Cases Of Gallbladder Disease Research Articles

English

BACKGROUND Cholecystectomy is a common surgical procedure done worldwide for both benign and neoplastic conditions. Cholecystectomy for benign conditions is performed based on clinical signs, symptoms, Ultrasound, CT. Hence there is fair chance of missing early malignant lesions like carcinoma-in-situ and other early carcinomas. Aim: The aim of the study is to analyse histopathological variations in post cholecystectomy specimens done for benign lesions. METHODS The study was conducted in Department of General Surgery, SVRRGGH, Tirupati, for a period of one year, from March 2019 to April 2020. This is a prospective Study conducted among 100 Patients, conducted over a period of one year from time of IEC approval from March 2019 to April 2020. All patients who underwent cholecystectomy for benign biliary disease and gall stone were included in the study. All patients with pre-diagnosed empyema gallbladder, gallbladder malignancy, gallbladder mass, and gallstones associated with obstructive jaundice are excluded from the study. RESULTS In our study, 100 cases of gall bladder disease were studied in the age group of 18 – 70 years, for a period of 1 year from March 2019 in the department of General surgery, SVRRGGH. Occurrence is high in patients of age group 18 – 45 years (65 %). The male to female ratio is 0.5:1 with female preponderance. The most common histopathologic finding was chronic calculus cholecystitis (59 %).Adenocarcinoma of gall bladder (2 %) of the cases with no preoperative suspicion of malignancy. CONCLUSIONS The occurrence of Incidental GBC found in my study is 2 %. Due to high estimate of residual disease, re-resection is still a curative option and is to be considered for pT2 & pT3, but not CBD removal. Prognosis usually is dismal, and five-year survival rates have been reported to be less than 5 % for more advanced stages. KEYWORDS Histopathology, Variations, Cholecystectomy, Specimen, Benign

Histomorphological study of mucosal changes in gall bladder in a tertiary care centre

Introduction: Gall bladder diseases are a cause of great concern. Cholelithiasis has troubled humanity since long and has been a common disease worldwide. They are among the most common gastrointestinal conditions presenting with acute pain in abdomen. Gall stone disease is usually common among middle aged females who are fertile and fatty. Materials and Methods: The present study was conducted in in the Department of Pathology of a tertiary care teaching Institute of Western Uttar Pradesh. The study period was one year (October 2015–September 2016) with a sample size of 500 cases. Gross examination of gall bladder was done in the department and sections from representative areas were taken for microscopic examination. Special stains were used as and when required. Statistical analysis was carried out to assess the significance of various risk factors and mucosal changes in different age groups and genders. Results: of the total 500 cases, 441(88.2%) were females and 59(11.80%) were males. Maximum cases of gall bladder disease were in the age group of 31-40 years in both the sexes. Amongst all lesions, 394 (78.8%) patients had gallstones and 106 (21.2%) were acalculous. Majority of the gall stones were of mixed type in 310 (78.69%) cases. The commonest pathological mucosal changes observed included chronic cholecystitis with cholelithiasis in 250 (62.5%) cases. 50 cases each in the pre-malignant and malignant category were observed. Conclusion: Gall bladder diseases are most commonly seen in females. Majority of cases were of chronic cholecystitis with cholelithiasis. Gall stones mainly injure the mucosal columnar epithelium leading to changes such as metaplasia, dysplasia or neoplasia. Knowledge of non-neoplastic as well as pre-neoplastic conditions is important especially since they cause significant morbidity or even mortality. Keywords: Gallbladder, Cholecystectomy, Stones, Carcinoma.

Incidental Finding of Gallbladder Cholesterolosis in an Infant with Rotavirus Infection and Transaminitis

Gall bladder diseases are relatively less prevalent in pediatrics compared to the adult population. With the use of ultrasound, more and more pediatric cases of gall bladder diseases are being reported. This is a case of an infant with Rotavirus gastroenteritis who was incidentally found to have cholesterolosis of gall bladder on abdominal ultrasound.

Ultrasonographic Gallbladder Abnormality of Primary Epstein-Barr Virus Infection in Children and Its Influence on Clinical Outcome.

