Gallbladder Calculi Research Articles

Demographic and Clinical Characteristics in Patients with Elevated Neutrophil-Lymphocyte Ratio Undergoing Cholecystectomy

Introduction: Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to address gallbladder-related conditions, primarily gallstones and cholecystitis. This study aimed to evaluate the demographic and clinical characteristics of patients with elevated neutrophil-lymphocyte ratio undergoing cholecystectomy. Methods: This prospective observational study was conducted at the various surgical units of the inpatient Department of Surgery, Dhaka Medical College Hospital, Dhaka, from July 2018 to June 2019. Patients with cholecystitis attending in the outdoor or emergency, admitted with cholecystitis in Dhaka Medical College Hospital, Dhaka were considered as the study population. A total of 50 patients were selected as study subjects by purposive sampling technique. Statistical Package for Social Science (SPSS) version 21 for Windows was used to analyze the data. A p-value < 0.05 was considered to be significant. Result: Among 50 cholecystectomy patients, 68% were admitted as outpatients, and 32% via the emergency department. The predominant symptom was abdominal pain (92%), and the mean serum leukocyte count was significantly higher in the elevated NLR (≥3) group (13500/mm³ vs. 6200/mm³, p <0.004). Eighty percent had gallbladder calculus, with 82% diagnosed with simple cholecystitis. Most procedures (78%) were laparoscopic, and 72% did not require drains. The mean postoperative hospital stay was 4 days, longer for the elevated NLR group (median 6 days vs. 4 days, p <0.002). Complications occurred in 30% of patients, with a higher incidence in the elevated NLR group. Conclusion: The findings suggest that an elevated neutrophil-lymphocyte ratio (NLR) is linked to important clinical characteristics and outcomes, especially in older adults and males. Patients with higher NLR exhibited increased rates of laparoscopic conversion, longer operative times, and extended postoperative hospital stays. Additionally, they were more likely to need ...

Combined Laparoscopic Cholecystectomy and Transcystic Common Bile Duct Exploration for Choledocholithiasis

Abstract Background: There is no consensus on the ideal approach for managing patients with common bile duct (CBD) stones. The combined approach is less popular, possibly due to the complexity of the surgical technique and the availability of choledochoscope. Aim: We aim to assess the safety and feasibility of transcystic (TC) CBD exploration using the flexible bronchoscope for choledocholithiasis. Methods: Forty patients with symptomatic calculus gallbladder with concomitant CBD stones were randomized into two groups. Single-session laparoscopic cholecystectomy (LC) and laparoscopic TC CBD exploration were performed for one group using the flexible bronchoscope. Endoscopic retrograde cholangiopancreatography followed by LC after 4–6 weeks was conducted for the other group. Results: Twenty patients were randomized to each group. The clearance rate of CBD stones was significantly higher in the single-session Group A (95%) than in the two-session Group B (70%). Group B was associated with a significantly prolonged operative (P = 0.01). The total hospital stay and operative time were significantly longer in Group B than in Group A (P = 0.004). There was no significant difference between both groups regarding the intraoperative or postoperative complications. Conclusion: Combined LC and TC CBD exploration is a safe and feasible approach and is associated with significantly shorter operative time and length of hospital stay.

Perioperative anaesthetic management of an elderly high-risk male with cardiac ochronosis undergoing aortic valve replacement with coronary artery bypass graft: A case report.

Alkaptonuria is a rare autosomal recessive congenital disorder of metabolism that affects 1 in 250,000 live births. It manifests as ochronosis and degenerative arthritis due to the accumulation of homogentistic acid in cartilage and heart valves along with precipitation of renal, salivary, pancreatic and gall bladder calculi. It is noted to cause cardiac valve stenosis and regurgitation secondary to calcification leading to cardiac failure in 10% of patients. Through this report, we present a successful perioperative anaesthetic management of a 74-year-old man with cardiac ochronosis, who underwent an aortic valve replacement with coronary artery bypass graft surgery at our centre.

