Diagnosis Of Gallbladder Disease Research Articles

Unspecified abdominal pain in primary care: the role of gastrointestinal morbidity

Many patients with abdominal pain have no obvious cause for their symptoms and receive a diagnosis of unspecified abdominal pain. The objective of this study was to ascertain risk factors and consequences of a diagnosis of unspecified abdominal pain in primary care. A population-based, case-control study was conducted using the UK General Practice Research Database. We identified 29,299 patients with a new diagnosis of abdominal pain, and 30,000 age- and sex-matched controls. Only diagnostic codes that did not specify the type or location of abdominal pain were included. The incidence of newly diagnosed unspecified abdominal pain was 22.3 per 1000 person-years. The incidence was higher in females than in males, and 29% of patients were below 20 years of age. Prior gastrointestinal morbidity was associated with abdominal pain, but high body mass index, smoking and alcohol intake were not. Patients newly diagnosed with abdominal pain were 16 to 27 times more likely than controls to receive a subsequent new diagnosis of gallbladder disease, diverticular disease, pancreatitis or appendicitis in the year after the diagnosis of abdominal pain. The likelihood of receiving other gastrointestinal diagnoses such as peptic ulcer disease, hiatus hernia, gastro-oesophageal reflux disease (GERD), irritable bowel syndrome (IBS) or dyspepsia was increased three- to 14-fold among patients consulting for abdominal pain. When managing abdominal pain in primary care, morbidities such as GERD and IBS should be considered as diagnoses once potentially life-threatening problems have been excluded.

Diagnosis of Gallbladder Diseases by Contrast-Enhanced Phase-Inversion Harmonic Ultrasonography

We evaluated the usefulness of contrast-enhanced ultrasonography(US) for detecting and differentiating gallbladder lesions. Contrast-enhanced coded phase-inversion harmonic US was performed on 90 patients with gallbladder abnormalities. After administering Levovist®, we observed the gallbladders in real time. Contrast-enhanced coded phase-inversion harmonic ultrasonography was compared with B-mode US and contrast-enhanced computer tomography (CT) with regard to the sensitivity and specificity in depicting the elevated gallbladder lesions. Furthermore, we assessed how the vascular patterns of the elevated gallbladder lesions depicted by contrast-enhanced US correlated with the diagnosis. Contrast-enhanced US efficiently discriminated true lesions from biliary sludge, unlike B-mode US. Consequently, contrast-enhanced US was more specific (100%) than B-mode US (81%), although their sensitivities were similar (98% and 96%, respectively). Contrast-enhanced US was also more sensitive that contrast-enhanced CT (98% versus 79%), although the two methods were equally sensitive (100% versus 95%). We classified the vascular patterns of the abnormalities depicted by contrast-enhanced US in the 90 cases into types 1 to 4, which represent branch-like, heterogeneous, homogeneous, and avascular patterns, respectively. All type 1 and 2 lesions were over 10 mm in size while most (88%) type 3 lesions were 10 mm or less in size. While the majority of carcinomas (86%) were type 1 or 2, three benign lesions also showed these patterns. Thus, the vascular pattern may simply reflect the size of the lesion and therefore its usefulness in diagnosing gallbladder lesions may be limited. Nevertheless, contrast-enhanced US is clearly superior to the other techniques in discriminating biliary sludge from other lesions.

1255: 3D ultrasound and the diagnosis of gallbladder diseases

Three-dimensional ultrasonography (3D-US) is now a widespread diagnostic technology. With the help of external workstation and magnetic positioning system (“free hand” method) 3D-US can be carried out with the use of any ultrasound diagnostic system. The dedicated systems with 3D probes (both mechanical and electronic) allow receiving either “live 3D” (up to 16 volumes/s) or “3D in real time or 4D” (16 and more volumes/s). However, despite the availability 3D-US, questions of its practical application and economical feasibility remain open. The gallbladder is an organ for which localization and structure are rather convenient for carrying out 3D-US. Presence of a liquid in a gallbladder cavity allows visualizing, differentiating and characterizing internal masses especially well. Potential directions in 3D-US application are the following: (1) gallbladder volume assessment; (2) gallbladder wall assessment; (3) gallbladder cavity masses assessment. Gallbladder volume measurement is important for assessment of its function. Accuracy of volume measurement with the help 3D-US is much higher than that of two-dimensional (2D) one. The relative error of a sum-of-cylinders method can be as high as 34%, and of an ellipsoid method can be as 72%. It is very important that reproducibility of gallbladder volume measurement with 3D-US is the highest and that it greatly surpasses 2D techniques. The gallbladder wall and surrounding tissues, structure and gallbladder wall blood supply represent the greatest interest in patients with acute cholecystitis. 3D-US allows estimating more precisely the degree and character of gallbladder wall structure and surrounding tissues infringement. 3D reconstruction of vessels gives the evident information of vascular pattern changes. 3D-US is not much more useful in gallbladder stones diagnosis than 2D one. 3D-US gives more information for differential diagnostics of gallbladder benign and malignant tumors, since it allows the visualization of granular surfaces of polypoid lesions and the pedunculated fundus.

