and laparoscopic cholecystectomy; indications for cholecystectomy, including asymptomatic gallstones, biliary colic, acute cholecystitis, gallstone pancreatitis, and special problems; surgery for choledocholithiasis; bile duct stricture; postcholecystectomy syndrome, including choledocholithiasis, cystic duct remnant, and sphincter of Oddi dysfunction; and the interplay of gallstones, cholecystectomy, and cancer. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 4 figures. 5 tables. 160 references.
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Your Liver Lets You Live. Cedar Grove, NJ: American Liver Foundation. 2002. [4 p.].
The liver, the largest organ in the body, plays a vital role in regulating life processes. These processes include: to convert food into chemicals necessary for life and growth; to manufacture and export important substances used by the rest of the body; to process drugs absorbed from the digestive tract into forms tat are easier for the body to use; and to detoxify and excrete substances that otherwise would be toxic to the body. This brochure reviews the functions of the liver, the symptoms and signs of liver disease, prevention strategies, the problem of gallstones, alcohol related liver disorders (fatty liver, alcoholic hepatitis, alcoholic cirrhosis), cirrhosis (scarring of the liver), liver disorders in children (biliary atresia, chronic active hepatitis, galactosemia, Wilson's disease, Reye's syndrome), cancer of the liver, and research efforts in liver disease. The brochure concludes with a description of the work of the American Liver Foundation (ALF) and its contact information (www.liverfoundation.org). 1 figure.
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Acalculus Cholecystitis. Care of the Critically Ill. 17(2): 44-47. April 2001.
This article discusses the etiology (causes), diagnosis, and treatment of acalculus cholecystitis (gallbladder inflammation not due to gallstones). In patients with a typical history of biliary colic (abdominal pain related to the gallbladder) in whom ultrasound examination for stones is negative, oral cholecystogram will occasionally reveal small stones missed on ultrasound and will give some information as to gall bladder function. Absent gallbladder function or lack of concentration of the test dye with typical symptoms probably justifies cholecystectomy (removal of the gallbladder). In some patients in whom all diagnostic tests are negative but the diagnosis of chronic acalculus cholecystitis is strongly suspected, cholecystectomy may be both diagnostic and therapeutic, but the patient must be adequately counseled about all aspects of the procedure, including the possibility of still having symptoms after surgery. A laparoscopic procedure is usually used for cholecystectomy. Acute acalculus cholecystitis is an uncommon condition, probably due to ischemia (lack of blood flow) in the gallbladder, perhaps during episodes of acute hypotension (low blood pressure). Diagnosis of acute acalculus cholecystitis depends primarily upon a high level of clinical suspicion of the condition in patients who are at risk by virtue of their underlying pathology. Laparoscopic cholecystectomy is both effect and safe in experienced hands. Overall mortality is thought to be in the range of 6 to 9 percent. Perforation significantly increases mortality and should be prevented wherever possible by early operative intervention. 3 figures. 1 table. 20 references.
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Acute Pancreatitis. In: Beckingham, I.J., ed. ABC of Liver, Pancreas and Gallbladder. London, UK: BMJ Publishing Group. 2001. p.33-36.
Acute pancreatitis is relatively common, and in more than 80 percent of patients the disease is associated with alcohol or gallstones, although the ratio of these two causes has a wide geographical variation. This chapter on acute pancreatitis is from an atlas of the liver, pancreas and gallbladder. Topics include pathogenesis and pathological processes, clinical presentation, diagnosis, clinical course, assessment of severity, radiology, treatment of acute attacks, prognosis, and long term management. The authors recommend the use of severity scoring to identify patients at greatest risk of complications. Treatment is mainly supportive. Patients with acute gallstone pancreatitis require early laparoscopic cholecystectomy (gallstone removal) once the attack has settled. Mortality for acute pancreatitis is 10 percent overall, but rises to 70 percent in patients with infected severe pancreatitis. The chapter concludes with summary points of the concepts discussed. 7 figures. 4 tables. 3 references.
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Adverse Effects of Drugs on the Gastrointestinal Tract. In: Farthing, M.J.G.; Ballinger, A.B., eds. Drug Therapy for Gastrointestinal and Liver Diseases. Florence, KY: Martin Dunitz. 2001. p. 331-339.
Adverse effects of drugs on the gastrointestinal tract are common, although epidemiological data demonstrating overall frequency and impact are limited. This chapter on the adverse effects of drugs on the gastrointestinal tract is from a textbook that reviews the drug therapy for gastrointestinal and liver diseases. The author considers the research evidence by category: case reports; gastrointestinal tract, including mouth, esophagus, stomach, small and large bowel; and drug interactions in the gut. Potential drug effects are discussed, including peptic ulceration, altered gastric emptying, anti-inflammatory drugs, exacerbation of colitis and Crohn's disease, constipation, obstruction, gallstones, and pancreatitis. 2 tables. 16 references.
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Cholecystitis and Mirizzi Syndrome. In: Okuda, K., ed.,et al. Hepatobiliary Diseases: Pathophysiology and Imaging. Malden, MA: Blackwell Science, Inc. 2001. p. 682-695.
