Enlarged Gallbladder Research Articles

Heart failure misdiagnosed as acute cholecystitis: a case report

BackgroundHeart failure is a clinical syndrome characterized by decreased cardiac output, leading to systemic organ hypoxia and resulting in dyspnea, pulmonary edema, organ congestion, and pleural effusion. Owing to the diverse clinical manifestations of heart failure, early diagnosis can be challenging, and misdiagnosis may occur occasionally. The use of echocardiography and blood brain natriuretic peptide can aid in obtaining a more accurate diagnosis.Case presentationThis article presents two case reports of patients who were misdiagnosed with acute cholecystitis. Both patients were young Mongolia males (age 26 and 39 years) who presented to the emergency department with acute upper abdominal pain, abdominal ultrasound revealed gallbladder enlargement, and blood tests suggested mild elevation of bilirubin levels. However, despite the absence of procalcitonin and C-reactive protein elevation, the patients were admitted to the general surgical department with a diagnosis of “acute cholecystitis.” Both patients were given treatment for cholecystitis, but their vital signs did not improve, while later examinations confirmed heart failure. After treatment with diuretics and cardiac glycosides, both patients’ symptoms were relieved.ConclusionWe aim to highlight the clinical manifestations of heart failure and differentiate it from rare conditions such as acute cholecystitis. Physicians should make accurate diagnoses on the basis of physical examinations, laboratory testing and imaging, and surveys while avoiding diagnostic heuristics or mindsets. By sharing these two case reports, we hope to increase awareness to prevent potential complications and improve patient outcomes.

Preoperative diagnosis and safe surgical approach in gallbladder amyloidosis: a case report

BackgroundPreoperative diagnosis of gallbladder amyloidosis is usually difficult. In our case, the patient exhibited gallbladder dyskinesia, which led us to suspect cholecystic amyloidosis. We were able to safely perform surgery before cholecystitis onset.Case presentationA 59-year-old male patient with a history of multiple myeloma and cardiac amyloidosis presented to our hospital with a chief complaint of epicardial pain. Abdominal ultrasonography and computed tomography revealed an enlarged gallbladder and biliary sludge without any specific imaging findings of cholecystitis. After percutaneous transhepatic gallbladder aspiration (PTGBA), the patient experienced recurrent bile retention and right upper quadrant pain. Flopropione was effective in relieving these symptoms. Based on his symptoms and laboratory findings, we diagnosed the patient with dyskinesia of the gallbladder. Considering his medical history, we suspected that it was caused by amyloidosis of the gallbladder. A laparoscopic cholecystectomy was performed. The histopathological examination showed amyloid deposits in the gallbladder mucosa, from the intrinsic layer to the submucosa, and in the peripheral nerves of the gallbladder neck. The patient was discharged on postoperative day 5 and has had no recurrence of abdominal pain since then.ConclusionIn our case, gallbladder dyskinesia symptoms led us to suspect gallbladder amyloidosis. We safely surgically treated the patient before cholecystitis onset.

Traumatic gallbladder rupture in a 9-year-old child

We present gallbladder rupture following trauma. A 9-year-old boy admitted in 1.5 hours after injury. Considering clinical and ultrasound data, we diagnosed traumatic damage to the spleen and hemoperitoneum, biliary dyskinesia, cholestasis, sludge. Hemostatic therapy was carried out. After 3 days, signs of peritonitis appeared. Follow-up ultrasound revealed gallbladder enlargement with heterogeneous content, fluid in all parts of abdominal cavity. Intraoperatively, the gallbladder was enveloped in omentum soaked in bile. After mobilization of the gallbladder, we found longitudinal linear tear up to 3 cm clogged with omentum. Cholecystectomy was performed. Thus, we present a patient with combined injury and damage to the spleen. However, gallbladder wall thickening and heterogeneous content were interpreted as concomitant pathology. Delayed manifestation of peritonitis was due to gallbladder enveloped in omentum. The last one soaked in bile partially entered the gallbladder through perforation and prevented bile leakage into abdominal cavity. Timely diagnosis of gallbladder damage presents certain difficulties, especially in case of combined injury. Ultrasound signs of traumatic gallbladder rupture in this case were wall thickening, heterogeneous content and gradual gallbladder enlargement. It is necessary to analyze all organs at the damage site including computed tomography in patients with combined trauma.