Adenomyomatosis as a source of error in the diagnosis of gall-bladder disease.

Abstract A series of cases is described where delay and difficulty were encountered in the diagnosis of pain suggestive of a biliary origin. In such circumstances the most probable diagnosis is adenomyomatosis of the gall-bladder which can usually be diagnosed by careful scrutiny of the periphery of the organ on a good cholecystogram. Treatment is by cholecystectomy.

Impact of three-dimensional sonography on the diagnosis of gallbladder diseases: comparison with two-dimensional sonography

Impact of three-dimensional sonography on the diagnosis of gallbladder diseases: comparison with two-dimensional sonography

Endoscopic ultrasound in the diagnosis of gallbladder disease

Endoscopic ultrasound in the diagnosis of gallbladder disease

Prevalence and ethnic differences in gallbladder disease in the United States

Background & Aims: Gallbladder disease is one of the most common conditions in the United States, but its true prevalence is unknown. A national population-based survey was performed to determine the age, sex, and ethnic distribution of gallbladder disease in the United States. Methods: The third National Health and Nutrition Examination Survey (NHANES III) conducted gallbladder ultrasonography among a representative U.S. sample of more than 14,000 persons. The diagnosis of gallbladder disease by detection of gallstones or cholecystectomy was made with excellent reproducibility. Results: An estimated 6.3 million men and 14.2 million women aged 20–74 years had gallbladder disease. Age-standardized prevalence was similar for non-Hispanic white (8.6%) and Mexican American (8.9%) men, and both were higher than non-Hispanic black men (5.3%). These relationships persisted with multivariate adjustment. Among women, age-adjusted prevalence was highest for Mexican Americans (26.7%) followed by non-Hispanic whites (16.6%) and non-Hispanic blacks (13.9%). Among women, multivariate adjustment reduced the risk of gallbladder disease for both Mexican Americans and non-Hispanic blacks compared with non-Hispanic whites. Conclusions: More than 20 million persons have gallbladder disease in the United States. Ethnic differences in gallbladder disease prevalence differed according to sex and were only partly explained by known risk factors. GASTROENTEROLOGY 1999;117:632-639

Pitfalls in the Diagnosis of Gallbladder Disease in Clinically Severe Obesity

Pitfalls in the Diagnosis of Gallbladder Disease in Clinically Severe Obesity

Pitfalls in the diagnosis of gallbladder disease in clinically severe obesity.

Cholelithiasis affects 10-20% of the USA population, with higher incidence in certain ethnic groups. Obesity is associated with an increase in gallstone formation, reported in up to 45% of morbidly obese patients. Ultrasound is the best diagnostic tool, although its accuracy is less in this particular population. This paper discusses false negative sonographic findings in morbid obesity. Retrospective review of 5257 patients submitted to bariatric surgery. Cholecystectomy had previously been performed in 16%. Gallbladder ultrasound was obtained in the remaining group, and cholecystectomy was done based on this information and/or intraoperative observations. Radiology results and surgical findings were correlated with pathology reports. Misread films were reviewed by a radiologist blind to these reports. The series consisted of 88% females. Mean age, weight and percentage overweight were 37 years, 125 kg and 105%, respectively. Cholecystectomy was performed in 3084 patients (59%). Discrepancies between radiological and pathological findings were found in 35 cases (1.1%). Five correct diagnosis of lithiasis also had gallbladder hydrops. Four 'inconclusive' and 20 'negative' studies showed definitive pathology. In six cases of 'non/poor visualization', lithiasis was encountered. Preoperative gallbladder ultrasound is mandatory in bariatric surgery. Results are accurate and false-negative reports rare if sonographers and radiologists are experienced. Non/poor visualization is usually due to technical problems or gallbladder pathology, not due to the patient's size. False-negative results are commonly caused by soft stones, microlithiasis or polypoid cholesterolosis. Single calculus impacted in the cystic duct can produce hydrops, resulting in a negative sonogram.

Risk factors for self-reported colon polyps.

