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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The gallbladder does have features of cholecystitis; however, the most accurate diagnosis is Mirizzi syndrome because this also explains the underlying cause. A gallbladder polyp will be within the gallbladder rather than in the ducts and will not demonstrate posterior acoustic shadowing. Adenomyomatosis is suspected when there are small hyperechoic foci in a frequently thickened gallbladder wall. A choledochocele does not match the description in this case, it is instead a focal dilatation of the intramural segment of the distal common bile duct within the duodenal wall.
Neonatal and General paediatric Surgery
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Type III: miscellaneous: diverticulum of common bile duct.intraduodenal choledochocele.intrahepatic dilatation alone (Caroli).
Choledochal cyst
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Riccardo A Superina, Niramol Tantemsapya
Choledochal cyst type III choledochocele is rare, representing only 1.4% of choledochal cysts, and associated with non-specific symptoms varying from asymptomatic to severe pancreatitis. It is usually intraduodenal, but occasionally it is intrapancreatic. The aetiology of choledochocele is thought to be different from other forms of choledochal cyst; it is a simple diverticulum occurring between the ampullary and common bile duct components of the sphincter or a congenital duodenal duplication that arises in the region since its lining is most commonly the duodenal mucosa. The condition should be differentiated from other more common cystic lesions within the area such as duodenal duplication, pancreatic cyst, renal cyst and retroperitoneal teratoma.
Differences in Neuregulin 4 Expression in Children: Effects of Fat Depots and Obese Status
Published in Endocrine Research, 2020
Ran Wang, Wei Zhou, Xiaolei Zhu, Nan Zhou, Fan Yang, Bin Sun, Xiaonan Li
A total of 58 children were recruited from Nanjing Children’s Hospital from July 2015 to September 2016. Paired SC and OM adipose tissue biopsies were obtained during elective abdominal surgery. All samples were taken in the same area of the abdomen and at a safe distance from the appendix. Eight of the children had reconstructive surgery due to various malformations of the digestive tract: Hirschsprung’s disease (4 children), choledochocele (3 children), and Meckel’s diverticulum (1 child). Eighteen of the children had intussusception. An additional 32 underwent surgery based on the suspicion of appendicitis. None of the individuals had diabetes, a family history of diabetes or severe systemic illness. The average weather temperature at operation day was recorded. The characteristics of study subjects are shown in Table 1.
Imaging in pancreatitis: current status and recent advances
Published in Expert Opinion on Orphan Drugs, 2018
Itegbemie Obaitan, Umar Hayat, Hiba Hashmi, Guru Trikudanathan
Endoscopic ultrasound(EUS) involves using an echoendoscope which generates high-frequency sound waves and is passed through the stomach and duodenum, to evaluate pancreatic parenchyma and ductal system. When compared to USG, EUS has closer proximity to the pancreas and non-interference of the intestinal gases with image acquisition. EUS is not generally needed for the diagnosis of acute pancreatitis (AP). If performed at the time of diagnosis, pancreas appears diffusely hypoechoic from pancreatic edema. Less common findings include pancreatic enlargement and peripancreatic fluid collection [28]. Although imaging with CT and MRI is more relevant in assessing severity of pancreatitis, few studies have explored the role of EUS in severity of AP. One study concluded that a geographic hyperechoic area with the pancreas was an adverse clinical predictor of severity [29]. However increasingly, it has emerged as a reliable modality for the diagnostic evaluation of patients with idiopathic acute pancreatitis since studies have suggested that gallbladder microlithiasis or sludge can explain cases of idiopathic pancreatitis in up to 75% of the patients [2]. Additionally, congenital anomalies such as annular pancreas, choledochocele, anomalous pancreato-biliary junction and pancreatic divisum can be diagnosed using EUS. It is additionally valuable in detecting undiagnosed chronic pancreatitis in patients with idiopathic recurrent attacks of pancreatitis. A recent prospective study evaluating use of EUS in patients with acute idiopathic pancreatitis revealed a diagnosis in 46% of the cases who had a single episode and 85% of the cases with multiple episodes [30]. In a recent systematic review of 13 studies, EUS identified additional diagnostic information in 61% of patients with IAP, with 41% having biliary tract disease [31]. Currently there is a slight debate regarding the initial work-up after an idiopathic episode of pancreatitis [32]. EUS is superior to MRCP in excluding the presence of small (<5mm) gallstones but MRCP is less invasive, less operator-dependent and probably more widely available than EUS [2]. In a recent prospective study to compare the results of EUS and MRCP to diagnose etiology for idiopathic pancreatitis, the diagnostic yield of EUS was higher than MRCP (29 vs. 10.5%). EUS was more accurate in identifying biliary etiology whereas MRCP identified pancreatic duct abnormalities, such as intraductal papillary mucinous neoplasm of the pancreas or chronic pancreatitis. The combination of EUS and MRCP revealed 50% of etiologies and was successful in reducing recurrent attacks in two-third of patients [33]. Thus, EUS should be considered as the first strategy towards the etiological evaluation of IAP irrespective of presence of gallbladder and secretin-stimulated MRCP should be considered as a complimentary tool rather than competitive [32].