Duodenal volvulus of the sigmoid flexure in five cows. A retrospective study

Medical data of five Holstein Friesian cows with duodenal volvulus of the sigmoid flexure admitted to the Clinic for Cattle, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany during a two-year period were reviewed in this study. The aim of this study was to present the clinical, laboratory and surgical findings as well as the postoperative healing progress and therapy of these five cases. All cows showed a loss of appetite and were dehydrated, with a marked drop in milk yield. The rumen motility was severely reduced and an untypical tympanic resonance or ping and a splashing sound were present at the right flank at auscultation. All the cows had only a small amount of faeces. All animals had hypochloraemic metabolic alkalosis and most of them hyperlactatemia. Two of the cows were hypokalaemic. Hyperbilirubinaemia was revealed in all cows. Four of the cows had an increased haematocrit level. A standing right flank laparotomy was performed in all cows. A common surgical finding was the severely dilated, dorsally dislocated and twisted sigmoid flexure of the duodenum, and the empty descending duodenum. The abomasum of all cows was dilated, but not displaced. An enlarged gall bladder was found in four animals. The duodenal sigmoid loop was manually untwisted, followed by promoting gas and ingesta flow aborally in the descending duodenum. Omentopexy was performed in each cow. No cow had had any history of omentopexy or other abdominal surgery. All cows received intravenous fluid therapy after the surgery. A total of 10-20 L 0.9 % NaCl solution containing an additional KCL (30 mmol/L) was administered intravenously via drip infusion daily for the first two days after surgery. Amoxicillin (10 mg/kg; s.c.) was administered once daily (SID) in two cases. Three of the cows were additionally drenched with 30 L water and 100-150 g KCL via an orogastric tube once per day for two days postoperatively. Four cows received neostigmine s.c. after surgery and for the following one to two days (every 8 or 12 hours; 0.02 mg/kg or 0.025 mg/kg, respectively). All cows were administered meloxicam (0.5 mg/kg; s.c.) before and on the first postoperative day. Sodium sulphate (250 g per os; SID) was administered to four cows for one to two days. Feed intake, rumen motility and defaecation were normalised gradually after surgery. All cows had a positive post-surgical outcome and were discharged from the clinic after 7 to 15 days.
 Keywords: ileus; dairy cattle; duodenum; intestinal obstruction

Isolated IgG4-related cholecystitis mimicking an advanced gallbladder cancer: Don't fall into the trap.

A 59-year old women developed spontaneous jaundice without fever and after a progressive loss of 10 kg in 6 months. Iconography showed an enlarged gallbladder with gallstones and thickening walls responsible for an intrahepatic bile duct dilatation with infiltration of the hepatic pedicle and a portal stenosis (Fig. 1). Jaundice spontaneously resolved but cholestasis remained. Surgical and radiological guided biopsy were performed twice without contributive histology. We decided to proceed to a right portal vein embolization in the aim to proceed to an extended right hepatectomy. Fortunately, definitive histology of the last biopsy revealed inflammatory condition with a high IgG4-plasmocytes rate although the patient's serum concentration of IgG4 was moderate (1.39 g/L, normal rate: 0.86–1.35 g/L) and initially considered as not significant. A complete check up was performed and concluded that it was the unique location of an IgG4-related disease [ [1] Lanzillotta M. Mancuso G. Della-Torre E. Advances in the diagnosis and management of IgG4 related disease. BMJ. 2020; 369: m1067https://doi.org/10.1136/bmj.m1067 Crossref PubMed Scopus (97) Google Scholar ]. Corticotherapy was introduced.