This chapter on cholecystitis and Mirizzi syndrome is from a textbook that familiarizes the reader with various imaging modalities, the information they provide, and the merits of each, in order to facilitate the combined use of different imaging techniques in the diagnosis and management of hepatobiliary (liver and bile tract) diseases. Acute calculous cholecystitis is an acute inflammation of the gallbladder precipitated by obstruction of the neck of the gallbladder or cystic duct by a gallstone. Acute cholecystitis is the most common complication of gallbladder stones, causing the patient severe pain and illness. Emphysematous cholecystitis is rare and characterized by the gallbladder being infected by gas-forming bacteria, including Clostridia, Escherichia coli, and Staphylococcus and Streptococcus species. Chronic cholecystitis is almost always associated with gallstones, whether or not the patient has had symptoms. Xanthogranulomatous cholecystitis is characterized by multiple, yellowish brown intraluminal nodules, proliferative fibrosis, and foamy histiocytic infiltration (bile within the gallbladder wall). Porcelain gallbladder is defined as diffuse calcification of the wall of the organ. Milk of calcium bile, or limy bile, is formed by the precipitation of calcium carbonate, calcium phosphate, and calcium bilirubinate in the gallbladder, resulting in a semifluid or putty like material. Mirizzi syndrome is an uncommon complication of long standing gallstone disease that occurs in 0.7 to 1.4 percent of all cholecystectomies (gallbladder removals) performed. Mirizzi syndrome includes stricture (narrowing) of the common hepatic (liver) bile duct due to inflammation of the gallbladder and fistula after erosion of the impacted stone into the common hepatic duct. For each condition, the author discusses pathogenesis, pathology, clinical presentation, diagnostic imaging, and treatment options. 23 figures. 19 references.
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Clinical Management of Short-Bowel Syndrome. In: Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 479-484.
This chapter on the clinical management of short bowel syndrome is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and ulcerative colitis (UC), together known as inflammatory bowel disease (IBD). Short bowel syndrome generally implies either malabsorption of the necessity for specific nutrient therapies. Short bowel syndrome can occur in patients with CD who undergo multiple intestinal resections (surgical removal of a piece). Depending upon the length and health of the remaining intestine, as well as the presence or absence of the ileocecal valve or colon, such patients may require various oral supplements, intravenous fluids, or even total parenteral nutrition (TPN). Bowel length may be difficult to determine because most commonly used methods such as barium contrast studies and intraoperative measurement are imprecise. In addition, there is significant individual variation in the adaptive response to differing lengths of residual intestine. Younger individuals, especially neonates, have a much greater capacity to adapt than adults. Complications of short-bowel syndrome include dehydration (which may result in uric acid nephrolithiasis, kidney stones), generalized malnutrition, electrolyte disturbances, specific nutrient deficiencies, calcium-oxalate nephrolithia-sis, and cholelithiasis (gallstones). Those patients with significant malabsorption requiring long-term TPN are at additional risk for hepatic steatosis (fatty liver) and cholestasis (an interruption of the flow of bile) with potential progression to cirrhosis (liver scarring), either acalculous or calculous cholecystitis (inflammed gallbladder), metabolic bone disease, nephropathy (kidney disease), and central venous catheter-related problems, including infection and occlusion (thrombotic and nonthrombotic; clotting or nonclotting). 10 references.
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Congenital Anomalies and Dilation. In: Okuda, K., ed.,et al. Hepatobiliary Diseases: Pathophysiology and Imaging. Malden, MA: Blackwell Science, Inc. 2001. p. 636-650.
Congenital anomalies (anatomical differences present at birth) are encountered in both the gallbladder and bile ducts. Most of these anomalies are usually of no clinical importance. However, some can lead to cholestasis, inflammation, gallstones, and cancer. This chapter on congenital anomalies and dilatation is from a textbook that familiarizes the reader with various imaging modalities, the information they provide, and the merits of each, in order to facilitate the combined use of different imaging techniques in the diagnosis and management of hepatobiliary (liver and bile tract) diseases. Topics include congenital dilatation of the bile duct, pancreaticobiliary maljunction and gallbladder anomalies of number, form, and position. 14 figures. 3 tables. 40 references.
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Endoscopic Retrograde Cholangiopancreatography. Gastrointestinal Endoscopy Clinics of North America. 11(4): 585-601. October 2001.
Endoscopic retrograde cholangiopancreatography (ERCP) is an established procedure in the evaluation and treatment of adult patients with suspected disorders of the pancreas and the biliary tract. This article defines the technique, indications, complications, and diagnostic and therapeutic applications of ERCP in children. The use of this technique in children has been limited. This may be caused by multiple factors including the relatively low incidence of pancreatic and biliary diseases in childhood and a low index of clinical suspicion; limited availability of pediatric duodenoscopes; lack of pediatric gastroenterologists adequately trained to perform ERCP; the impression that ERCP in children is technically difficult to accomplish; difficulty in the effective evaluation of a therapeutic result; and lack of well-defined indications and safety of ERCP in children. The article reviews biliary findings, including bile plug syndrome, primary sclerosing cholangitis, biliary obstruction due to parasitic infestation, cholelithiasis (gallstones) and choledocholithiasis (bile tract stones), benign and malignant biliary strictures, biliary obstruction or leaks after liver transplantation, and common bile duct complications after laparoscopic cholecystectomy (removal of the gallbladder). The authors also discuss pancreatic findings, including recurrent pancreatitis, congenital disorders, pancreatic anomalies, duodenal anomalies, acquired disorders, chronic pancreatitis, and pseudocysts. 8 figures. 4 tables. 67 references.
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Epidemiology of Gallstones: Prevalence of Gallstone Disease in Iran. Journal of Gastroenterology and Hepatology. 16(5): 564-567. May 2001.
