Incidence Of Cholelithiasis Research Articles

Cholecystectomy in the elderly

A series of 347 elderly patients undergoing cholecystectomy has been presented. The older a patient is at the time of cholecystectomy, the more likely it is for that patient to present with an acute biliary complication. The elderly tolerate biliary tract operations quite well, especially before acute complications of cholelithiasis occur. Early cholecystectomy can prevent the morbidity associated with the natural progression of cholelithiasis. Whether prophylactic cholecystectomy for asymptomatic cholelithiasis would be cost effective is an issue that can be resolved only when further data regarding the natural history and incidence of cholelithiasis in the elderly is known.

Cholecystitis and Cholelithiasis

Cholelithiasis and cholecystitis, with their complications, remain major health problems in the United States. At this time, cholecystectomy is the treatment of choice for all patients with symptomatic gallstones and those with acute cholecystitis, except those who are too ill to undergo surgery. Present therapeutic options may be summarized as follows: Asymptomatic patients and those with flatulence and dyspepsia who have gallstones should be observed. Those who have symptoms of biliary pain, gallstone-induced pancreatitis, or common duct stones should have corrective surgery. Those who refuse surgery or who aren't surgical candidates might be treated with dissolution therapy. Dissolution of gallstones with chemical agents and extracorporeal shock-wave lithotripsy show some promise. We need a better understanding of the etiology and formation of gallstones to address the disease from a preventive standpoint and reduce the incidence of cholelithiasis and cholecystitis, and their complications.

Ultrasound diagnosis of liver and biliary tract diseases

In recent years, there has been an increase in the incidence of cholelithiasis.

Cholecystectomy in cirrhotic patients.

Cholecystectomy is the most common intraperitoneal operation done by general surgeons in this country and is generally considered safe. The incidence of cholelithiasis is doubled among cirrhotic patients, and biliary surgery in such patients carries tremendous risk, primarily due to excessive intraoperative hemorrhage. One author has reported a mortality of 83% among patients with severe cirrhosis having cholecystectomy. In this report, we review seven consecutive cirrhotic subjects having biliary surgery. There were no deaths. Blood loss roughly correlated with preoperative prothrombin times. Blood transfusions were required in five patients. Factors believed to improve operative outcome are discussed.

The changing aspects of cholelithiasis in children through a sonographic study

Ultrasonography has made the study of the biliary tract easier. This may account for an apparent increase in the incidence of cholelithiasis in children. Twenty-nine cases of biliary stones, mostly gallstones, were seen in a 3 year period. More than half of the cases were secondary to a definite cause, among which the interruption of the enterohepatic circulation of bile salts should be emphasized. The etiological factors of biliary stones and biliary sludge appeared identical in our material.

Incidence of cholelithiasis in sickle cell anemia using the ultrasonic gray-scale technique

Gray-scale ultrasound examination of the gallbladder was successfully performed in 226 patients with sickle cell hemoglobinopathy from 2 to 18 years of age. Sixty-three (27%) demonstrated the presence of gallstones; 14 additional patients had "sludge." The incidence of gallstones increased significantly with age, from 12% in the 2- to 4-year age group to 42% in the 15- to 18-year-old group. The proportion of females with gallstones increased significantly in adolescence. Patients with gallstones had higher mean bilirubin levels, but their mean hemoglobin values and reticulocyte counts were not significantly different from those in patients without gallstones. Ultrasound examination of the gallbladder is a simple, noninvasive technique for evaluating the biliary system. The incidence of gallstones in patients below the age of 10 is higher than expected and raises management questions that must be resolved.

Treatment of Cholelithiasis in Patients With Sickle Cell Anemia

The incidence of cholelithiasis and surgical risk of cholecystectomy in patients with sickle cell anemia is reviewed. Records of all patients with sickle cell disease currently attending the Medical University of South Carolina Hematology Clinic were reviewed. An oral cholecystogram has been part of the initial evaluation for the past year. The records of 16 patients having cholecystectomy from 1968 to 1977 were reviewed with regard to diagnostic studies, preoperative preparation, morbidity, and mortality. When the status of the gallbladder is known, the incidence of cholelithiasis is 67%. The morbidity of elective cholecystectomy was high (37%); there was one death. Cholecystectomy is not recommended for the discovery of asymptomatic gallstones because of the relatively poor surgical risk and short life expectancy of these patients.

