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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.
Cholecystectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
It is possible to have gallbladder disease without gallstones though this should only be considered after appropriate investigations. Two situations are worthy of note. Biliary dyskinesia, though controversial, is being increasingly recognized as a cause of epigastric or right upper quadrant abdominal pain, nausea, and/or vomiting. If a radioisotope gallbladder-emptying scan can show an abnormal ejection fraction of <35% (or better still <10%), then cholecystectomy may be considered. Still, up to 40% of those patients will not benefit from surgery.Acalculous cholecystitis in children arises in association with and is caused by severe sepsis, trauma, or burns. Ultrasound may show evidence of the inflammatory process, with mural edema and thickening, gallbladder distention, and occasionally sludge. It should be treated conservatively in the first instance though acute decompression with a cholecystostomy may be considered.
Intestinal Pharmacomanometry
Published in Fuad Lechin, Bertha van der Dijs, Neurochemistry and Clinical Disorders: Circuitry of Some Psychiatric and Psychosomatic Syndromes, 2020
Fuad Lechin, Bertha van der Dijs, Francisco Gomez, Marcel Lechin, Luis Arocha, Simon Villa
Irritable bowel syndrome—An unbalanced neurologic control of the gastrointestinal tract with dominance of a-adrenergic over the cholinergic activity was found in patients affected by nervous diarrhea (those lacking abdominal pain).1 On the contrary, the opposite DCM pattern was found among spastic colon patients.2 The DCM profile guided us in designing succesful treatments for both these phases of irritable bowel syndrome. α-Adrenergic agents were employed in nervous diarrhea patients while pharmacological manipulations tending to enhance the catecholaminergic system were employed to treat spastic colon patients. The latter treatment was also successfully used in patients suffering from biliary dyskinesia. Such patients showed a DCM pattern similar to that found in spastic colon.37
Changes in serum interleukin-6 levels as possible predictor of efficacy of tocilizumab treatment in rheumatoid arthritis
Published in Modern Rheumatology, 2018
Motohiko Aizu, Ichiro Mizushima, Satoshi Nakazaki, Akikatsu Nakashima, Takashi Kato, Takashi Murayama, Shinichi Kato, Yasuo Katsuki, Kunihiro Ogane, Hiroshi Fujii, Kazunori Yamada, Hideki Nomura, Akihiro Yachie, Masakazu Yamagishi, Mitsuhiro Kawano
Thirty-seven patients suffered adverse events. The most common was flulike symptoms in 20 patients (22.2%). The other common was skin rash in 6 patients (11.1%), herpes zoster in 4 (7.4%), foot ulcer and cellulitis in 3 each (5.6%), sinusitis and leukopenia in 2 each (3.7%), and septic arthritis, iliopsoas abscess, facial palsy, sudden deafness, severe liver injury, pneumonia, enteritis, and biliary dyskinesia in 1 each (1.9%). Seven patients required hospitalization because of these side effects. Two patients suffered from cellulitis, and one each from pneumonia, severe liver injury, iliopsoas abscess, enteritis, and biliary dyskinesia. Serum IL-6 elevation was observed in 5 of these 7 patients (cellulitis, pneumonia, severe liver injury, iliopsoas abscess, biliary dyskinesia). All patients recovered from these side effects and none died. The clinical courses of patients complicated with severe pneumonia and severe liver injury in whom serial serum IL-6 measurement was performed were shown in Figure 2.
Gallstones were associated with the gastrointestinal adverse events of cinacalcet in hemodialysis patients with secondary hyperparathyroidism
Published in Renal Failure, 2018
Keiichi Otsuka, Yoichi Ohno, Joji Oshima
The pathogenesis of gallstones in SHPT patients on HD is unclear. However, we suggest that the longer time on HD, hypercalcemia, hyperphosphatemia and elevated PTH level may be associated with the high prevalence of gallstones in the HD patients with advanced SHPT on cinacalcet. Besides, cinacalcet may frequently induce GI adverse events by biliary dyskinesia in the SHPT patients with gallstones. Therefore, we propose that SHPT patients should be screened for gallstones by ultrasonography before dosing cinacalcet to reduce the risk of GI adverse events.