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Gallbladder–Biliary Dyskinesia/ Functional Gallbladder Disorder/Cystic Duct Syndrome
Published in Charles Theisler, Adjuvant Medical Care, 2023
The gallbladder is a four-inch long, pear-shaped organ under the liver on the right side of the upper abdomen that stores bile from the liver, which digests fats. Biliary dyskinesia, where bile does not drain out of the gallbladder properly, is an increasingly common functional disease of the gallbladder. Patients with this condition present with gallbladder (biliary-type) pain, but show no evidence of gallstones in the gallbladder. In classic biliary colic, or a gallbladder attack, the pain is identical to a symptomatic gallstone. (See Gallstone Disease below.) Attacks are often brought on by a heavy or fatty meal.
An overweight patient with epigastric pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Biliary colic is caused by the gall bladder contracting under the influence of cholecystokinin (exacerbated by fatty food), forcing a stone into the gall bladder outlet/cystic duct. This produces pain, which may be described as deep and sometimes sharp. As the gall bladder relaxes, the stone falls back from the cystic duct. This leads to cyclical waves of pain, hence the term colic.
Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Treatment of symptomatic cholelithiasis, otherwise known as biliary colic, can be controversial. Many people recommend nonoperative treatment for biliary colic. However, as shown in their review of the disease, Steinbrook et al. reported recurrence of symptomatic gallstones in 92% of women managed nonoperatively in their first trimester, 64% in their second, and 44% in their third (13,41). A 57% symptom recurrence during pregnancy and a 23% complication rate of acute cholecystitis and gallstone pancreatitis are reported (13,42).
Same day endoscopic retrograde cholangio-pancreatography immediately after endoscopic ultrasound for choledocholithiasis is feasible, safe and cost-effective
Published in Scandinavian Journal of Gastroenterology, 2021
Wisam Sbeit, Anas Kadah, Amir Shahin, Tawfik Khoury
Overall, 106 patients were included during the study period, among them, 61 patients (57.5%) underwent EUS with confirmed choledocholithiasis followed by consequent same day-same session ERCP with definite stone extraction (group A), as compared to 45 patients (42.5%) who had separate sessions EUS and ERCP (group B). The average age in group A was 66.1 ± 20.7 years vs. 65.8 ± 19.3 years in group B (p = .47). Twenty-one patients (34.4%) in group A were males as compared to 20 patients (44.4%) in group B (p = .15). Biliary colic with elevated cholestatic liver enzymes was the most common clinical presentation in both groups A and B (38 patients [62.3%] and 25 patients, [55.6%], respectively, p = .24). Moreover, there was no difference in medical history between the two groups. Table 1 demonstrates the baseline characteristics of the study cohort.
Development of elexacaftor – tezacaftor – ivacaftor: Highly effective CFTR modulation for the majority of people with Cystic Fibrosis
Published in Expert Review of Respiratory Medicine, 2021
Peter G Middleton, Jennifer L. Taylor-Cousar
With the uptake of elexacaftor–tezacaftor–ivacaftor around the world, case reports and case series of different rare side effects are now being reported. Already there are reports of testicular pain as a transient side effect within a few days of commencement of elexacaftor–tezacaftor–ivacaftor [41]. Furthermore, recently a case series was reported of seven individuals who developed biliary colic within 4 weeks of commencing elexacaftor – tezacaftor – ivacaftor, including five cases who deteriorated within 3 days of commencing therapy [42]. Six of the cases proceeded to cholecystectomy and all individuals continued with the elexacaftor–tezacaftor–ivacaftor [42]. Rare side effects of the tezacaftor–ivacaftor combination when given in conjunction with azithromycin have also been described [43], so vigilance will be needed in the long term with the triple combination and the possibility of drug interactions. While pregnancy in the presence of early single and dual modulator therapy appears safe to date [44], the experience with elexacaftor-tezacaftor–ivacaftor during pregnancy or lactation is small. Early reports are now showing increased pregnancies in women with CF likely relating to improvements in cervical mucous pH and viscosity, lung function, and nutrition [45]. Treating younger and younger children with CF may increase the likelihood of lens opacities or other as yet unknown effects on growth and development.
Incidental metastases and lymphoma of the gallbladder – an analysis of ten rare cases identified from a large national database
Published in Scandinavian Journal of Gastroenterology, 2019
Carolina Muszynska, Linda Lundgren, Roland Andersson, Torunn Søland, Gert Lindell, Per Sandström, Bodil Andersson
The largest case series with metastasis to the gallbladder (n = 20) found most cases originated from the stomach (n = 8) [3]. Four patients were presented with cholecystitis, only one patient had gallstones and no one was presented with biliary colic. In our study, only one case originated from the stomach, and in nine cases the indication for surgery was either biliary colic or cholecystitis. The overall median survival was 8.7 months compared to 5.8 months in our study. Another retrospective study described 18 cases of lymphoma involvement of the gallbladder [9], but most of the other studies are one-case studies and reviews of the literature [2,5,10–13].