235 A case of Painless Palpable Gall bladder - a rare Exception of the Courvoisier's Law

Abstract Introduction The Courvoisier's law states that a painless palpable enlarged gallbladder with jaundice is unlikely to be caused by gallstones. There are however various exceptions to the law. We report a rare case of such an exception to make us aware of the clinical condition. Case Description 72-year-old male, otherwise fit and healthy, presented to the Emergency department with epigastric discomfort, along with dark urine and pale-coloured stool. He was clinically examined to have jaundice, and a painless globular palpable gall bladder, with blood results confirming obstructive picture i.e. raised bilirubin (70 μmol/L), ALT (103 U/L) and Alkaline Phosphatase (590 IU/L). Ultrasound abdomen showed acute cholecystitis. CT chest-abdomen-pelvis showed cholelithiasis and choledocolithiasis with dilated common bile duct (CBD), as well as asymmetric gallbladder wall thickening. The MRCP showed concentric and uniform thickening of the entire gallbladder wall, with minimal pericholecystic fluid reflecting acute inflammation. Multiple calculi were noted to be present within the CBD and gall bladder, resulting in dilation of CBD (15.8mm). The patient had ERCP with sphincterotomy and retrieval of multiple stones by balloon trawl. He was discharged the following day and is planned to undergo laparoscopic cholecystectomy as an elective procedure. His liver function test markedly improved at discharge bilirubin of 18 μmol/L and ALP of 364 IU/L. Conclusion This is an unusual case of painless jaundice with palpable gall bladder due to stones impacted in the CBD and not due to periampullary carcinoma, which is an exception to the Courvoisier's Law.

Pathogenicity of Aeromonas hydrophila in High-value Native Pangasius Catfish, Pangasius nasutus (Bleeker)

Pangasius catfish, Pangasius nasutus, is a promising candidate for aquaculture due to its high market value. However, the presence of pathogenic bacteria in Aeromonas hydrophila is a major concern in P. nasutus farming in this country. This study determines the pathogenicity of A. hydrophila in P. nasutus. A total of 80 P. nasutus juveniles were intraperitoneally injected with 0, 103, 105, and 107 CFU mL-1 of A. hydrophila and monitored until 240 hr. The infected moribund fish’s kidneys, livers, and spleens were collected for histopathological analysis. The LD50-240hr value was found at 0.8 × 104 CFU/ml of A. hydrophila. The percentage of mortality in 0, 103, 105, and 107 CFU/ml infected groups were found to be at 0, 40, 60, and 90%, respectively. The infected fish showed congestion at the base of the fin, ascites, enlarged gall bladder, and swollen spleen. It is the earliest report on A. hydrophila’s pathogenicity in high-value native fish, P. nasutus.

Pathogenicity of Aeromonas hydrophila in High-value Native Pangasius Catfish, Pangasius nasutus (Bleeker)

Pangasius catfish, Pangasius nasutus, is a promising candidate for aquaculture due to its high market value. However, the presence of pathogenic bacteria in Aeromonas hydrophila is a major concern in P. nasutus farming in this country. This study determines the pathogenicity of A. hydrophila in P. nasutus. A total of 80 P. nasutus juveniles were intraperitoneally injected with 0, 103, 105, and 107 CFU mL-1 of A. hydrophila and monitored until 240 hr. The infected moribund fish’s kidneys, livers, and spleens were collected for histopathological analysis. The LD50-240hr value was found at 0.8 × 104 CFU/ml of A. hydrophila. The percentage of mortality in 0, 103, 105, and 107 CFU/ml infected groups were found to be at 0, 40, 60, and 90%, respectively. The infected fish showed congestion at the base of the fin, ascites, enlarged gall bladder, and swollen spleen. It is the earliest report on A. hydrophila’s pathogenicity in high-value native fish, P. nasutus.

Xanthogranulomatous Cholecystitis: A Distinctive Subtype of Importance.

A 53-year-old female with a history of hiatal hernia repair presented with right upper quadrant pain and jaundice. Physical examination revealed tenderness of the right upper quadrant. Laboratory tests showed elevated C-reactive protein of 109 mg/L (normal <10) and total bilirubin of 181 μmol/L (normal 0–21). Abdominal computed tomography highlighted a gallstone within the main bile duct and an enlarged gallbladder with heterogenous enhancement and intramural hypoattenuating nodules (Figure A). These radiological features established the diagnosis of xanthogranulomatous cholecystitis (XC).