The prevalence of gallstone disease varies depending on the geographic region involved. Few studies, in Asia but not from Iran, about the frequency of gallstone disease have been published. This article reports on a study of the prevalence of gallstone disease in Iran. The study included 477 nomads from southern Iran, 513 industrial laborers older than 34 years, and 421 laborers from a pharmaceutical company above 30 years of age, and 471 elderly persons from three nursing homes near Tehran underwent abdominal sonography. There was a total of 1,373 men and 509 women. Gallstone disease was present in 89 subjects; 10.1 percent of them had undergone cholecystectomy (removal of the gallbladder). While the prevalence in the men and women in the age group 31 to 40 years was very low (0.3 percent in men and 1.8 percent in women), it increases sharply in men older than 60 years and women older than 50 years to more than 10 fold (12.5 and 24.6 percent in males and females aged 71 to 80 years, respectively). The author concludes that, in Iran, gallstone disease is very uncommon in middle aged people, but increases sharply in older people. However, this does not reach the high prevalence seen in Western countries. The intake of a high fiber containing diet, and low numbers of overweight people, smoking habits, and hyperlipidemia (elevated concentrations of fats in the blood) are probably the cause for this low prevalence. 2 tables. 44 references.
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ERCP: Locating and Treating Common Bile Duct Blockages. San Bruno, CA: StayWell Company. 2001. [2 p.].
This patient education brochure describes endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to view the common bile duct. ERCP is used to help located and treat blockages in the duct. Written in nontechnical language, the brochure describes how to prepare for the ERCP, what the patient can expect during the test itself, and when the patient will get the results. ERCP is most often done in a radiology or endoscopy suite. After the patient is sedated, the endoscope is placed into the throat and guided through the digestive tract. The scope lets the doctor see all the way through the esophagus, stomach, and duodenum to the opening of the common bile duct. The doctor can also insert instruments. As blockages are located and removed, x rays are taken. The most common blockages are gallstones, which can often be removed during ERCP. Stents (tubes) may also be placed in narrow places to allow bile to flow out. The day after the test, the patient can go back to a normal routine and diet. One section of the brochure illustrates the common bile duct and surrounding organs and describes how problems can occur. The brochure is illustrated with full color line drawings. 9 figures.
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Gallstone Disease. In: Beckingham, I.J., ed. ABC of Liver, Pancreas and Gallbladder. London, UK: BMJ Publishing Group. 2001. p.5-8.
Gallstones are the most common abdominal reason for admission to the hospital in developed countries and they account for an important part of healthcare expenditures. This chapter on gallstone disease is from an atlas of the liver, pancreas and gallbladder. Topics covered include the types of gallstones and their etiology; the clinical presentation of gallstone problems, including biliary colic or chronic cholecystitis, acute cholecystitis, jaundice, acute cholangitis, acute pancreatitis, and gallstone ileus; the natural course of gallstone disease; the management of gallstone disease, including cholecystectomy (removal of the gallbladder) and alternative treatments; and the management of common bile duct stones. The author notes that laparoscopic cholecystectomy has become the treatment of choice for gallbladder stones, with an accompanying risk of bile duct injury of approximately 0.2 percent. Asymptomatic gallstones do not require treatment. The chapter concludes with summary points of the concepts discussed. 10 figures. 5 tables.
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Gallstone Management in Inflammatory Bowel Disease. In: Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 317-320.
This chapter on gallstone (cholelithiasis) management in inflammatory bowel disease (IBD) is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and Ulcerative Colitis (UC), together known as IBD. The association between IBD and hepatobiliary (liver, gallstone, bile ducts) disorders has been well established. Both CD and chronic Ulcerative Colitis (UC) can affect the liver and biliary system. Indeed, hepatobiliary involvement in patients with IBD varies from the asymptomatic state to the development of symptomatic complications related to chronic liver injury. Gallstones represent one of the most frequently encountered clinical hepatobiliary problems in patients with IBD especially those with Crohn's disease. In this chapter, the authors present an overview of the management of gallbladder stones and biliary sludge in patients with IBD. A summary of the epidemiology and pathogenesis of gallstones and biliary sludge in these patients is provided to guide therapeutic decision-making, which should aim not only to address symptomatic stones but also to prevent their development. Precipitating factors or conditions including prolonged fasting, total parenteral nutrition (TPN), and use of the drugs ceftriazone or octreotide must be avoided. Patients with symptomatic sludge or complications should have cholecystectomy (removal of the gallbladder). In poor surgical candidates, alternative interventions include oral agents for bile acid dissolution and percutaneous cholecystostomy. 1 figure. 1 table. 8 references.
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Gallstones. Toronto, Ontario: Canadian Liver Foundation. 2001. 2 p.
This brochure describes gallstones (cholelithiasis), solid lumps of cholesterol crystals or pigment material that form in the gallbladder. The gallbladder is a pouch that sits beneath the liver and stores bile. With a meal, the gallbladder releases bile into the small intestine where it helps to digest fats. The brochure discusses how gallstones are formed, the different types of gallstones, risk factors for developing gallstones, the symptoms of gallstones, diagnostic strategies, prevention of gallstones, and treatment options, including open cholecystectomy (removal of the gallstone), laparoscopic cholecystectomy, and dissolution therapy. The brochure concludes with the contact information for the Canadian Liver Foundation (www.liver.ca).
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Hepatobiliary Diseases: Pathophysiology and Imaging. Malden, MA: Blackwell Science, Inc. 2001. 764 p.