The incidence of pediatric acute inflammatory gallbladder (GB) disease without gallstone such as acute acalculous cholecystitis has increased with the development of improved diagnostic modalities. Although Epstein–Barr virus (EBV) infection is common in general population, only few cases of GB diseases caused by EBV infection have been reported. This study analyzed ultrasonographic characteristics of primary EBV infection in children and evaluated the influence of EBV-associated GB disease on clinical course and outcome of EBV infection.Between March 2004 and January 2013, 94 of 287 pediatric patients with EBV infection underwent abdominal ultrasonography (USG); clinical features, laboratory data, and USG findings were collected and analyzed retrospectively.Of 94 children, ultrasonographic thick GB wall was observed in 24 (25.3%). Platelet counts were lower in the thickened GB wall group than in the normal GB wall thickness group (P = 0.004). Direct bilirubin, alanine aminotransferase, and γ-glutamyl transferase levels were higher in the thickened GB wall group (P = 0.000, P = 0.041, and P = 0.001, respectively). The duration of hospitalization was longer in patients with thickened GB wall (P = 0.043).Radiologic findings of acute acalculous inflammatory GB disease such as thickened GB wall caused by primary EBV infection are more common than previously reported. Consideration of EBV infection in the differential diagnosis of children suspected with acute acalculous GB diseases may avoid unnecessary surgical intervention.

Physical Activity and the Biliary Tract in Health and Disease

Cholecystitis and gallstones affect a large segment of the population in developed nations, and a small proportion of affected individuals subsequently develop cancer of the gallbladder. However, little is known about the possible beneficial effects of physical activity. Accordingly, a systematic review examined the influence of both acute and chronic exercise on gallbladder motility, and relationships were examined between habitual physical activity, gallbladder disease, and gallbladder cancer. A search of Ovid/MEDLINE from 1996 to November 2014 yielded 67 articles relating to physical activity and gallbladder function or disease; 18 of these relevant to the objectives of the review were supplemented by 22 papers from personal files and other sources. Because of the limited volume of material, all were considered, although note was taken of the quality of activity measurement, care in excluding covariates, and experimental design (cross-sectional, case-control or randomized controlled trial). The impact of physical activity upon gallbladder function remains unclear; acute activity could augment emptying by stimulating cholecystokinin release, and one of two training experiments found a small increase in gallbladder motility. The largest and most recent cross-sectional and case-control trials show a reduced risk of gallbladder disease in active individuals. A small number of randomized controlled trials in humans and one animal study generally support these trends, although the number of cases of gallstones are too few for statistical significance. Three studies of gallbladder cancer also show a non-significant trend to benefit from physical activity. Although there remains a need for further research, regular physical activity seems likely to reduce the risk of both gallstones and gallbladder cancer. A substantial number of individuals must be persuaded to exercise in order to avoid one case of gallbladder disease, but the attempt appears warranted because of the other health benefits of regular physical activity.

Prognostic significance of AgNOR Proliferative Index in gallbladder carcinoma - A potential alternative to frozen section analysis

Introduction: Number of Argyrophillic Nucleolar Organizer Regions (AgNORs) is a good indicator of cellular proliferation activity and is useful diagnostic tool to estimate the malignant potential of tumors. Methods: Tissue sections from 40 cases of gall bladder disease, including 27 cases of gallbladder carcinoma and 13 cases of chronic cholecystitis, were studied for AgNORs count. The correlation of the AgNOR was carried out with various clinco-pathological parameters. Results: Mean AgNOR counts in gallbladder cancer (11.354 ± 1.7866) were significantly higher than chronic cholecystitis (2.0815 ± 0.3731). Amongst patients with gallbladder carcinoma, well-differentiated (9.5867 ± 1.8928), moderately-differentiated (11.1971 ± 1.3181) and poorly-differentiated adenocarcinoma (13.1829 ± 0.9779) showed statistically significant difference in AgNOR counts. On inter stage comparison, study revealed progressive and statistically significant increase in AgNOR count from Tis to T4 stage. Mean AgNOR count for GBCs without metastasis was lower (10.5186 ± 1.6911) than metastatic GBC (12.2538 ± 1.4581), difference being statistically significant (p=0.009). Discussion and conclusions: Our results demonstrate that AgNOR parameters are useful indicators to evaluate malignant behavior of gallbladder carcinoma and its combination with conventional cytology may increase the diagnostic accuracy. AgNOR index can be used as a rapid, inexpensive and easily performed diagnostic tool to aid in early confirmation of a suspicious case of malignant gallbladder disease.