7, 8-Dihydroxy-4-methyl coumarin alleviates cholestasis via activation of the Farnesoid X receptor in vitro and in vivo

Cholestasis is primarily caused by bile acid homeostasis dysregulation, resulting in retention, aggregation, and accumulation of the toxic cholate in the hepatocytes. Existing therapies for cholestasis are limited, demanding the urgent development of novel drugs. As a result, targeting FXR specifically promises a unique treatment strategy for cholestasis. The current study aims to evaluate the influence of 7, 8-dihydroxy-4-methyl coumarin (DMC) against alpha-naphthyl isothiocyanate (ANIT)-induced liver injury in mice. The “Computer-Aided Drug Design” (CADD) and molecular docking study anticipated that DMC would proficiently bind and activate the FXR. Accordingly, the hepatoprotective activity of DMC against ANIT-induced hepatotoxicity and cholestasis was investigated in ANIT-treated HepaRG cells and the ANIT-induced cholestatic mouse model. Outcomes indicated the protective effects of DMC against ANIT toxicity in HepaRG cells after 24 h of intervention and animals after seven days of treatment. DMC partially blocks ANIT-induced increases in serum markers of hepatocellular injury, liver and gall bladder enlargement, and hepatic necrosis. Western blotting revealed that DMC alleviates ANIT-induced hepatotoxicity and cholestasis via activating the FXR receptor and regulating CYP7A1, the enzyme responsible for bile acid synthesis. DMC exhibited protective activity against cholestasis through activating FXR, suggesting it might be a promising strategy for preventing and treating cholestatic liver disease.

Protective potential of the gallbladder in primary sclerosing cholangitis

Gallbladder enlargement is common in patients with primary sclerosing cholangitis (PSC). The gallbladder may confer hepatoprotection against bile acid overload, through the sequestration and cholecystohepatic shunt of bile acids. The aim of this study was to assess the potential impact of the gallbladder on disease features and bile acid homeostasis in PSC. Patients with PSC from a single tertiary center who underwent liver MRI with three-dimensional cholangiography and concomitant analyses of serum bile acids were included. Gallbladder volume was measured by MRI and a cut-off of 50ml was used to define gallbladder enlargement. Bile acid profiles and PSC severity, as assessed by blood tests and MRI features, were compared among patients according to gallbladder size (enlarged vs. normal-sized) or presence (removed vs. conserved). The impact of cholecystectomy was also assessed in the Abcb4 knockout mouse model of PSC. Sixty-one patients with PSC, all treated with ursodeoxycholic acid (UDCA), were included. The gallbladder was enlarged in 30 patients, whereas 11 patients had been previously cholecystectomized. Patients with enlarged gallbladders had significantly lower alkaline phosphatase, a lower tauro-vs. glycoconjugate ratio and a higher UDCA vs. total bile acid ratio compared to those with normal-sized gallbladders. In addition, gallbladder volume negatively correlated with the hydrophobicity index of bile acids. Cholecystectomized patients displayed significantly higher aspartate aminotransferase and more severe bile duct strictures and dilatations compared to those with conserved gallbladder. In the Abcb4 knockout mice, cholecystectomy caused an increase in hepatic bile acid content and in circulating secondary bile acids, and an aggravation in cholangitis, inflammation and liver fibrosis. Altogether, our findings indicate that the gallbladder fulfills protective functions in PSC. In patients with primary sclerosing cholangitis (PSC), gallbladder status impacts on bile acid homeostasis and disease features. We found evidence of lessened bile acid toxicity in patients with PSC and enlarged gallbladders and of increased disease severity in those who were previously cholecystectomized. In the Abcb4 knockout mouse model of PSC, cholecystectomy causes an aggravation of cholangitis and liver fibrosis. Overall, our results suggest that the gallbladder plays a protective role in PSC.