This textbook aims to familiarize the reader with various imaging modalities, the information they provide, and with the merits of each, in order to facilitate the combined use of different imaging techniques in the diagnosis and management of hepatobiliary (liver and bile tract) diseases. The book includes 47 chapters in seven sections: progress in imaging, anatomy and gross changes in the liver, diffuse liver diseases, vascular disease, space-occupying lesions, other liver diseases, and biliary tract disease. Specific topics include computed tomography (CT scan) and magnetic resonance imaging (MRI); harmonic ultrasound; anatomy of the liver; acute hepatitis and acute hepatic failure; chronic hepatitis; cirrhosis (liver scarring); fatty liver (steatosis); alcoholic liver disease; iron overload; Wilson's disease; amyloidosis, metabolic diseases, drug-induced and chemical-induced liver injuries; vascular anatomy of the liver and vascular anomalies; portal hypertension (high blood pressure); thrombosis (clotting) affecting the liver; Budd-Chiari syndrome; primary malignant tumors of the liver (liver cancer); benign liver lesions; cysts of the liver; liver abscess; blunt hepatic trauma; parasitic diseases; infections and the liver; transplantation; anatomy of the biliary tract; congenital anomalies and dilatation; Caroli's disease; stone disease (gallstones); biliary tract stenosis; primary sclerosing cholangitis; cholecystitis and Mirizzi syndrome; tumors of the gallbladder; adenomyomatosis and cholesterolosis; Hilar carcinoma; and tumors of the common bile duct and papilla of Vater. Each chapter includes black and white reproductions of imaging techniques and a list of references. The book includes a color plate section and a detailed subject index.
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Identification of Pancreatitis in the Ambulatory Setting. Gastroenterology Nursing. 24(1): 20-22. January-February 2001.
Acute pancreatitis can be life threatening and nurse practitioners must know the signs, symptoms, and risk factors for pancreatitis. This article reviews the identification of pancreatitis in the ambulatory setting. The author uses a case study of a 59 year old white woman who presents to the clinic with vague complaints of abdominal pain. Her symptoms began the evening before presentation and are progressively worsening. The author uses this case to illustrate the differential diagnostic process. The most common differential diagnoses for this patient's symptoms include appendicitis, acute pancreatitis, mesenteric ischemia or infarction, perforated gastric or duodenal ulcer, intestinal obstruction, biliary colic, and perhaps even inferior wall myocardial infarction. Making a diagnosis of acute pancreatitis depends on clinical history, physical examination, serum enzyme assays, and radiologic tests. The main goal of treatment for pancreatitis is supportive care, limitation of complications, and prevention of necrosis (tissue death) of the pancreas. In the case example, the patient's pancreatitis was thought to be caused by a mixture of estrogen and an ACE inhibitor. Although alcohol consumption and gallstones are the most frequent causes of pancreatitis in the general population, mediations are now being recognized as important causative agents that are often overlooked. The author reiterates that early recognition and treatment of acute pancreatitis can reduce suffering and serious complications for the patient. 3 tables. 7 references.
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Liver Abscess (Amebic and Pyogenic). In: Okuda, K., ed.,et al. Hepatobiliary Diseases: Pathophysiology and Imaging. Malden, MA: Blackwell Science, Inc. 2001. p. 517-532.
Worldwide, the most common type of liver abscess is amebic abscess, which is caused by Entamoeba histolytica, a protozoan parasite. In the industrialized coutries, amebic liver abscess is rare, and more liver abscesses are pyogenic (caused by bacterial infection). This chapter on amebic and pyogenic liver abscess is from a textbook that familiarizes the reader with various imaging modalities, the information they provide, and the merits of each, in order to facilitate the combined use of different imaging techniques in the diagnosis and management of hepatobiliary (liver and bile tract) diseases. As medicine has progressed, the incidence of pyogenic liver abscess has been reduced, and the primary foci from which infection spreads to the liver have also undergone considerable changes. In developed countries in which there is no amebic dysentery, amebic abscess does occur sporadically, and it is frequently mistaken for pyogenic abscess. With current imaging methods, abscesses are easily detected, and early diagnosis and treatment have vastly improved the prognosis. The mortality rate associated with liver abscess, which was previously 70 percent, has been reduced to less than 10 percent in developed countries. The prognosis largely depends on the primary infection causing the pyogenic liver abscess, and on the complications arising. The most common current source of infection for pyogenic liver abscess is biliary tract disease, particularly cholangitis (gallbladder inflammation), a common complication of gallstones. The author reviews bacteriology, pathogenesis and pathology, epidemiology, clinical features, imaging techniques, treatment options, complications, and prognosis. 13 figures. 1 table. 40 references.
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Liver Abscesses and Hydatid Disease. In: Beckingham, I.J., ed. ABC of Liver, Pancreas and Gallbladder. London, UK: BMJ Publishing Group. 2001. p.29-32.
Liver abscesses are caused by bacterial, parasitic, or fungal infection. This chapter on liver abscesses and hydatid disease is from an atlas of the liver, pancreas and gallbladder. Topics include the etiology, microbiology, clinical features, laboratory investigations, and treatment of pyogenic liver abscesses; the pathogenesis, clinical presentation, diagnosis and treatment of amoebic liver abscess; and the presentation, diagnosis, treatment of hydatid disease (caused by the dog tapeworm) in humans. Most patients with pyogenic abscesses will require percutaneous drainage and antibiotics. A cause can be identified in 85 percent of cases of liver abscess, most commonly gallstones, diverticulitis, or appendicitis. The chapter concludes with summary points of the concepts discussed. 8 figures. 4 table. 3 references.
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Pancreatitis in Inflammatory Bowel Disease. In: Bayless, T.M. and Hanauer, S.B. Advanced Therapy of Inflammatory Bowel Disease. Hamilton, Ontario: B.C. Decker Inc. 2001. p. 329-332.