Investigate risk factors for colon polyp using multivariate analyses. In a group responding to a 1992 mail survey, we assessed the association between physician-diagnosed colon polyp and possible risk factors reported primarily 10 years earlier. Survey respondents within the Cancer Prevention Study II. Respondents, 72,868 men and 81,356 women, who reported no polyp diagnosis when questioned in 1982 at ages 40 to 64 years. The characteristics of 7,504 men (10.3%) and 5,111 women (6.3%) reporting a first colon polyp were compared with those of participants who did not report a polyp. After adjustments for age, family history of colorectal cancer, and other potential risk factors, polyp occurrence was associated with 1982 histories of smoking, former smoking, alcohol use of at least two drinks per day (odds ratios [ORs] from 1.5 to 1.1; all p < .005), and a body mass index > or = 28 kg/m2 (men's OR 1.06; 95% confidence interval [CI] 1.00, 1.13; women's OR 1.08; 95% CI 0.99, 1.17). Polyps were also associated with a diagnosis of gallbladder disease or gallstone at any time and with gallbladder surgery up to 1982 (OR from 2.7 to 1.3; all p < .001). Polyp occurrence was inversely associated with 1982 histories of high exercise level (men's OR 0.83; 95% CI 0.76, 0.91; women's OR 0.90; 95% CI 0.78, 1.03), frequent aspirin use in women (OR 0.85; 95% CI 0.77, 0.95), and high parity in women (OR 0.84; 95% CI 0.75, 0.94). Among participants lacking a clinically normal gallbladder, the polyp risks associated with smoking and high body mass index were reduced (p < .04 for interactions). Despite the limitations and potential biases in these self-reported data, the risk factors described here may be useful for identifying persons at modestly increased risk of having a colon polyp. The effect-modifying role of gallbladder status deserves further investigation.

Management and treatment of gastrointestinal disorders

This article outlines the clinical management of common gastrointestinal disorders encountered in the primary care setting. The general assessment of a woman presenting with a gastrointestinal concern is reviewed. Diagnosis and management of acute and chronic diarrhea, constipation, irritable bowel syndrome, and anorectal disorders are covered with emphasis on client education. Gastroesophageal reflux disease and peptic ulcer disease is discussed with the latest treatment recommendations for Helicobacter pylori infection outlined. Diagnosis of gallbladder disease and gallstones with alternative treatment options is reviewed. Finally, the diagnosis and management of viral hepatitis is outlined. A case study is given to illustrate the basic principles needed by the nurse-midwife in the assessment, diagnosis, and management of a woman with a gastrointestinal concern.

A new trial of intraluminal ultrasonography in the diagnosis of gallbladder diseases by endoscopic transpapillary catheterization in the gallbladder technique (ETCG technique).

A new trial of intraluminal ultrasonography in the diagnosis of gallbladder diseases by endoscopic transpapillary catheterization in the gallbladder technique (ETCG technique).

Ultrasonographic Angiography in Gallbladder Diseases

Ultrasonographic (US) angiography was performed by sonographic examination with injection of carbon dioxide microbubbles through a catheter following conventional angiography in 41 patients with various gallbladder diseases. Three enhancement patterns were found; strong enhancement in the lesion from the periphery to the center was noted in patients with adenocarcinoma and benign polyp (type I), irregular partial enhancement at the margins of the lesion in those with adenosquamous carcinoma (type II), and internal regular enhancement in those with chronic cholecystitis, xanthogranulomatous cholecystitis and adenomyomatosis (type III). Pseudopolypoid lesion such as gallbladder debris showed no enhancement. US angiography may be useful in the differential diagnosis of gallbladder diseases, especially to differentiate the wall thickening type of gallbladder carcinoma from chronic cholecystitis or adenomyomatosis, and the pseudopolypoid lesion and fundal type of adenomyomatosis from benign polyp or polypoid-type carcinoma.

Ultrasonographic Angiography in Gallbladder Diseases

Ultrasonographic (US) angiography was performed by sonographic examination with injection of carbon dioxide microbubbles through a catheter following conventional angiography in 41 patients with various gallbladder diseases. Three enhancement patterns were found; strong enhancement in the lesion from the periphery to the center was noted in patients with adenocarcinoma and benign polyp (type I), irregular partial enhancement at the margins of the lesion in those with adenosquamous carcinoma (type II), and internal regular enhancement in those with chronic cholecystitis, xanthogranulomatous cholecystitis and adenomyomatosis (type III). Pseudopolypoid lesion such as gallbladder debris showed no enhancement. US angiography may be useful in the differential diagnosis of gallbladder diseases, especially to differentiate the wall thickening type of gallbladder carcinoma from chronic cholecystitis or adenomyomatosis, and the pseudopolypoid lesion and fundal type of adenomyomatosis from benign polyp or polypoid-type carcinoma.