Ring and flower in the eye – An incidental finding of Wilson disease in a case of diabetic retinopathy: A case report

This is to report a rare case of Wilson disease (WD) with Kayser–Fleischer (KF) ring with sunflower cataract along with diabetic retinopathy. A 43-year-old male patient presented to the comprehensive clinic with a chief complaint of diminution of vision of both eyes since 8 months. On ocular examination, the cornea showed golden brown color pigment deposition in the Descemet membrane, indicative of KF ring, which is a pathognomonic feature of WD. There was brown plaque or spoke-like radial opacities on the anterior lens capsule in both eyes, which gives sunflower appearance, which is also a feature of WD. The posterior segment revealed diabetic retinopathy in both eyes. Serum ceruloplasmin was reduced, and the bilirubin level was mildly raised. Liver function test was mildly altered. Urine excretory copper levels were raised. Ultrasonography of the abdomen and pelvis revealed liver cirrhosis with portal hypertension, splenomegaly, gross ascites, and gall bladder calculi. This is a rare case of WD with KF ring with sunflower cataract with diabetic retinopathy in both eyes. Slit lamp examination is mandatory to diagnose it as WD in the presence of KF ring.

Pre-hospital ultrasonography screening for biliary disease in remote settings

AbstractScreening ultrasound, including Point of Care Ultrasonography (POCUS), is widely utilized for rapid clinical guidance in diverse healthcare settings. In this case report, a 34-year-old male with recurrent biliary colic symptoms underwent a Basic Emergency Service ultrasound, revealing a 13 mm gallbladder calculus and signs of inflammation, and was promptly referred to the hospital for further evaluation and treatment. Medical specialist confirmation at the hospital underscored the significance of early detection through POCUS. Despite inconclusive laboratory results, the detailed ultrasound assessment provided a comprehensive understanding, emphasizing the tool's value in averting complications. Thus, screening ultrasound played a pivotal role in justifying the hospital referral, showcasing its vital role in healthcare, especially in resource-limited settings. The judicious use of POCUS can lead to superior outcomes, avoiding unnecessary referrals for non-emergent cases.

Chronic Cholecystitis with Cholelithiasis with Gall Bladder Adenomyomatous Hyperplasia in a Young Female - A Case Report

A thirty-year-old female presented to the Surgery outpatient department of Shri Ram Care Hospital, Bilaspur, Chhattisgarh, with complains of pain in whole abdomen with abdominal distention, nausea, anorexia, dyspepsia and constipation off and on for the last twenty days. There was no history of jaundice in the past. There were no bowel / bladder complaints. On examination, pallor was present. Per abdomen palpation revealed splenomegaly. She was evaluated completely; clinically, radiologically and by routine investigations. She was found to be anaemic (her haemoglobin level was 5.8 gm/dl) and her ultrasound abdomen revealed multiple gall bladder calculi with splenomegaly. She was admitted and a laparoscopic or if needed, an open cholecystectomy was planned after three units of blood transfusion.
 She underwent the procedure well at Shri Ram Care Hospital and her cholecystectomy specimen was sent to Anushka Diagnostics, Bilaspur, for histopathological evaluation.

A Retrospective Study in Patients With Varying Prescription Coverage With Ursodeoxycholic Acid and Association With Incidence of COVID-19 Diagnosis in Primary Care

Background: The 2019 novel coronavirus (COVID-19) pandemic resulted in significant mortality and morbidity. Ursodeoxycholic acid (UDCA) is reportedly widely in demand in some countries, such as China, to protect individuals from the effects of infection, as there is evidence that it is effective in preventing viral replication in some in vitro studies. UDCA is commonly prescribed in patients with primary biliary cirrhosis and gallbladder calculi. By evaluating a set of patients prescribed UDCA, whether or not the risk of COVID-19 infection is attenuated by adherence to UDCA can be determined. Method: This is a retrospective database study using the Clinical Practice Research Datalink (CPRD Aurum). Patients who received a prescription of UDCA in the study timeframe of March 1, 2020–May 30, 2021 were characterized, and their primary care electronic medical records analyzed for presence of COVID-19 infection. The proportion of days covered for each patient was used as a proxy for adherence. A comparison was made between categorized high- and low-adherence, and adherence as a continuous variable. Inverse probability weighting was used to adjust for confounding. Results: Higher categorized adherence (≥80%) to UDCA was associated with a statistically significant lower incidence of COVID-19 (odds ratio [OR]: 0.864; 95% confidence interval [CI]: 0.759–0.984; p=0.027). This contrasted to adherence as a continuous variable, which was not statistically significant. Obesity and hematological malignancy were also associated with a higher incidence of COVID-19 infection. Conclusion: There is evidence to suggest that the regular use of UDCA is associated with a lower risk of COVID-19 infection when compared to irregular or sporadic usage.