This chapter on pancreatitis is from the second edition of a book devoted to the details of medical, surgical, and supportive management of patients with Crohn's disease (CD) and Ulcerative Colitis (UC), together known as inflammatory bowel disease (IBD). There is a higher incidence and prevalence of pancreatitis in patients with inflammatory bowel disease (IBD) than in the general population. The pancreatitis can be acute or chronic, or subclinical or overt, and has many causes. The most common cause is medications used to treat IBD, especially azathioprine and 6 mercaptopurine. Other causes of pancreatitis include duodenal involvement from Crohn's disease (CD), gallstones (cholelithiasis), and primary sclerosing cholangitis (PSC). Pancreatitis also can be caused by high serum concentrations of triglycerides during total parenteral nutritional (TPN) therapy for CD, and may also be a primary extra-intestinal manifestation of IBD. Treatment is different for each cause. For drug-induced pancreatitis, discontinuation of the drug should improvethe pancreatitis. For TPN-induced pancreatitis, oral medium-chain triglycerides should be substituted for the lipid emulsion. For pancreatitis that has developed from gallstones, the usual treatment is laparoscopic cholecystectomy (removal of the gallbladder). Idiopathic (of unknown cause) pancreatitis is often successfully treated by treating the underlying IBD. 1 table. 10 references.
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Pancreatitis. Bethesda, MD: National Digestive Diseases Information Clearinghouse (NDDIC). 2001. 4 p.
This fact sheet describes pancreatitis, a rare disease in which the pancreas becomes inflamed. There are two forms of pancreatitis, acute and chronic, and the fact sheet describes the symptoms, diagnosis, and treatment of both. Topics include gallstones, alcoholic pancreatitis, nutrition, and drug and surgical treatments. The fact sheet lists four additional readings. 1 figure.
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Shock-Wave Lithotripsy in Gallstones and Bile Duct Stones: Long-Term Evaluation of Extracorporeal Shock-Wave Lithotripsy for Cholesterol Gallstones. Journal of Gastroenterology and Hepatology. 16(1): 93-99. January 2001.
Extracorporeal (outside the body) shock wave lithotripsy (ESWL) is a treatment for gallstones that preserves the gallbladder. Problems after ESWL treatment can include stone recurrence and the development of biliary symptoms. This article reports on a study of 262 patients with cholesterol type gallstones (the best indication for ESWL treatment) who underwent ESWL and 42 control patients with cholesterol type gallstones who received no treatment. The authors evaluated the factors associated with recurrence of gallstones after stone clearance and the development of biliary symptoms after ESWL treatment. The 3, 5, and 7 year cumulative probabilities of gallstone recurrent were 20.6, 27.1, and 33.1 percent, respectively, with the recurrence probability significantly lower in patients with good gallbladder contractility. In patients with recurrence, treatment with ursodeoxycholic acid (UDCA, given orally) was effective. In 69 patients with residual gallstones, the 3, 5, and 7 year cumulative risks of biliary symptoms were 17.3, 24.9, and 30.5 percent, respectively. With residual gallstones, the risk of biliary symptoms developing was significantly lower in patients with a smaller than 3 mm fragment size at the end of ESWL treatment and in those treated consistently with UDCA for 6 months or more after treatment with ESWL. The risk of biliary symptoms was significantly lower in ESWL treated patients with residual stones who had a less than 3 mm fragment size after treatment, compared with control patients. The authors conclude that UDCA was effective in clearing stones in patients with gallstone recurrence. In patients with residual stones, the fragmentation of stones to less than 3 mm and UDCA administration effectively reduced the risk of subsequent biliary symptoms. 3 figures. 4 tables. 18 references.
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Stone Disease. In: Okuda, K., ed.,et al. Hepatobiliary Diseases: Pathophysiology and Imaging. Malden, MA: Blackwell Science, Inc. 2001. p. 658-668.
Specific diagnoses of gallstones and their complications can only be made using accurate imaging modalities. This chapter on gallstone disease (cholelithiasis) is from a textbook that familiarizes the reader with various imaging modalities, the information they provide, and the merits of each, in order to facilitate the combined use of different imaging techniques in the diagnosis and management of hepatobiliary (liver and bile tract) diseases. Topics include epidemiology; pathogenesis of gallstones, either cholesterol or pigment gallstones; clinical features; diagnosis and imaging, including ultrasonography and endoscopic ultrasound, computed tomography (CT scan), cholecystography and cholangiography; treatment options, including dissolution therapy with bile acids, direct dissolution therapy, extracorporeal shock wave lithotripsy, endoscopic lithotripsy, and cholecystectomy; complications; and prognosis. The authors stress that since there are so many kinds of treatment for gallstones, the diagnosis should include not only the presence or absence of gallstones, but also their characteristic features and complications of inflammation and biliary malignancies (cancer), and the most optimal treatment should be selected. 10 figures. 1 table. 15 references.
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Understanding Pancreatitis and Pancreatic Cancer. Digestive Health and Nutrition. 3(3): 17-20. May-June 2001.