Cholecystokinin-enhanced cholescintigraphy in the diagnosis of gallbladder disease

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2022 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

Cholecystokinin-Enhanced Cholescintigraphy in the Diagnosis of Gallbladder Disease

Cholecystokinin-Enhanced Cholescintigraphy in the Diagnosis of Gallbladder Disease

Biliary Sonography

Ultrasonography is a dynamic, powerful, and readily available tool in the armamentarium of biliary diagnosis. The use of this modality is indicated in the initial work-up of jaundice since ultrasonography is exquisitely sensitive to the presence of intrahepatic or extrahepatic biliary dilatation. The liver and pancreas may be screened for focal masses. In acute right upper quadrant pain, ultrasonography can assess the organs residing in this area, often yielding significant information in the diagnosis of gallbladder disease. Newer modalities such as color Doppler may add specificity and reliability to sonographic findings.

LOW INCIDENCE OF HOSPITALIZATION WITH GALLBLADDER DISEASE AMONG BLACKS IN THE UNITED STATES

Low rates of gallbladder disease among blacks have been reported but not systematically studied. The authors investigated the rate of hospitalization with a diagnosis of gallbladder disease in the follow-up in 1982-1984 of the first National Health and Nutrition Examination Survey, a population-based study conducted across the United States in 1971-1975. Based on hospital discharge diagnoses of gallbladder disease, 368 cases were identified for the period 1971-1984 among 10,551 persons, aged 25-74 years, who denied gallbladder disease at the baseline examination. The crude incidence of gallbladder disease per 1,000 person-years was 2.59 for white men, 1.45 for black men, 4.09 for white women, and 2.35 for black women. Controlling for obesity, parity, ethanol consumption, use of diuretics, use of oral contraceptives, and two indicators of socioeconomic status, the authors found that the hazard rate of hospitalization with gallbladder disease increased with age for white women and decreased for black women. The hazard ratio for black women compared with white women at 30 years of age was 0.71 with a 95% confidence interval of 0.52-0.96, but at age 70, it was 0.18 with a 95% confidence interval of 0.09-0.37. For women, obesity and parity were important risk factors for gallbladder disease (p less than or equal to 0.001), and the use of diuretics was marginally associated (p = 0.08). Black men compared with white men had a hazard rate of gallbladder disease of 0.53 with a 95% confidence interval of 0.24-1.16. For men, increasing age was related to gallbladder disease (p less than 0.001), and obesity was weakly related (p = 0.06). The black/white hazard ratios decreased further when controlling for socioeconomic status, persisted if the study population was limited to those hospitalized during follow-up, and increased slightly for cases with an acute complication of gallbladder disease. Thus, differential access to medical care may not explain the lower rate among blacks.

The usefulness and limitations of ultrasonography for the diagnosis of adenomyomatosis of the gallbladder

Ultrasonography has been popular for the diagnosis of gallbladder diseases since the mid-1970s. Although this technique has replaced oral cholecystography (OCG) for the diagnosis of cholecystolithiasis, it has not gained popularity in the diagnosis of adenomyomatosis of the gallbladder (AMMG). We examined 141 patients with clinically suspected gallbladder disease. Ultrasonography (previously done by a radiologist) had produced no positive findings. On ultrasonographic re-evaluation by the same radiologist, but in the presence of a surgeon from our study group, 64 cases of AMMG were detected. OCG revealed the diagnosis of AMMG in 13 other cases. In the study group there were no false-positive results. However, the false-negative rate of sonography in diagnosing AMMG was 16.9%. Thus, in our opinion ultrasonography is a worthwhile technique in diagnosing AMMG done by a surgeon.

Looking for gall bladder disease in the patient's iris.

In alternative health care iridology is used as a diagnostic aid. The diagnosis of gall bladder disease was used to study its validity and interperformer consistency. The presence of an inflamed gall bladder containing gall stones is said to be easily recognised by certain signs in the lower lateral part of the iris of the right eye. Stereo colour slides were made of the right eye. Stereo colour slides were made of the right eye of 39 patients with this disease and 39 control subjects of the same sex and age. The slides were presented in a random order to five leading iridologists without supplementary information. The prevalence of the disease was estimated at 56%. The median validity was 51% with 54% sensitivity and 52% specificity. These results were close to chance validity (iota = 0.03). None of the iridologists reached a high validity. The median interperformer consistency was 60%. This was only slightly higher than chance consistency (kappa = 0.18). This study showed that iridology is not a useful diagnostic aid.