INTRAOPERATIVE SIGNS OF ACUTE BILIARY PANCREATITIS

Summary. Introduction. According to the opinion of a number of experts, acute biliary pancreatitis should be considered a combination of acute pancreatitis with chronic or acute diseases of the biliary tract.&#x0D; Aim. To assess intraoperative morphological changes during laparoscopy in patients with acute biliary pancreatitis.&#x0D; Materials and methods. We treated 65 patients with acute biliary pancreatitis who had isolated cholecystolithiasis. Forty-two patients had acute calculous cholecystitis, twenty-three patients had chronic calculous cholecystitis. All patients underwent laparoscopy, which included diagnostic and treatment stages.&#x0D; Results. Signs of acute biliary pancreatitis were: serous fluid (6.2 %), fibrinous fluid (10.8 %), hemorrhagic fluid (41.5 %), fatty spots (7.7 %), mesenteric hemorrhagic edema of the large intestine (64.6 %), pancreas edema (23.1 %), omentum edema (50.8 %), vitreous edema of the hepatoduodenal ligament (36.9 %), enlarged gallbladder (60.0 %), destructive acute cholecystitis (9.2 %). When the head of the pancreas was damaged, we observed hemorrhagic fluid, hepatoduodenal ligament edema, an enlarged gallbladder, and acute cholecystitis. When the body of the pancreas was damaged, we observed serous fluid, fatty spots, mesenteric edema of the large intestine, and parapancreatic infiltrate. In the inflammatory process of the pancreas tail, we often observed fibrinous fluid in the abdominal cavity.

S1792 Painless Obstructive Jaundice: Pancreatic Adenocarcinoma Cannot Be Excluded

Introduction: Autoimmune pancreatitis (AIP) is a chronic inflammatory condition typically presenting with abdominal pain, jaundice and weight loss. AIP is an uncommon cause of pancreatitis and diagnosis may be challenging, but it is highly responsive to corticosteroids. We present a case of painless obstructive jaundice complicated by a mass on the pancreatic head. Case Description/Methods: A 57-year-old Indian male with no past medical history presented with vague abdominal pain, pruritus, and clay colored stools. Vital signs were unremarkable and laboratory investigations revealed alkaline phosphatase 515 U/L, alanine transaminase 732 IU/L, and total bilirubin 7.6 mg/dL. The patient underwent a right upper quadrant ultrasound which showed an enlarged gallbladder and dilated common bile duct (1.9 cm) down to the level of the pancreatic head. An endoscopic ultrasound (EUS) revealed a 3.2 x 3.7 cm hypoechoic mass in the head of the pancreas obstructing the bile duct, 2 enlarged lymph nodes in the area near the bile duct, marked bile duct dilation, and an enlarged sludge-filled gallbladder. Of note, unlike most ductal tumors the pancreatic duct upstream of the mass was not dilated. Fine needle aspiration (FNA) was unsuccessful due to the obstruction by the lymph nodes. Endoscopic retrograde cholangiopancreatography (ERCP) showed stricture of bile duct consistent with a pancreatic head mass, and was stented. Abdominal and pelvic computed tomography (CT) confirmed a 3 cm pancreatic head mass. Pathology result from the attempted FNA was inconclusive. Further labs revealed normal IgG4 and CA 19-9 level of 194; indicative of possible pancreatic malignancy. The patient developed jaundice, scleral icterus and rapid weight loss. EUS with FNA with repeat biopsies revealed rare degenerated epithelial cells. The patient was treated with high dose steroids, with planned pancreaticoduodenectomy. Follow-up CT revealed resolution of the pancreatic mass and was confirmed by repeat EUS/ERCP and normal CA 19-9 level. Discussion: Although painless obstructive jaundice with a pancreatic mass is a typical presentation for a pancreatic neoplasm; it is not the only possible diagnosis. Despite biochemical and radiographic evidence suggesting a malignancy; if AIP remains in the differential, a trial of steroids may be warranted to avoid unnecessary surgical intervention and associated morbidity.