Single-incision laparoscopic cholecystectomy: Single institution experience and literature review

Single-incision laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery. We report one of the initial clinical experiences in Japan with this new technique. Four cases of gallbladder diseases were selected for this new technique. A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus. A 12-mm trocar was placed through an open approach, and the abdominal cavity was explored with a 10-mm semi-flexible laparoscope. Two 5-mm ports were inserted laterally from the laparoscope port. A 2-mm mini-loop retractor was inserted to retract the fundus of the gallbladder. Dissection was performed using an electric cautery hook and an Endograsper roticulator. There were two women and two men with a mean age of 50.5 years (range: 40-61 years). All procedures were completed successfully without any perioperative complications. In all cases, there was no need to extend the skin incision. Average operative time was 88.8 min. Postoperative follow-up did not reveal any umbilical wound complication. Single-incision laparoscopic cholecystectomy is feasible and a promising alternative method as scarless abdominal surgery for the treatment of some patients with gallbladder disease.

Oral contraceptives and other risk factors for gallbladder disease.

Prior studies of the association between oral contraceptives (OCs) and gallbladder disease (GBD) have yielded conflicting results. To clarify this association, a retrospective (historical) cohort study was performed on a very large data base including 1980 and 1981 Medicaid billing data from the states of Michigan and Minnesota in which 138,943 users of OCs were compared with 341,478 nonusers. The crude relative risk (RR) and 95% confidence interval (CI) for symptomatic GBD resulting in medical care was 1.14 (CI 1.09 to 1.20), with a clear dose-response (P less than 0.001). Age markedly modified the effect of OCs on GBD. The RR (CI) decreased from 3.1 (2.7 to 3.6) in women 15 to 19 years old to 1.2 (0.9 to 1.5) in women 40 to 44 years old, providing an explanation for previously conflicting reports. The effects of a number of other risk factors on GBD, some which have been controversial, were also confirmed. Adjustment for these did not change the results. In conclusion, OCs are risk factors for GBD, although the risk is of sufficient magnitude to be of potential clinical importance only in young women.

Effect of bezafibrate during 4.5 years of treatment of hyperlipoproteinaemia

Bezafibrate in a dosage of 200 mg 3 times daily was given to 24 patients with type II A (n = 8), II B (n = 1) and IV (n = 15) hyperlipoproteinaemia for 4.5 years. In type II A the content of total cholesterol and that of low density lipoprotein in serum decreased by 10–23 and 11–34 percent over the years compared to pretreatment. In type IV the content of total triglycerides and that of very low density lipoprotein decreased by 28–39 and 38–52 percent, respectively, over the years. High density lipoprotein cholesterol increased in both types. The “atherogenic index” was reduced by the drug. The effect remained through the 4.5 years of treatment. Compliance to the drug was good. Changes in safety laboratory parameters were minor and reversible. No subjective side-effects occurred and no cases of gallbladder disease or cancer were noted. It is conculded that bezafibrate is a safe, convenient and effective serum lipid-lowering drug suitable for the use in primary and secondary prevention of atherosclerotic disease.

Gallbladder disease in children

Four cases of gallbladder disease in children under fifteen years of age are presented. Two cases were associated with congenital anomalies. Two were associated with infection and two with cholelithiasis. None of the patients had jaundice. In one case choledocholithiasis was present. A brief discussion of the incidence and some theories of the cause are presented.