Acute pancreatitis (inflammation of the pancreas) can happen to anyone, anytime. However, repeated episodes put the patient at risk for chronic pancreatitis and pancreatic cancer, so it is important to learn about the risk factors and symptoms of these diseases. This article reviews the presenting symptoms of pancreatitis, the anatomy and physiology of the healthy pancreas, treatment options, and the risk factors for pancreatic cancer. The most common cause of acute pancreatitis is gallstones that get caught at the opening into the small intestine. Excessive alcohol use is another common cause of the disease. Diagnosis can include blood tests, an abdominal CT (computed tomography) scan, and endoscopic ultrasound. Treatment for acute pancreatitis is usually relatively low tech, featuring hydration (adequate fluids), pain management, and nutrition support (intravenous). During an episode of acute pancreatitis, which can last days or even a week, patients usually do not eat any food at all initially. Clear liquids and then low fat foods are added gradually as symptoms improve. When gallstones cause pancreatitis, surgery to remove them is usually necessary. For those who already have chronic pancreatitis or are at risk for developing it, a healthy lifestyle and positive attitude are essential. Many people with pancreatitis find that a low fat diet helps reduce the severity of acute episodes and also slows the progression of the chronic disease. One sidebar offers a description of hereditary pancreatitis, which is a rare condition. The final section of the article discusses pancreatic cancer, noting that both chronic and hereditary pancreatitis put people at higher risk for developing pancreatic cancer. Appended to the article is a list of websites for readers who want to locate additional information about pancreatitis. 2 figures.
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Your Liver, Your Health. Toronto, Ontario: Canadian Liver Foundation. 2001. 4 p.
Virtually all the blood returning from the intestinal tract to the heart passes through the liver. This means that all foods and compounds that are swallowed that are absorbed into the bloodstream pass through the liver. This brochure describes the role of the liver and the common diseases that can affect the liver. Topics include the physiology of the liver; who is affected by liver disease; common liver diseases including gallstones, viral hepatitis, hepatitis A, hepatitis B, hepatitis C, cirrhosis (scarring of the liver), liver cancer, liver disease in children, autoimmune hepatitis, alcohol-related liver disease, hemochromatosis, and primary biliary cirrhosis (PBC); the symptoms and signs of liver disease; strategies for taking care of one's liver; and the use of liver transplantation. The brochure concludes with a brief description of the goals and activities of the Canadian Liver Foundation (www.liver.ca).
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Acute Pancreatitis After Abdominal Vascular Surgery. Journal of the American College of Surgeons. 191(4): 373-380. October 2000.
Retroperitoneal dissection and ischemia (lack of blood to a body part) have been proposed as risk factors for postoperative pancreatitis. This study was undertaken to determine the incidence and outcomes of pancreatitis after abdominal vascular surgery. The authors collected data on 21 patients who developed pancreatitis after abdominal vascular operations; 21 controls undergoing identical operations were also randomly identified from the authors' operative log. The incidence of pancreatitis among all patients undergoing abdominal vascular operations during the 6 year study period was 1.8 percent. Pancreatitis was diagnosed a mean of 9.8 days (plus or minus 8 days) after operation and was associated with 3 or less Ranson signs in all 21 study subjects. Although there was a trend towards longer hospitalization in the subjects, there was no difference in complication rates between the two groups. Sixteen subjects (76 percent) had no complications. Three developed severe complications, two of whom died of causes unrelated to pancreatitis. One developed a pseudocyst that resolved spontaneously. Cholelithiasis (gallstones) was a causative factor in two subjects; no cause was established in the remaining 19. There was no difference in operative details between the two groups. The authors conclude that pancreatitis is a rare and self limited complication of abdominal vascular surgery. Pancreatitis is costly and inconvenient but rarely serious after abdominal vascular operations. 3 tables. 26 references.
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Digestive Diseases and Disorders Sourcebook. Detroit, MI: Omnigraphics. 2000. 300 p.
This sourcebook provides basic information for the layperson about common disorders of the upper and lower digestive tract. The sourcebook also includes information about medications and recommendations for maintaining a healthy digestive tract. The book's 40 chapters are arranged in three major parts. The first section, Maintaining a Healthy Digestive Tract, offers basic information about the digestive system and digestive diseases, information about tests and treatments, and recommendations for maintaining a healthy digestive system. The second section, Digestive Diseases and Functional Disorders, describes nearly 40 different diseases and disorders affecting the digestive system. These include appendicitis, bleeding in the digestive tract, celiac disease, colostomy, constipation, constipation in children, Crohn's disease, cyclic vomiting syndrome, diarrhea, diverticulosis and diverticulitis, gallstones, gas in the digestive tract, heartburn (gastroesophageal reflux disease), hemorrhoids, hernias, Hirschsprung's disease, ileostomy, indigestion (dyspepsia), intestinal pseudo-obstruction, irritable bowel syndrome (IBS), IBS in children, lactose intolerance, Menetrier's disease, rapid gastric emptying, short bowel syndrome, ulcerative colitis, ulcers, Whipple's disease, and Zollinger Ellison syndrome. The final section offers a glossary of terms, a subject index and a directory of digestive diseases organizations (which includes website and email addresses as available). Material in the book was collected from a wide range of government agencies, nonprofit organizations, and periodicals.
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Gallbladder and Biliary Tract Diseases. New York, NY: Marcel Dekker, Inc. 2000. 928 p.