S3329 An Unusual Presentation of Seronegative Autoimmune Hepatitis

Introduction: Seronegative autoimmune hepatitis presenting as acute liver failure is uncommon. Case Description/Methods: A 74-year-old woman with past medical history of GERD and moderate Alzheimer’s dementia was noted to have transaminitis on routine outpatient labs (ALT 272, AST 183), which did not resolve over four months. Her only medications were calcium and famotidine. She took no supplements or substances. She presented to the hospital after recent repeat chemistries showed worsening transaminitis. Upon admission, she appeared fatigued and jaundiced. Family noted she was unable to care for herself as usual. Initial labs revealed: total bilirubin 14.8 mg/dL, direct bilirubin 10.0 mg/dL, INR 1.7, AST / ALT 1428 and 1224 IU/L, Alk Phos 168 IU/L , Albumin 3.4 g/dL. Toxicology, immunologic serologies, including anti-smooth muscle antibodies (ASMA), and infectious testing were unremarkable. Immunoglobulin G was elevated (2700). CT of the abdomen and pelvis noted a small lesion in the pancreas and pancreatic and periportal adenopathy, and an enlarged gallbladder with sludge. She was admitted to medical oncology with a presumed diagnosis of pancreatic cancer. She could not complete MRI and underwent endoscopic ultrasound (EUS) on hospital day 4, which revealed normal pancreas and bile ducts. EUS-guided biopsy of the liver was done. On hospital day 6, she developed acute liver failure and methylprednisolone and N-acetylcysteine were started. Due to dementia, she was ineligible for liver transplant. On hospital day 8, pathology confirmed autoimmune hepatitis with bridging fibrosis. By hospital day 10, liver function improved (Figure 1 A-B); however, she developed fever and, despite broad-spectrum antibiotics, suffered from septic shock and expired on day 11. Discussion: Fulminant-onset autoimmune hepatitis (AIH) with hepatic encephalopathy is rare, occurring in < 6% of patients with AIH. The frequency of seronegative autoimmune hepatitis in acute and severe AIH is further estimated to be ≤7%. This case illustrates the challenge in diagnosis, particularly when confounding factors are present. Our patient suffered from dementia and aphasia, which masked developing hepatic encephalopathy, and pancreatic cancer was initially suspected as the cause of her painless jaundice, which delayed steroid treatment. A high index of suspicion for AIH is needed in patients with liver failure of uncertain etiology, as early treatment with steroids may improve the clinical outcome.Figure 1.: (A-B).

Prenatal diagnosis with chromosome microarray and pregnancy outcomes of fetuses with biliary tract system abnormalities

To investigate the prenatal diagnostic value of chromosome microarray analysis (CMA) in fetuses presenting with ultrasound-based biliary tract system (BTS) anomalies. Amniocentesis was performed and CMA was applied in 271 pregnant women carrying fetuses with BTS abnormalities between April 2015 and December 2020. Pregnancy outcomes and fetal prognosis were followed from 1 to 6years. Sixteen cases (5.9%, 16/271) of chromosomal anomalies were detected. The detection rate of chromosomal abnormalities was significantly higher for fetuses with nonisolated BTS anomalies than for those with isolated BTS anomalies (9.0% vs. 0%, p=0.0017). Follow-up results were obtained from 267 fetuses, including 25 cases of termination of pregnancy (9.4%), 237 live births (88.8%), and 5 (1.9%) neonatal demises. The incidence of congenital biliary atresia in the small gallbladder and nonvisualized gallbladder groups was 3.0% (1/33) and 9.5% (7/74), respectively; however, none was detected on postnatal ultrasound reexamination in the gallbladder enlargement or the other BTS groups. An isolated BTS abnormality is not an indication for invasive prenatal chromosomal analysis. When combined with other ultrasonographic abnormalities, prenatal CMA should be provided. When a small or nonvisualized gallbladder is found prenatally, ultrasonography is limited in the differential diagnosis of congenital biliary atresia.

