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Results for “CHOLELITHIASIS”

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PubMed1979

Cholelithiasis in children with sickle cell disease.

A group of 47 children with homozygous sickle cell disease ranging in age from 2 to 18 years was studied for the prevalence of gallstones. All of these patients had oral cholecystogram and cholecystosonogram. Eight of the 47 patients (17%) had gallstones both on oral cholecystography and on cholecystosonography. These eight patients had a history of recurrent abdominal pain usually localized to the right upper quadrant. All were admitted on several occasions for sickle cell abdominal crises and four of these were admitted for acute hepatic crisis. These patients have undergone elective cholecystectomy and gallstones were found in every patient. The patients have been followed up from seven to 17 months after cholecystectomy and none have had abdominal symptoms or required hospitalization for abdominal crises.

Adolescent↗
PubMed2003

A rational approach to cholelithiasis in bariatric surgery: its application to the laparoscopically placed adjustable gastric band.

BACKGROUND: Gallstones are more common in the obese population and may be formed during rapid weight loss. A rational approach to the management of the gallbladder should be incorporated into bariatric surgical practice. It has been recommended that patients undergoing Roux-en-Y gastric bypass have routine cholecystectomy regardless of gallstone status. We analyzed the outcomes of a noninterventionist policy on 1000 patients undergoing laparoscopic adjustable gastric banding. HYPOTHESIS: Patients scheduled for adjustable gastric banding should undergo investigation for and treatment of gallbladder disease regardless of symptoms. METHODS: Patients were screened preoperatively for symptoms of gallstones. Ultrasound examination was performed only in those with symptoms and, if stones were present, cholecystectomy was performed with gastric banding. The remaining patients were followed up clinically and outcomes were noted. RESULTS: A total of 1000 patients were followed up for 12 to 96 months, a total of approximately 3500 patient-years. Cholecystectomy was performed in 181 patients before and 10 at gastric banding surgery. Of the 809 patients at risk, 55 (6.8%) presented with symptomatic disease during follow-up and proceeded to undergo elective cholecystectomy without complications from the disease or the treatment. CONCLUSIONS: The incidence of cholecystectomy after gastric banding surgery was not different from the expected rate for a nonsurgical obese population. In contrast, after Roux-en-Y gastric bypass, a median of 40% of patients form stones in the postoperative period, and prophylactic cholecystectomy may be justified. Our data indicate that a noninterventionist approach to the gallbladder is appropriate for patients undergoing adjustable gastric banding surgery.

Anastomosis, Roux-en-Y↗
PubMed1997

Ultrastructural aspects of human gallbladder epithelial cells in cholelithiasis: production of anionic mucus.

The surface epithelium of 28 gallbladders removed during elective cholecystectomies and pathology collection was studied ultrastructurally. Focusing on 10 of the 28 cases that were diagnosed as cholecystitis, we found that the epithelium displayed numerous apical mucous granules and bulging apical apices. Mucous granule changes included 1) hyperproduction of secretory granules of neutral type containing an electron-dense proteinaceous spherule, similar to that described in other mucus-producing glands of the digestive system, and 2) production of anionic, osmiophilic secretory mucus. Other alterations of the surface epithelial cells included the production of bizarre surface appendages resembling primitive cilia without axoneme and epithelial excrescences.

Adult↗
PubMed1997

Cholelithiasis induced in the Syrian hamster: evidence for an intramucinous nucleating process and down regulation of cholesterol 7 alpha-hydroxylase (CYP7) gene by medroxyprogesterone.

This report reviews previously published studies from our laboratory and shows some recent morphological data obtained with scanning and transmission electron microscopy regarding gallstone formation and alteration of the gallbladder epithelium in the Syrian hamster model. Both male and female hamsters were treated with female sex steroids (estradiol alone, estradiol and medroxyprogesterone, medroxyprogesterone alone) during one month. The results show that the Syrian hamster is a good model to study bile changes, gallbladder structure changes, including gallstone formation, and the regulation of cholesterol metabolism at the molecular level. Arguments in favor of this animal model are presented and, during gallstone formation, epithelial cell changes, anionic mucus secretion, and formation of gallbladder luminal deposits can be demonstrated. Recent molecular biology observations related to the effect of female sex steroids on liver cholesterol 7 alpha-hydroxylase (CYP7) gene suggest that progestin alone or primed by estrogen down regulates CYP7 transcription and activity. In addition, progesterone in cell culture systems has been shown to enhance intracellular accumulation of free cholesterol by increasing its uptake and synthesis and by decreasing its esterification by inhibiting the activity of acylcoenzyme A: cholesterol acyltransferase. Non-esterified cholesterol is free to migrate to the extracellular spaces and may contribute to nucleation within the bile. It is suggested that these effects of progesterone on cholesterol metabolism combined with the CYP7 gene down regulation, physical changes in the mucus and the hypomotility of the gallbladder and biliary ducts result in hypersaturation of cholesterol in the bile which favors gallstone formation.

Acyl Coenzyme A↗
PubMed1978

Cholelithiasis and cholecystitis in pre-Columbian Chileans.

Two cases of gallbladder disease found in Chilean mummies are presented. The cholesterol gallstones in these cases produced in one individual a localized peritonitis and in the other a probable duct obstruction. No cases of this disease have been seen in Peruvian mummies while in Chile it seems quite common, suggesting some environmental factor in the etiology.

Chile↗