The gallbladder and biliary tract are the 'orphan' organs of the digestive system, falling between the realms of the solid organ liver specialist and the hollow organ intestinal expert. This comprehensive text covers the gallbladder and biliary tract disease, noting that the management of gallbladder and biliary disease is truly multidisciplinary, involving gastroenterologists, surgeons, endoscopists, and radiologists. The text attempts to translate advances in basic science into clinically relevant treatment and to bridge the gap between clinical disciplines. Parts I and II focus on important physiological and pathophysiological principles, with a special emphasis on gallstones. In Parts III to V, the authors focus on clinical disorders of the gallbladder and biliary tree, with input on management from surgeons, endoscopists, and radiologists. New imaging techniques, such as magnetic resonance cholangiography and endoscopic ultrasound, are discussed from both the radiologist's and endoscopist's perspective, and their role in disease management is defined. The 37 chapters cover the neurobiology of the gallbladder, gallbladder mucosal function, gallbladder smooth muscle function and dysfunction, canalicular lipid secretion, bile ductal secretion and its regulation, the pathogenesis of gallstones, pigment gallstones, cholesterol crystallization in bile, normal gallbladder motor functions, gallbladder motility and gallstones, the role of intestinal transit, prevention of gallstones, the gallbladder and biliary tree in cystic fibrosis, the silent gallstone, biliary crystals and sludge, biliary colic and acute cholecystitis (gallbladder infection), laparoscopic cholecystectomy (removal of the gallbladder), nonsurgical therapy of gallstones, biliary lithotripsy, topical contact dissolution of gallbladder stones, common bile duct stones, acalculous cholecystitis, gallbladder cancer, primary sclerosing cholangitis, vanishing bile duct syndrome, cholangiocarcinoma (bile duct cancer), ampullary tumors, infections of the bile ducts, and bile duct injuries. Each chapter includes extensive references and the text concludes with a detailed subject index.
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Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy. Canadian Journal of Gastroenterology. 14(11): 929-932. December 2000.
The use of laparoscopic cholecystectomy (LC, removal of the gallbladder) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary (heart and lung) function. Moreover, these patients present with acute cholecystitis (inflammation of the gallbladder) and associated common bile duct stones more often than their younger counterparts. In this article, the authors report on their experience from 1990 to 1999 when they performed 943 LCs; 31 (3.2 percent) were attempted on elderly patients, 11 (35 percent) of which were on an emergency basis because of acute cholecystitis, cholangitis (bile duct inflammation) or acute biliary pancreatitis. Ten percent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure (LC usually uses gas to increase the abdominal cavity for access and visualization purposes) was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0 percent. Associated gallbladder and common bile duct stones were found in five (16 percent) patients. The success rate was 100 percent, overall morbidity was 29 percent and there was no mortality. The authors conclude that their results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists' class III. 4 figures. 21 references.
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Gallstones, from Gallbladder to Gut: Management Options for Diverse Complications. Postgraduate Medicine. 108(3): 143-146, 149-153. September 1, 2000.
Gallstones may be incidental and asymptomatic or painful and accompanied by life threatening obstruction or infection. A thorough knowledge of potential complications is therefore critical, especially because some asymptomatic stones require prompt treatment. In this article, the authors offer guidelines for recognizing and treating the various manifestations of gallstone disease (cholelithiasis). Once the gallstones become symptomatic, surgical removal of the gallbladder (cholecystectomy) is usually recommended. Endoscopic retrograde cholangiopancreatography (ERCO) with sphincterotomy and stone extraction is performed if bile duct stones are evident on imaging studies or suspected on the basis of the clinical picture or liver enzyme abnormalities. In patients with cholangitis (a consequence of bacterial infection superimposed on an obstructed biliary system), the mainstay of therapy is biliary drainage, which should be performed as early as possible, even before determining and treating the cause of obstruction. In selected patients with gallstone pancreatitis, use of early ERCP, sphincterotomy, and stone extraction results in lower morbidity (illness) and mortality (death). Nonsurgical treatment is appropriate for patients with recurrent biliary colic or chronic cholecystitis (gallbladder infection), but not for those with acute cholecystitis. Recurrence rates are high with nonsurgical treatment. 3 figures. 29 references.
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Gallstones. In: King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 133-142.
This chapter on gallstones (cholelithiasis) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of gallstones, including upper abdominal pain; pain in the back, chest, or right shoulder blade; and nausea and vomiting. Gallbladder pain, commonly called a gallbladder attack, occurs when stones in the gallbladder become lodged in the neck of the gallbladder or the cystic duct and obstruct the gallbladder's opening. This leads to a buildup of pressure in the gallbladder as it slowly contracts, causing constant pain and often nausea. The authors review how gallstones form and the three most common types: cholesterol stones, pigment stones, and primary bile duct stones. Risk factors for gallstones include being female, excess weight, diet and dieting (diet high in fat and sugar, fasting, and rapid weight loss diets are particularly risky), age, family history, and ethnic group. Gallstones are diagnosed with the assistance of ultrasound, computed tomography (CT scan), radionuclide scan, blood tests, and endoscopic retrograde cholangiopancreatography (ERCP). Treatment options range from watchful waiting to bile salt tablets, MTBE (methyl tertiary butyl ether) injection, sound wave therapy (extracorporeal shock wave lithotripsy), to surgery, either open or through the use of laparoscopy. One sidebar reviews the home remedies that are purported to prevent gallstones (none are supported), noting that the best preventive steps are to maintain a healthy weight and avoid crash diets. 1 figure.
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Liver Disorders Sourcebook. Detroit, MI: Omnigraphics. 2000. 591 p.
This Sourcebook provides basic health care information about liver functions, guidelines for liver health, and tests that assess liver distress. The book also presents the symptoms, treatments, and preventive measures available for liver cancer; hepatitis A, B, C, D and E; genetically based liver diseases; and other liver diseases. The liver transplantation process is explained. Specific topics include strategies for protecting the liver, risk factors, common laboratory tests in liver disease, liver biopsy, cancer tumor markers, cirrhosis (scarring of the liver), infectious agents and parasites, pregnancy and the liver, jaundice in the healthy newborn, the liver's response to drugs, alcohol and the liver, acetaminophen, herbs and alternative medicine, galactosemia, Gaucher disease, hereditary hemochromatosis, Niemann-Pick disease, Wilson's disease, biliary atresia, cystic disease of the liver, fatty liver, gallstones, primary biliary cirrhosis, primary sclerosing cholangitis, organ donation, and the bioartificial liver. A glossary, a directory of organizations and support groups with up to date contact information (including websites and email addresses), a listing of transplant centers, and a subject index conclude the volume.