An observational study on spectrum of complications in gallstone disease in Western Maharashtra

Gallbladder calculus prevalence exhibits significant regional disparities, affecting public health. This study aimed to assess the incidence of complications in diagnosed cases of gallbladder stones using a prospective observational approach. Methods encompassed comprehensive history-taking, clinical examinations, imaging, and biochemical markers' analysis. In this study encompassing 238 cases of symptomatic gallstones, a comprehensive analysis revealed that 31.9% of patients presented with complications. Among these, choledocholithiasis emerged as the most prevalent complication, affecting 13.45% of the cases. Acute cholecystitis and gallstone pancreatitis were also significant complications, occurring in 10.9% and 6.7% of the cases, respectively. Noteworthy is the consistent alignment between clinical diagnoses and imaging findings, highlighting the accuracy and reliability of the diagnostic process. Turning to the exploration of management modalities, the data showcased laparoscopic cholecystectomy as the predominant surgical intervention. Both early and delayed laparoscopic cholecystectomies were frequently performed, reflecting the versatility of this approach in addressing symptomatic gallstone cases. However, it is essential to note that an overall 6% conversion rate from laparoscopic to open cholecystectomy was observed, underscoring the importance of adaptability in surgical strategies. These findings not only contribute to a deeper understanding of the prevalence and complications associated with symptomatic gallstones but also emphasise the significance of accurate diagnostic measures and the need for surgical flexibility in managing these cases. The results presented in this study offer valuable insights that can inform clinical decision-making and enhance the overall management of patients presenting with symptomatic gallstones

Infection Prevalence at a Tertiary Hospital in Hail, Saudi Arabia: A Single-Center Study to Identify Strategies to Improve Antibiotic Usage.

Identifying the burden of disease and the condition of the Saudi population is in high demand from both a surveillance and analytical standpoint. The objective of this study was to determine the most prevalent infections among hospitalized patients (both community-acquired and hospital-acquired), the antibiotics prescribing pattern, and their relationship with patient characteristics like age and gender. A retrospective study was conducted comprising 2646 patients with infectious diseases or complications admitted to a tertiary hospital in the Hail region of Saudi Arabia. A standardized form was used to collect information from patient's medical records. Demographic data such as age, gender, prescribed antibiotics, and culture-sensitivity tests were included in the study. Males represented about two-thirds (66.5%, n = 1760) of the patients. Most patients (45.9%) who suffered from infectious diseases were between the ages of 20 and 39. The most prevalent infectious ailment was respiratory tract infection (17.65%, n = 467). Furthermore, the most common multiple infectious diseases were gallbladder calculi with cholecystitis (40.3%, n = 69). Similarly, COVID-19 had the greatest impact on people over 60. Beta-lactam antibiotics were the most commonly prescribed (37.6%), followed by fluoroquinolones (26.26%) and macrolides (13.45%). But performing culture sensitivity tests were rather uncommon (3.8%, n = 101). For multiple infections, beta-lactam antibiotics (such as amoxicillin and cefuroxime) were the most commonly prescribed antibiotics (2.26%, n = 60), followed by macrolides (such as azithromycin and Clindamycin) and fluoroquinolones (eg, ciprofloxacin and levofloxacin). Respiratory tract infections are the most prevalent infectious disease among hospital patients, who are primarily in their 20s. The frequency of performing culture tests is low. Therefore, it is important to promote culture sensitivity testing in order to support the prudent use of antibiotics. Guidelines for anti-microbial stewardship programs are also highly recommended.

Histomorphological Study of Acalculus and Calculus Gall Bladder in a Tertiary Care Hospital of Western Uttar Pradesh