CHOLECYSTITIS AND CHOLELITHIASIS IN CHILDREN

Four cases of gallbladder disease in a young age group are presented. Etiologic factors are discussed. Although gallbladder disease in children is uncommon, it should be ruled out in patients who present with abdominal complaints, especially with symptoms consistent with gallbladder disease. A good medical, economic and family-racial history is, as always, very important. There may be a female preponderance for cholelithiasis, even in children. A higher index of suspicion in the differential diagnosis of abdominal complaints may lead to a higher percentage of pre-operative diagnoses.

A suggestion in the technic of cholecystectomy for the complicated case of gallbladder disease

A suggestion in the technic of cholecystectomy for the complicated case of gallbladder disease

PERITONITIS DUE TO BILE AND TO LIVER AUTOLYSIS

Bile peritonitis is a clinical entity due to the action of escaped bile on the peritoneal surfaces that is probably more common than has been realized. Eliason and McLaughlin1report that perforation of the gallbladder occurs in from 1 to 3 per cent of all cases of biliary disease. These figures were based on a study of more than 7,000 cases of gallbladder disease. It has also been recognized2that bile peritonitis may occur in the absence of demonstrable perforation of the biliary system. Once the importance of this hitherto rarely recognized condition was demonstrated, numerous experimental studies on the mechanism of death in bile peritonitis were made. These observations include the work of Horrall and others3and center chiefly around the postulates that toxic action and anaerobic bacterial invasion are the chief two lethal factors in bile peritonitis. From other data4similarly obtained by experiment,

CHOLECYSTITIS AND CHOLELITHIASIS OF CHILDHOOD

A case report of cholecystitis with cholelithiasis in a boy, aged 8 years, is here recorded to stress the necessity of consideration of lesions of the gallbladder in the differential diagnosis of abdominal disease in children. It is probable that pathologic changes in the preadolescent gallbladder are not as rare as clinical and postmortem records indicate. For this reason and for the reason that many of these cases present long and indefinite antecedent histories, we believe that children who have indefinite abdominal symptoms of epigastric pain and indigestion should be investigated more frequently with such diagnostic aids as cholecystography. In 1928 Potter 1 reported four personal cases of gallbladder disease in children 4 ½, 6, 11 and 15 years of age, and he supplemented the report with a review of the literature. He was able to collect 226 cases in which the ages were less than 15 years, as follows: fetuses 2,

The Late Results of Operation in 109 Cases of Gall-Bladder Disease

The Late Results of Operation in 109 Cases of Gall-Bladder Disease

PANCREATIC ENZYMES IN CHOLECYSTITIS

Cholecystitis is frequently associated with a certain degree of pancreatitis. Of 1,290 cases of diseases of the gallbladder and bile duct reported by Judd,1347 or 26.8 per cent. had associated pancreatitis. In his cases, the clinical history did not, as a rule, suggest pancreatitis. The condition was determined at the time of operation by enlargement, hardening or edema of the pancreas. Deaver believes that cholecystitis causes a pancreatic lymphangitis, which condition precedes interstitial pancreatitis. Pancreatitis is sufficiently far advanced in over one fourth of the cases of gallbladder disease operated on to cause a macroscopic change in the organ. Another interesting illustration of the intimate relationship between gallbladder and pancreatic disease is the not infrequent occurrence of glycosuria in long standing cholecystitis. In routine examination of the fasting duodenal juice for pancreatic enzymes, we frequently encountered an absence of, or a decrease in, the amount of one or more

THE SIGNIFICANCE OF CARDIAC IRREGULARITIES

REPORT OF CASES AND COMMENT By Dr. Straus Cardiac irregularities in cases of gallbladder disease are not infrequent; many are functional. During the last few months I have operated in four cases (three cases of gallbladder disease and one of duodenal ulcer) in which the pulse before operation showed a permanent irregularity consisting of premature contractions. In only one of the cases was there any enlargement of the heart; none of the others showed any other evidence of organic disease. In these four cases the extrasystoles may have been due to a vagus reflex phenomenon. While it is generally agreed that extrasystoles are abnormal systoles of a portion of the heart due to impulses which originate, independent of the pacemaker and the Purkinje system, in certain heterogenic zones in the heart itself, and are due to conditions of abnormal irritability, in the cases I report this increased local irritability may