A Patient With Right Upper Quadrant Pain

A 78-year-old man presented to the emergency department with persistent epigastric pain that started after eating dinner. His vital signs were within normal limits. On physical examination, he was found to have epigastric and right upper quadrant tenderness with a negative Murphy sign. Laboratory results showed moderately increased leukocyte count, serum C-reactive protein, and biliary enzymes. Point-of-care ultrasonography showed an enlarged gallbladder with debris precipitating at the neck and multiple small, echogenic foci moving from the neck toward the fundus against gravity (Figure 1, Video E1, and Video E2 [available at http://www.annemergmed.com]).

4. Case Study: Gallstones (Cholelithiasis) in Long-tailed Macaques (Macaca fascicularis)

The purpose of this case study is to diagnose the cause of death of the long-tailed macaque (Macaca fascicularis). Two cadaver of Macaca fascicularis were received by the Lampung Veterinary Center from a customer. Necropsy was carried out at the Pathology Laboratory of the Lampung Veterinary Center by observing macroscopic changes. The samples taken were then observed by gram staining in the Bacteriology laboratory and hematoxylin-eosin staining at the Pathology laboratory. The results of macroscopic observations showed an enlarged gallbladder with a length of 4 cm and a width of 2 cm, blackish in color. Gallbladder surgery found 15 gallstones measuring 2 mm in diameter, brownish-colored bile, fibrin clots, and blood. The native gram stain of bile showed several types of rod-shaped bacteria form and gram-negative cocci (eosinophilic), and gram-positive rods (basophilic). Specific histopathological changes in the ductus choleductus are multifocal neutrophil inflammatory cell infiltration, enlarged gallbladder lumen filled with multi-bacterial, cell debris, fibrin, and erythrocytes. Multifocal hepatitis occurs by neutrophils, multibacterial, and fibrin. It can be concluded that the causes of death of Macaca fascicularis were cholelithiasis and hepatitis.

Dietary polyethylene inclusion affecting rabbit's performance

A feeding experiment was conducted with rabbits as experimental animals for 2 months at 4 treatment groups under the same environmental conditions. The aim was to study the toxic effects of dietary graded levels of polyethylene (PE, 0, 1, 2, and 4 g/ton diet). The main effects were that some animals fed the PE-contaminated diets suffered from mange, diarrhea, weakness, and/or loss of weight. Post-mortem examination of the contaminated-diets fed rabbit revealed presence of bad smell liquids in its abdomen, residues of collective PE in the small intestine, collective feces in one part of the intestine and the parts were filled with aqueous accumulation, the color of one hepatic lobule was pale, and the lungs' color was bloody red. Yet, feed intake and water consumption increased by feeding the contaminated diets. Moreover, animals offered the contaminated diets reflected heavier body weight. However, the feed conversion (utilization) was negatively affected by the PE- contaminated diet; since, dietary PE-inclusion increased apparently feed consumption than the real body weight gain. Slaughter test of the PE-treated animals reflected many remarks including loss of rabbit's weight; increased skin weight, skin was thick and dough, changes in the color and quality of the carcass flesh, easy broken bone. When these animals were eviscerated, it were observed white-colored lungs, with necrosis and bloody infiltration, small-sized liver, with blackly-red color, enlarged gall bladder, narrow diameter of the small intestine, presence of collective mass of PE on the internal wall of the small intestine. The presence of PE in the experimental diets was responsible for significant lowering the specific gravity of the treated animals' bone, as well as their flesh moisture and fat; yet, their crude protein increased besides their edible parts and boneless meat percentages increased too, but not significantly. Dietary contamination with PE reflected its residues in the rabbits' flesh and increased the flesh content of ash (P&gt;0.05). The contaminated diets were responsible for significantly (P≤0.05) evaluating lymphocytes %, MCV, MCH, and PLT and lowering both monocytes and granulocytes % as well as RBCs count. Significant (P≤0.05) increases in albumin, creatinine and uric acid concentrations and decreases of ALT activity were recorded with feeding rabbits the PE-contaminated diets; but, Cho. and Trig. concentrations were decreased (P≤0.05). There was a significant increase of scores of hepatic congestion and necrosis in liver from rabbits group received 0.4 PE when compared with control group. Statistical analysis shows significant increase of scores of renal congestion, fibrosis and acute tubular necrosis in group received 0.4 PE when compared with control group. Hence PE negatively affected rabbits' performance, health and quality, and may affect the consumers' health too.