Introduction: Gall bladder is the most common surgically resected specimen as gallstones are one of the major causes of morbidity. There is increasing incidence of gall stones in India and more so in North India. It can be due to changes in life style such as fat rich food and sedentary life style. Stones can produce a wide variety of mucosal changes ranging from inflammatory, metaplastic, dysplastic and neoplastic lesions. Aim: This study was performed to find out the spectrum of histopathological lesions in gall bladder in cholecystectomy specimens with or without stones. Materials and Methods: This was a hospital based cross- sectional study conducted on 415 cholecystectomy specimens received between 1st November 2019 to 31st October 2020 in the department of Pathology of NCR Institute of Medical Sciences, Meerut. The specimens were received in 10% formalin, the gross details of specimens and stones were studied. Sections were taken from the representative areas, processed and stained with Haematoxylin and Eosin stain. These sections were studied meticulously. Demographic data was expressed as percentages. The p-value was calculated by chi-square test. Results: Of the 415 cholecystectomy specimens 337 were from females and 78 were from males with female to male ratio of 4.3:1. The most common histopathological finding was chronic cholecystitis followed by cholesterolosis observed in 206/231 (89.17%) and 28/31 (90.32%) respectively in gall bladders with stones and in 25/231 (10.82%) and 3/31 (9.36%) of gall bladders without stones. Metaplasia and dysplasia was found in 81/83 (97.59%) and 15/16 (93.75%) of cases with stones, and in 2/83 (2.40%) and 1/16 (6.25%) cases without stones. Conclusion: Cholelithiasis produces diverse mucosal alterations some of which are precancerous and can progress to cancer. So, histopathological examination of all the gall bladders is essential for the detection of premalignant and malignant conditions.

Situs inversus totalis - pogled na sliku u ogledalu

Introduction: Situs inversus totalis (SIT) is a rare phenomenon and the incidence of this condition ranges from 1:10.000 to 1:20.000 people. It is a condition in which the arrangement of internal organs is a mirror image of normal anatomy. It can occur independently or as part of a syndrome with other abnormalities. Congenital heart defects are present in about 5-10% of such individuals. The underlying cause and genetics of situs inversus are complex. Case report: A 69-year-old female patient was referred to the Department of General Surgery in May 2023 for ventral hernia surgery. This was her third admission to the same department; in 1998, she had appendectomy, and in 2018, the patient underwent a cholecystectomy due to gallbladder calculus. Upon admission, the patient was referred for a CT scan of the thorax and the abdomen, in order to confirm the correct anatomy, given that she was already familiar with her condition and the existence of situs inversus. During the CT examination, the arrangement of the abdominal organs was confirmed as a mirror image of normal anatomy with the heart on the right side of the chest. Conclusion: Most people with SIT live completely normal lives. Life expectancy and risk of acquired diseases are similar to those of the general population. In a certain number of cases, there is a connection with certain pathological entities. In patients with SIT, common causes of acute abdominal pain often lead to wrong conclusions, and the localization of the cause of abdominal pain is extremely complicated and difficult. Identifying people with SIT makes it possible to reduce risks during surgical procedures and interventional procedures.

Laparoscopic Cholecystectomy after Acute Biliary Pancreatitis in a Patient with Situs Inversus Totalis.

Situs inversus totalis (SIT) is a rare disorder defined as symmetrical transposition of thoracic and abdominal organs. Laparoscopic cholecystectomy (LC) is a routine surgical operation and gold standard for symptomatic gallstones. LC can be challenging in SIT due to patient positioning on the operating table and the surgeon's operating position, especially for right-handed surgeons. In this case, we share our experience of a 60-year male with a history of SIT presenting with acute epigastric pain. Serum amylase and lipase were increased and imaging studies showed multiple millimetric calculi in gallbladder. The patient was diagnosed as having acute biliary pancreatitis and admitted to the surgery ward. Intravenous fluids and symptomatic treatment were given. The patient recovered and a delayed LC was planned. During the operation, trocar sites were mirror images of routine LC and the operation was completed without complications. Diagnosis of acute abdominal pain and abdominal surgery in SIT patients can be demanding. Various transformations in standard LC are possible and SIT is not a contraindication for LC Key Words: Laparoscopy, Cholecystectomy, Situs inversus totalis, Pancreatitis, Gallbladder.

Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of Demographics and Complication Rates.