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Living with the Condition. In: Zonderman, J. and Vender, R.S. Understanding Crohn Disease and Ulcerative Colitis. Jackson, MS: University Press of Mississippi. 2000. p. 36-55.
Crohn's disease and ulcerative colitis, together known as inflammatory bowel disease (IBD), are chronic illnesses of unknown origin. This chapter on living with IBD is from a book that provides timely information about how to obtain and maintain the highest quality of life possible while living with IBD. The authors offer a patient's perspective on coping with IBD. The authors take a look at the lifelong effects of Crohn disease (CD) and ulcerative colitis (UC) and their impact on the patient's quality of life. The chapter covers flareups of disease, nutrition, nonintestinal complications, and special situations such as the appearance of IBD in children, effects on those of childbearing age, and IBD in the elderly. The authors stress that individuals differ in their ways of coping with chronic illness, their tolerance for pain, and their ability to live with the uncertainty that comes with IBD. Poor nutrition and even malnutrition are a constant threat to individuals with IBD. Nutritional treatments for IBD focus on increasing the intake of calories, protein, vitamins, minerals, and trace elements, and on creating an eating pattern that minimizes stress on the bowel (usually this means smaller, more frequent feedings). Extraintestinal complications discussed include arthralgia (pain in the joints) and arthritis, osteoporosis (loss of bone density), kidney stones, gallstones, sclerosing cholangitis, fatty liver, eye inflammation, and skin inflammation.
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Management of Gallstones and Their Complications. American Family Physician. 61(6): 1673-1680. March 15, 2000.
This article reviews the management of gallstones (cholelithiasis) and their complications. The accurate differentiation of gallstone induced biliary colic (pain) from other abdominal disease processes is the most crucial step in the successful management of gallstone disease. Despite the availability of many imaging techniques to demonstrate the presence of gallstones, clinical judgement ultimately determines the association of symptoms with cholelithiasis and its complications. The authors contend that adult patients with silent or incidental gallstones should be observed and managed expectantly, with few exceptions. In symptomatic patients, the intervention varies with the type of gallstone induced complication. Diagnostic tests reviewed include laboratory tests, ultrasonography, endoscopic retrograde cholangiopancreatography, bile microscopy, computed tomography (CT) and magnetic resonance imaging (MRI), and hepatobiliary scintigraphy. Ultrasound provides more than 95 percent sensitivity and specificity for the diagnosis of gallstones greater than 2 mm in diameter. Ultrasonography of the gallbladder should follow a fast of at least 8 hours because gallstones are visualized better in a distended, bile filled gallbladder. Nonoperative therapies for symptomatic gallstones include oral bile acid dissolution, contact solvents, and extracorporeal shock wave lithotripsy. A patient care algorithm offers management strategy for gallstones. 1 figure. 5 tables. 26 references.
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Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. 194 p.
This comprehensive guidebook from the Mayo Clinic focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. After two introductory chapters in which the authors review the anatomy and physiology of the digestive tract and practical suggestions for maintaining a healthy digestive tract, the book includes 12 chapters on symptoms, common diagnostic tests, gastroesophageal reflux disease (GERD), ulcers and stomach pain, irritable bowel syndrome, Crohn's disease and ulcerative colitis (together called inflammatory bowel disease or IBD), celiac disease, diverticular disease, gallstones, pancreatitis, liver disease, and cancer. Each chapter on a specific condition reviews the symptoms, diagnosis, risk factors, prognosis, and treatment options for that condition. The book concludes with a list of resource organizations through which readers can obtain more information, and a subject index.
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Pancreatitis. In: King, J.E., ed. Mayo Clinic on Digestive Health. Rochester, MN: Mayo Clinic. 2000. p. 143-150.
This chapter on pancreatitis (inflammation of the pancreas) is from a comprehensive guidebook from the Mayo Clinic that focuses on a variety of digestive symptoms, including heartburn, abdominal pain, constipation, and diarrhea, and the common conditions that are often responsible for these symptoms. Written in nontechnical language, the book includes practical information on how the digestive system works, factors that can interfere with its normal functioning, and how to prevent digestive problems. This chapter first reviews the key signs and symptoms of pancreatitis, which include abdominal pain, nausea and vomiting, fever, bloating and gas, foul-smelling, loose, oily, or bulky stools (feces), and weight loss. The authors describe the physiologic role of the pancreas, then differentiate between acute pancreatitis, which occurs when digestive enzymes produced in the pancreas remain and activate in the pancreas, irritating and inflaming delicate pancreatic tissues, and chronic pancreatitis, which is more difficult to recognize but can result in serious consequences (including diabetes) over time. The two most common known causes for pancreatitis are excessive alcohol use and gallstones. Treatment for acute pancreatitis centers on controlling the pain, allowing the pancreas to rest (intravenous fluids and nutrition), and restoring a normal balance of pancreatic juices (which can include surgery to remove gallstones). Complications of acute pancreatitis include infection, pseudocysts, and abscess. The main goals of treatment for chronic pancreatitis are to control pain and treat malabsorption problems (with enzyme supplementation and treatment for any diabetes). The chapter concludes with strategies for people with chronic pancreatitis to follow: avoid alcohol, eat smaller meals, limit dietary fat, follow a high carbohydrate diet, find safe ways to control pain, and think positively. 1 figure.
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