Relationship of obesity to bile lithogenicity in man.

Gallbladder bile was aspirated and analyzed for content of bile salts, cholesterol, and phospholipids in 97 patients undergoing jejunoileal bypass. Lithogenic indices (LI) (mole % cholesterol in sample/mole % cholesterol at saturation) were correlated with age, sex, lipid levels and hepatic fatty metamorphosis. The overall incidence of gallstones in the group was 43%(N = 121). Cholelithogenesis was unrelated to age, serum lipid concentrations, LI, or hepatic morphology. A significant relationship was noted between cholelithogenesis and female sex (p less than .03). The incidence of gallstones was greater in patients weighing more than 270% of ideal body weight and the LI greater in those weighing more than 230%. The mean LI of bile was greater than 1.0 (supersaturated) in all patients except nongallstone forming diabetics. The lithogenic index in diabetics without gallstones was 0.88 +/- 0.11, while in nondiabetics without gallstones, the LI was 1.49 +/- 0.10 (p less than 0.001). These observations indicate that grossly obese patients have an increased incidence of cholelithiasis, probably related to supersaturation of bile with cholesterol. In addition, female patients are especially at risk, while other parameters had little or no detectable influence on cholelithogenesis in this group of patients.

Bile lipid composition and bile acid pool size in diabetes.

Since the prevalence of gallstones is higher in diabetics than in controls and since cholelithiasis is often associated with supersaturated bile, we measured bile lipid composition and bile acid pool size in 8 patients with juvenile diabetes, 16 with maturity-onset diabetes, and 10 control subjects. Bile lipid composition was expressed as "saturation index." In the maturity-onset diabetics the saturation index (1.60 +/- 0.45 SDM) was significantly higher (P less than 0.005) than that in the controls (0.82 +/- 0.20) and in patients with juvenile diabetes (0.75 +/- 0.24). The absolute values for biliary bile acid concentration were significantly lower (P less than 0.01) in the maturity-onset diabetics than in the other two groups. There were no differences in either the proportion of the individual biliary bile acids or the size of the bile acid pool between the three groups. The results suggest that the incidence of cholelithiasis in diabetes is associated with the secretion of a supersaturated bile only in the maturity-onset subgroup.

Alterations in gallstone solubility following distal ileal resection.

Resection of the distal 30% of the small intestine in dogs caused a decreased gallstone dissolution rate and phospholipid/ cholesterol (P/C) ratio when compared to that of the controls. This effect was not seen in animals with 10% distal ileal resection or those fed cholestyramine resin, which binds bile salts in the intestine. The incidence of cholelithiasis in a survey of 52 patients with regional ileitis or distal ileal resection was 26.8%. This is greater than twice the incidence (11%) found in a comparison group of 75 patients. The mechanism of the association of cholelithiasis with regional ileitis or distal ileal resection is most likely the result of the formation of lithogenic bile due either to the decreased P/C ratio or an increase in the glycine/taurine ratio.

The incidence of cholelithiasis in sickle cell disease.

THE INCIDENCE OF CHOLELITHIASIS IN SICKLE CELL DISEASEJERRY C. PHILLIPS, M.D. and BARRY E. GERALD, M.D.Audio Available | Share

CHOLELITHIASIS IN THE ÆTIOLOGY OF GALLBLADDER NEOPLASMS

A study of all newly diagnosed patients with gallbladder and biliary tract cancer in Israel during a five-year period indicates that cholelithiasis plays a major part in the ætiology of gallbladder cancer. This conclusion is based on the following findings: (a) high frequency of gallstones in gallbladder cancer cases compared with biliary tract cancer and the general population; (b) similar frequency of gallstones in gallbladder cancer in both sexes and in all ethnic groups; (c) similar sex and ethnic population trends in the incidence of cholelithiasis and of gallbladder cancer.

Cholelithiasis in Thalassemia Major

Abstract In a study of patients with thalassemia major by oral cholecystography, the incidence of cholelithiasis is determined. Six of 26 patients aged ten years and older have biliary calculi; in addition, gallstones have been demonstrated during life or at autopsy in 7 of 35 who have died. The association of gallstones with thalassemia, less frequent than in hereditary spherocytosis, has the same degree of magnitude as the relationship in sickle-cell anemia. The authors formulate an explanation for these different frequencies of stone formation in hemolytic disease.