Metabolomic Analysis Reveals the Therapeutic Effects of MBT1805, a Novel Pan-Peroxisome Proliferator-Activated Receptor Agonist, on α-Naphthylisothiocyanate-Induced Cholestasis in Mice.

Background and Aims: Therapeutic drugs that are used to treat cholestatic liver disease are limited; however, the results of clinical trials on primary biliary cholangitis treatment targeting peroxisome proliferator-activated receptors (PPARs) are encouraging. In this study, we aimed to identify the effects of MBT1805, a novel balanced PPARα/γ/δ agonist, on cholestasis induced by α-naphthylisothiocyanate (ANIT) and elucidate the underlying mechanisms through untargeted and bile acid-targeted metabolomic analysis. Methods: Levels of serum biochemical indicators (transaminase, aspartate transaminase, alkaline phosphatase, and total bilirubin) and liver histopathology were analyzed to evaluate the therapeutic effects of MBT1805 on ANIT-induced cholestasis in C57BL/6 mice. Untargeted and bile acid-targeted metabolomic analysis of liver tissues was performed using ultrahigh-performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-MC/MC). qRT-PCR and Western blot analysis were carried out to measure the expression of key enzymes and transporters regulating bile acid synthesis, biotransformation, and transport. Results: MBT1805 significantly improved abnormal levels of liver biochemical indicators and gallbladder enlargement induced by ANIT. Histopathological analysis showed that MBT1805 effectively relieved ANIT-induced necrosis, vacuolation, and inflammatory infiltration. Untargeted metabolomic analysis identified 27 metabolites that were involved in the primary biliary acid biosynthesis pathway. In addition, bile acid-targeted metabolomics showed that MBT1805 could alleviate the abnormal bile acid content and composition induced by ANIT. Furthermore, qRT-PCR and Western blot results confirmed that MBT1805 could effectively regulate bile acid synthesis, biotransformation, and transport which helps relieve cholestasis. Conclusions: MBT1805 is a potential candidate drug for cholestasis, with a balanced PPARα/γ/δ activation effect.

Postnatal outcomes of fetuses with isolated gallbladder anomalies: be aware of biliary atresia

Objectives To analyze the normal development of fetal gallbladder (GB) and evaluate the postnatal outcomes of fetuses with isolated GB anomalies without other structural abnormalities by ultrasound. Methods This was a retrospective study. We collected normal cases during 2016 between 15 and 40 gestational weeks and measured the length and width of GB to establish a normal reference range of GB. Using the 10th and 90th percentiles of the normal reference range, isolated cases of enlarged or small GB without other structural anomalies were selected between January 2017 and December 2019. Simultaneously, cases of echogenic material in the GB were included. Fetuses with non-visualization of the fetal gallbladder (NVFGB) were collected between January 2010 and December 2019. Postnatal outcomes of these cases were followed up and analyzed. Results There were 670 cases in the normal group and a linear correlation was found between the dimensions of GB and the gestational age, including the length (r = 0.69; p < .05; y = 0.97 + 0.70 × gestational age) and width (r = 0.48; p < .05; y = 1.65 + 0.12 × gestational age). Sixty-two cases with isolated GB anomalies were collected, including nine cases of enlarged GB, four cases of small GB, three cases of echogenic material in the GB, and 46 cases of NVFGB. Sixty fetuses (96.8%, 60/62) had good outcomes, except that two neonates (4%, 2/50) in small GB and NVFGB groups were both born with BA. In the NVFGB group, 97.8% (45/46) were with good outcomes, in which gallbladders were finally visualized in 37 (80.4%, 37/46) cases and GB agenesis was postnatally diagnosed in eight (17.4%, 8/46) patients by ultrasound. Conclusion The postnatal outcomes of most fetuses (96.8%) with isolated GB anomalies such as enlarged GB, echogenic material in the GB were favorable. When it comes to cases of small GB or NVFGB in prenatal ultrasound diagnosis, we should alert biliary atresia in prenatal counseling.