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Physiology of the Human Biliary System
Published in Wenguang Li, Biliary Tract and Gallbladder Biomechanical Modelling with Physiological and Clinical Elements, 2021
The acalculous biliary pain (ABP) or functional biliary pain or stoneless GB disease is defined as steady pain located in the epigastrium and right upper quadrant in the absence of gallstones or when other structural abnormalities exist in biliary tract (Delgado-Aros et al. 2003; Shaffer 2003). The frequency of acalculous biliary pain may be as high as 7.6% in men and 20.7% in women, or as low as 2.4% overall (Corazziazri et al. 1999). The issue of acalculous biliary pain has drawn attention since 1920s (Meyer 1921; Muller 1927; Stanton 1932; Graham and Mackey 1934; Brown 1938). Currently, acalculous biliary pain is an increasingly interesting topic in recent years because there exists difficulty to diagnose the acalculous biliary pain. As a result, several comprehensive reviews on this topic are available now (Canfield et al. 1998; Corazziazri et al. 1999; Shaffer 2003; Delgado-Aros et al. 2003; Rastogi et al. 2005). The major points are illustrated in the following sections.
Clinical Disease and Pathology
Published in Ronald Fayer, Lihua Xiao, Cryptosporidium and Cryptosporidiosis, 2007
Cirle Alcantara Warren, Richard L. Guerrant
The biliary tract has been a well-known site of cryptosporidial disease in patients with AIDS (Forbes et al., 1993; Lopez-Velez et al., 1995, Vakil et al., 1996; Chen and LaRusso, 2002), and rare cases have been reported in bone marrow and solid-organ transplant recipients and immunocompetent children (Campos et al., 2000; Goddard et al., 2000; Westrope and Acharya, 2001; Abdo et al., 2003; Dimicoli et al., 2003). Cryptosporidium is the most common cause of AIDS-cholangiopathy (Chen and LaRusso, 2002). Biliary involvement in AIDS patients is associated with low CD4 counts and increased mortality (Hashmey et al., 1997; Vakil et al., 1996). Radiographic imaging revealed dilation of ducts, thickening of gallbladder walls, and pericholecystic fluid collection (McCarty et al., 1989; Teixidor et al., 1991; Vakil et al., 1996). The clinical features usually include right upper quadrant abdominal pain, nausea, vomiting, and fever, accompanied by elevated serum alkaline phosphatase levels. Hepatobiliary disease can mimic pancreatic involvement (de Souza et al., 2004). However, involvement of the pancreas itself has been documented in autopsy cases (Godwin, 1991). Acute and chronic forms of pancreatitis have been described in cases presenting with severe abdominal pain, elevated serum amylase levels, abnormal radiologic findings, and endoscopic retrograde cholangiopancreatography revealing papillary stenosis (Calzetti et al., 1997).
Gastrointestinal tract and salivary glands
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Many patients present with epigastric/right upper quadrant pain. If gastric or duodenal pathology is suspected clinically (ulcer or malignancy) endoscopy is the first test. If thought more likely to be biliary in origin, the first test is normally ultrasound, followed if necessary by CT, MR/magnetic resonance cholangio-pancreatography (MRCP) or endoscopic retrograde cholangio-pancreatography (ERCP) as appropriate.
Environmental contaminants and preeclampsia: a systematic literature review
Published in Journal of Toxicology and Environmental Health, Part B, 2018
Emma M. Rosen, MG Isabel Muñoz, Thomas McElrath, David E. Cantonwine, Kelly K. Ferguson
The clinical definition and diagnosis of preeclampsia has changed relatively little in the last 60 years and is primarily characterized by new onset or worsening hypertension (blood pressure greater than or equal to 140 mm Hg systolic or 90 mm Hg diastolic). Prior to 2013, new-onset significant proteinuria at or after 20 weeks’ gestation (excretion of ≥300 mg of protein in urine during a 24-h urine collection, or protein/creatinine ratio ≥ 0.3) was required for diagnosis. However, the definition has expanded so that in combination with hypertension, any of the following (at or after 20 weeks’ gestation) are sufficient for diagnosis: new-onset thrombocytopenia (platelet count < 100,000/microliter), impaired liver function (abnormally elevated blood concentrations of liver enzymes and/or severe persistent right upper quadrant or epigastric pain), renal insufficiency (serum creatinine ≥ 1.1 mg/dl or a doubling of the serum creatinine concentration), pulmonary edema, or visual or cerebral disturbances (ACOG 2013).