Study of <i>Helicobacter hepaticus</i> in gallbladders with cholelithiasis and its sensitivity pattern

Cholelithiasis is one of the most common digestive surgical disorders. The natural history of gallstone development is unknown. Bacteria are found in high concentration in bile and stone. It is difficult to ascertain whether bacterial infection of the bile arose before stone formation or vice versa. Prospective study was carried out in 30 cholecystectomy specimens of patients with cholelithiasis collected from 15th January 2005 to 24th July 2005 in Department of Pathology, Kathmandu Medical College Teaching Hospital. The samples were collected in a sterile vial containing 0.5% saline. A small piece of gallbladder was taken in Blood agar and Chocolate agar media for micro anaerobic culture at 370 degrees Celsius. The growth of the organism was observed after 48 hours of incubation. Gram stain and various biochemical tests were performed for the confirmation of Helicobacter hepaticus and its sensitivity pattern was studied. Histologically Helicobacter hepaticus was demonstrated in formalin fixed tissue sections using Warthin Starry Silver stain. A total of 76.66% cases showed growth positivity. Nitrofurantoin was found to be the most sensitive drug (95.7%) for Helicobacter hepaticus followed by Ciprofloxacin (91.3%), Cephalaxin (91.3%), Certriaxone (91.3%),Ofloxacin (82.6%), Amikacin (65.2%) and Norfloxacin (60.9%). Helicobacter hepaticus was least sensitive to Amoxycillin (57%). From this study, it is quite apparent that Helicobacter hepaticus infection is commonly associated (76.66%) with cholelithiasis. If the patients are treated with the sensitive antibiotics regularly and the infection, that is the number one cause for the precipitation of bile leading to the formation of gallstones, can be controlled, the incidence of cholelithiasis can be reduced so that the health care expenditure related to gallbladder disease can be reduced markedly.

Relapsing pancreatitis secondary to choledocholithiasis.

The early report by Darling,⁸followed by the extensive studies of Gambill, Comfort, and Baggenstoss,* has, in the past decade, stimulated an increasing interest in the problem of relapsing pancreatitis, an interest necessitated by the inherent difficulties in treatment. Several of the earlier reports indicated that relapsing pancreatitis, in contradistinction to simple acute pancreatitis, was not characteristically associated with cholelithiasis. This experience led to the hypothesis that relapsing pancreatitis might be a primary disease of the pancreas, with biliary concretions playing a rather unimportant role in etiology. More recent studies of a large series of patients reveal that the incidence of cholelithiasis is essentially the same in relapsing pancreatitis as in simple acute pancreatitis.¹⁸Of real importance is the observation that the results of treatment are distinctly better in those patients with biliary-tract disease than in those without. Most authors advocate thorough exploration of the biliary tree with

Acute stoneless cholecystitis.

Most gall bladders surgically removed contain stones. The incidence of cholelithiasis in published cholecystectomy series ranges from 75% to 100%, with an average for the aggregate of 92.5%.¹Only occasionally has stonefree cholecystitis been considered separately.* However, acute inflammation, and even gangrene, of the gall bladder can occur in the absence of calculi. The pathogenesis of this form of cholecystitis is often obscure, since acute cholecystitis is generally attributed to blockage of the cystic duct by a gallstone. The present study was undertaken in a search for clues to the etiology of acute stoneless cholecystitis and to emphasize certain features apparently peculiar to this form of gall-bladder disease. The impression gained is not in accord with the oft-quoted statement that "cholecystitis without stones seems to belong to a region on the borderline between functional and organic disease."² <h3>MATERIAL</h3> A total of 542 cholecystectomies were performed during the five

Comparative incidence of choletithiasis in the Negro and white races; a study of 6185 autopsies.

According to the latest census (1950), the population of Jefferson County, Ala., which includes the city of Birmingham, is 558,928. There are basically two racial groups represented, namely, a white segment (59.1%), predominantly of European origin, and a Negro segment (40.9%), of African origin. (The state of Alabama as a whole shows a ratio of 61.8% whites to 38.2% Negroes.) In order to evaluate the health problems of this area properly it is important to delineate the disease patterns of these two races. As a part of this larger project we undertook to investigate the over-all incidence of cholelithiasis in Alabama and, more specifically, to establish the comparative incidence of this disease in the two races. MATERIAL The material for this study was obtained from the routine autopsy service of five Alabama hospitals, four of them in Jefferson County. Three of these four, namely, St. Vincent's, Lloyd Noland, and the

Management of remaining common duct stones by various solvents and biliary flush regimen.