This study aimed to aid in risk assessment of pediatric endoscopic retrograde cholangiopancreatography (ERCP) candidates by utilizing a national pediatric database with a large sample to assess how patient characteristics may affect ERCP complication rates. The Kids' Inpatient Database (KID) is a sample of pediatric discharges in states participating in the Healthcare Cost and Utilization Project (HCUP). This database provides demographic information, hospitalization duration, and outcome information for hospitalizations during which an ERCP occurred. International Classification of Diseases (ICD) codes were used to determine the hospitalization indication. ERCP complication rate was ascertained via ICD codes. All statistical analyses were performed using SAS 9.4. Complications were seen in 5.4% of hospitalizations with mortality observed in less than 0.2%. This analysis captured a large Hispanic population, specifically in the South and West regions. Gallbladder calculus and cholecystitis were more likely to occur in females. A higher percentage of patients in the age 10 - 17 group were female (72.2% vs. 52.7%, P < 0.01) and Hispanic (33.4% vs. 22.7%, P < 0.01) compared to the age 0 - 9 group. Age 0 - 5 and male gender were associated with lower routine home discharge rates and longer lengths of stay. Complications occurred at a higher rate in ages 0 - 5, though the difference was not statistically significant. ERCP is a safe procedure for pediatric patients with low complication rates and rare mortality. We found statistically significant differences in the procedure indications between pediatric age groups, races, and genders. Age ≤ 5 years and male gender were associated with more complicated healthcare courses.

Analysis of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis-a prospective study

Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) remains the cornerstone of treatment worldwide for coexisting CBD and gall bladder calculi. The interval between ERCP and LC is disputed. In our study, LC is performed at or more than 6 weeks after ERCP keeping in view by allowing the gall bladder to recover from the acute inflammatory changes if operated upon earlier.Methods: We conducted a prospective observational study in the postgraduate department of general surgery government medical college Srinagar J and K India over a period of 2 years. The 25 patients above age of 18 years and with cholecysto-choledocholithiasis who underwent ERCP and LC at or more than 6 weeks were included.Results: In our study the mean age was 45.3 years. Male: female ratio was 1:3.2. the distribution of patients as per Nassar grading scale 1 (4%) patient had grade I,12 (48%) patients had grade II, 5 (20%) patients had grade III and 7 (28%) patients had grade IV. In patients with grade I, the mean duration of surgery was 36.0 minutes, in grade II the duration of surgery ranged from 34-60 minutes with mean duration of surgery of 43.4 min (SD±8.9), in grade III duration of surgery ranged from 42-68 minutes with mean duration of surgery of 55.2 min (SD±10.06) and in grade IV duration of surgery ranged from 68-116 minutes with mean duration of surgery of 91.3 min (SD±17.66). We observed a definite relationship between the intraoperative Nassar grading scale and the post ERCP interval, 1 patient of grade I scale operated at 12 weeks post ERCP. 12 patients were between the post ERCP interval of 8-12 weeks (mean 10.1 weeks) and they had grade II. In grade III we had 5 patients with post ERCP interval of 7-11 weeks (mean 9.2 weeks). In grade IV we had 7 patients with post ERCP interval of 6-10 weeks (mean 7.9 weeks). p=0.008.Conclusions: Interval LC after ERCP is safe but challenging, longer the interval time between ERCP and LC lesser the chances of encountering intra-operative complications. We recommend LC more than 6 weeks after ERCP is safe.

The Study on the Clinico-pathological Spectrum of Non-neoplastic and Neoplastic Lesions in Cholecystectomy Specimens at a Tertiary Care Centre

Background: Most commonly used surgical procedure for gall-bladder pathology is cholecystectomy. Gall-bladder diseases incidence has increased over the past decade and are cause for a number of histopathological changes like pre-neoplastic conditions and ultimately culminating into the neoplasia. Histopathologic examination of the specimen serves as the absolute diagnosis of the non-neoplastic and neoplastic lesions as pre-operative imaging techniques fail to identify the lesions&#x0D; Aim: To analyse the clinico-pathological spectrum of various non- neoplastic and neoplastic lesions&#x0D; occurring in cholecystectomy specimens with and without gall bladder calculus.&#x0D; Materials &amp; Method: An observational, cross-sectional study was conducted between 2019 to 2020 at a tertiary care centre in Safedabad, Barabanki, UP. A total of 135 cholecystectomy specimens were evaluated for histopathological examination. After histopathological reporting all cases were clinicopatholically related. Data was analysed using SPSS software, the demographic data were presented as frequency, percentage; continuous variables with mean and standard deviation.&#x0D; Results: 74.8% were females (n=101) and 25.2% were males (n=34) with mean age of 42.96 years. Gall-bladder stone was present in 85.2% of patients (n=115) and absent in 14.8% patients (n=20). Neoplastic lesion in 7 of the patients, 5 patients with adenocarcinoma, 1 patient with adenosquamous carcinoma and 1 patient with papillary adenocarcinoma. Gall-bladder carcinoma were diagnosed in our study; the poorly differentiated GBC revealed high Ki67 Score.&#x0D; Conclusion: Gall-bladder diseases can have a varied presentation both clinically and histopathologically. Hence, a complete and meticulous macroscopic and microscopic examination of all cholecystectomy specimens should be mandatory for better patient care.