THE PROBLEM of the remaining common duct stones attains considerable significance when one is confronted with the necessity of advising another operation to a patient who has just undergone a recent major surgical procedure. An alternative nonoperative program that offers equal or better results is therefore highly desirable, particularly when one considers the increased morbidity and mortality rates associated with secondary operations on the biliary tract. The purpose of this investigation was to develop a regimen with an effectiveness that would warrant its use in this all too frequent problem in which postoperative choledochograms demonstrate the presence of remaining common duct stones. This report concerns the investigation of 113 solutions tested for their solvent action on gall stones and the effect of the most efficient agents on ductal and liver tissue. An improved, simplified biliary flush regimen is also presented. The reports on the incidence of cholelithiasis in the general

Incidence of Gallbladder Disease in Chronic Hemolytic Anemia (Spherocytosis)

Summary 1.One hundred fifty-two cases of hereditary hemolytic anemia have been reviewed with reference to cholelithiasis. 2.Forty-three per cent of the patients studied had biliary disease. Twentysix per cent of the total series (not all were operated upon or had cholecystography) had biliary disease. Over 51 per cent of the patients over the age of 40 showed biliary abnormalities. 3.The incidence of cholelithiasis increased in these cases as the age advanced to 40, and was higher than the quoted figures for gallstones in the general population. 4.The incidence of gallbladder disease in hereditary spherocytosis may be expected to decrease with early treatment (splenectomy), with a resultant decrease in the hemolytic condition. 5.Probably another factor in the incidence of cholelithiasis is the degree of activity of the hemolytic process—the more hemolysis present, the greater the likelihood of gallstones. 6.Because of the increased incidence of cholelithiasis in this disease, cholecystography is indicated in every patient with hereditary spherocytosis. 7.Hemolytic anemia should be considered in any young person who develops cholelithiasis.

Cholecystography as an aid in determining gall bladder stasis in pregnancy

T HE greater incidence of cholelithiasis in women, is undoubtedly secondary to pregnancy. Courvoisier found cholelithiasis present in every fourth woman and in every twelfth man in 16,025 autopsies. Schroeder found gallstones in 20 per cent of all females and 4.4 per cent of all males autopsied. W. Mayo reports that 90 per cent of 3075 female gall-bladder patients had their first symptoms during pregnancy. Peterson in 1910 reviewed this subject and reported his observations based upon the examination of the gall bladders of women he operated upon for a gynecologic complaint. He found that pregnancy increased the incidence of gallstones about 10 per cent, and further determined that about one-third of the patients could report the onset of a biliary attack when the uterus reached the umbilicus, thus pressing upon the gall bladder and biliary ducts.14 Of all the possible factors in pregnancy which can be blamed in the etiology of gallstones, stasis is generally accepted as most significant. Practically all authorities agree that such a stasis is present but differ in explaining its origin. Prior to the last few years the general consensus of opinion was that this stasis resulted from mechanical pressure of the gravid uterus upon the gall bladder or its ducts. Cannon in his text upon mechanical factors in digestion demonstrated that an increased intraabdominal pressure would affect the gall bladder and ducts equally, thus eliminating itself as a factor in causing ,stasis. In 1922 Westphal I9 fluoroscoped gravid women in the ninth month of pregnancy when the uterus was highest and noted that quite frequently there was no direct pressure of the uterus upon the lower liver surface. In his experimental work he demonstrated an increased tone of the sphincter of Oddi and believed that in this way bile was dammed back into the biliary system. With the advent of cholecystography and with Boyden’s observations upon the emptying of gall bladders by fat meals,l there was afforded, for the first time, the opportunity of definitely observing the behavior of the human gall bladder and noting whether or not there was stasis present as compared to normal. It is of interest that recently Mann and HigginsI in animal experiments, using 40 per cent iodized oil, found that pregnancy consistently delayed the emptying time of the gall bladders and that balloons the size of the gravid