Hypoglycemia with lactic acidosis caused by a new MRPS2 gene mutation in a Chinese girl: a case report

BackgroundMitochondrial ribosomal protein S2 (MRPS2) gene mutation, which is related to severe hypoglycemia and lactic acidosis, is rarely reported globally.Case presentationWe report a case of a new MRPS2 gene mutation in a Chinese girl who presented with hypoglycemia and lactic acidosis. A homozygous C.412C > G variant that could cause complex oxidative phosphorylation deficiency and had not been reported before was identified. The clinical manifestations included recurrent vomiting, hypoglycemia, lactic acidosis, sensorineural hearing loss, and gall bladder calculi. Hypoglycemia and lactic acidosis improved after the administration of sugary liquid and supportive treatments.ConclusionsRecurrent hypoglycemia with lactic acidosis and sensorineural hearing loss should lead to suspicion of mitochondrial defects and the early refinement of genetic tests.

Laparoscopic remnant cholecystectomy for calculi in the remnant gallbladder following subtotal-cholecystectomy: a report of two cases

Two cases of laparoscopic remnant cholecystectomy using near-infrared fluorescence cholangiography (NIFC) for remnant gallbladder calculi following subtotal-cholecystectomy are reported. Case 1: a 36-year-old woman was referred to our hospital with acute abdomen. Computed tomography showed remnant gallbladder calculi, with detected no other findings as the cause of the abdominal pain. For intraoperative exploration of the biliary anatomy, 0.25 mg/kg of indocyanine green (ICG) was administered intravenously the day before the operation. NIFC clearly showed the common bile duct and enabled safe laparoscopic remnant cholecystectomy. She was free from symptoms after the operation. Case 2: a 40-year-old woman was referred to our hospital with epigastralgia due to remnant gallbladder calculi after open cholecystectomy. ICG was administered intravenously the day before the operation. Severe adhesions were observed in the upper abdominal cavity and there was tight adherence of the duodenum to the remnant gallbladder. NIFC showed a clear margin that appeared to be the margin between the duodenum and remnant gallbladder. However, dissection of the margin observed by NIFC caused perforation of the duodenum. The clear margin seen with NIFC was likely due to visualization of the gallbladder through the duodenum. Although NIFC is a useful modality for confirming the intraoperative biliary anatomy, it is important not to rely too heavily on NIFC alone, which may lead to misinterpretation of the anatomy.

FACTORS ASSOCIATED WITH THE GALL-BLADDER CALCULUS AT TERTIARY HEALTH CARE CENTER: A CROSS SECTIONAL RESEARCH FROM CENTRAL INDIA

Background: Gall-calculus disease is a chronic recurring hepatobiliary illness characterised by the production of gall-calculus in the hepatic bile duct, common bile duct, or gall-bladder as a result of poor cholesterol, bilirubin, and bile acid metabolism. Aims &amp; objectives: Present research was aimed to research factors associated with the Gall calculus at tertiary health care center. Material and Methods: Present research was a hospital based, prospective, observational research, conducted in subjects attending the outpatient department or emergency department, with confirmed diagnosis of gall calculus disease. Results: During research period, 328 cases were studied with confirmed diagnosis of gall-calculus. Majority of subjects were from age group 51-60 years (31.1 %) followed by age group 41-50 years (26.8 %). Females (65.9 %) outnumbered males (34.15 %), male to female ratio was 1:2. Diabetes mellitus (35.4 %), gastro-esophageal reflux disease (34.15 %), hypertension (27.44 %), ischemic heart disease (20.12 %) and renal calculus (10.4 %) were common comorbidities noted among subjects with gall calculus disease. Common clinical symptoms noted among subjects with gall calculus disease were right hypochondrial pain (74.4 %), nausea (49.4 %), epigastric pain (47 %), vomiting (35.4 %) and jaundice (9.15 %). USG findings in majority of subjects multiple calculus (47 %), other findings were two to three calculus (19.5 %), biliary sludge (18.90 %), single calculus (12.80 %), choledocholithiasis (2.44 %) and carcinoma gall bladder (1.22 %). Sedentary lifestyle (67.1 %), female gender (65.9 %), obesity (BMI &gt; 25 kg/m2) (57.93 %), age &gt; 50 years (40.9 %), family history (38.41 %) was common risk factors noted in subjects with gall calculus disease. Less common risk factors were parity ? 3 (29.27 %), h/o rapid weight loss due to fasting, illness (27.44 %), alcohol drinking (23.17 %), smoking (20.73 %) and drugs like ceftriaxone, octreotide and thiazide diuretics. (6.10 %). Conclusion: Sedentary lifestyle, female gender, obesity (BMI &gt; 25 kg/m2), age &gt; 50 years, family history were common risk factors noted in subjects with gall calculus disease. Keywords: gall-bladder calculus, sedentary lifestyle, female gender, obesity

S3474 Symptomatic Cholelithiasis in the Setting of Porcelain Gallbladder and SARS-CoV-2 (COVID-19) Infection

Introduction: Porcelain gallbladder, a rare entity with female preponderance, is a manifestation of chronic inflammation of the gallbladder. It is an incidental finding characterized by calcification of the gallbladder wall on imaging studies. The affinity of SARS-CoV-2 for angiotensin converting enzyme 2 (ACE2) which is widely expressed in the lungs, heart, intestines, gallbladder, kidneys, and adipose tissue may account for its ability to accentuate indolent inflammation in the gastrointestinal tract. Case Description/Methods: 56 year old African American female with medical history of gastroesophageal reflux disease, obesity and hypertension presented with a 3 day history of fever, shortness of breath, cough and sudden onset intermittent, burning epigastric and right upper quadrant (RUQ) pain with no aggravating or relieving factors. Vital signs at presentation; Temperature 100.8 F, Respiratory rate 20 breaths/ minute, pulse of 89beats/min, oxygen saturation 97% on room air and blood pressure 147/105mmHg. Physical examination findings were reduced air entry at the lower lung zones bilaterally and moderate epigastric and RUQ tenderness. She was positive for SARS-CoV-2 RNA. Chest X-ray showed large bilateral lower lobe atelectasis and increased interstitial process in the lower lung fields. She was admitted for COVID pneumonia. On admission day 1 patient continued to complain of RUQ pain, warranting RUQ ultrasound scan which showed prominent gallbladder calculus with posterior shadowing, likely porcelain gallbladder in the setting of existing gallstones. Patient was managed with vitamins, ceftriaxone, azithromycin, remdesivir, famotidine and tylenol for pain. Abdominal pain improved and she was discharged home on day 3 of hospitalization for outpatient follow up. Discussion: Our patient presented with symptomatic cholelithiasis, in the setting of COVID infection and porcelain gallbladder. We believe this finding bolsters the assertion that COVID infection accentuates gallbladder inflammation which consequently leads to precipitation/ worsening of symptoms of underlying chronic gall bladder disease. In light of the aforementioned, we believe the diagnostic challenge is the ability to make a clear distinction between de novo inflammation of the gallbladder and accentuation of an ongoing chronic inflammatory process. Given that there is a risk of porcelain gallbladder progressing to gallbladder cancer, should routine surveillance be performed in this population of patients?

Gall Bladder Calculus in reproductive age group females attending the ultrasound clinic at a tertiary care hospital: A comparative Cross-sectional study

Background: Pregnant females are at risk for cholelithiasis' progress, and the obstruction in the bile duct produced by gallstones is responsible for jaundice and abdominal pain. Objective: The objectives of the present study were to see the burden of gall stones, relation with parity, and trimester among reproductive age group females. Methodology: A cross-sectional study was conducted on 467 females of age between 15 to 45 years. The gall bladder was thoroughly examined by an ultrasound probe of frequency 2-5 MHz in all planes. Results: In most females who had gallstones, single (68.8 percent) gall stone was common as compared to multiple (31.2 percent). More nonpregnant women had gall bladder stones than pregnant women (p-value &lt;0.005). Among the current nonpregnant group, the percentage of presence of gallbladder stones was greater in the female having parity of two or more (27.4 percent) than the females having parity of less than two (8.2 percent) with p-value &lt;0.05. Conclusion: Since Gallstones can further complicate the situation in the form of gallbladder carcinoma, and females with higher parity have more chances of developing gallstones. Therefore, it becomes necessary to know the trimester of gallstone formation and its role in the progression of symptoms.