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The Follow-Up Metabolic Medicine Hospital Consultation
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
The last category of PNALD involves the gallbladder and biliary tree. This condition appears to be related to a lack of normal entero-endocrine coordination and stimulation of gallbladder contraction by CCK. It can lead to gallbladder sludge and stones (Messing et al. 1983). Some authors have advocated the intermittent use of exogenous CCK for these patients (Messing et al. 1983).
Alimentary Tract Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ryan Lamm, Arturo J. Rios-Diaz, Priyadarshini Koduri, Francesco Palazzo
Imaging:Ultrasound is the most useful and sensitive test for detecting sludge and gallstones even as small as 2 mm [3, 19]. Classic sonographic findings suggestive of gallstones include acoustic shadowing of opacities in the gallbladder lumen that change with the patient's position. The false-negative and false-positive rates for ultrasound in gallstone patients are estimated at 2–4% [3].
Pseudolesions
Published in Jon W. Meilstrup, Imaging Atlas, 2018
Jon W. Meilstrup, Kenneth D. Hopper, Claudia J. Kasales
The two major components of sludge are calcium bilirubinate and cholesterol crystals,12 both in a matrix of mucus gel.13 The appearance of sludge is variable and related to its viscosity and composition. However, sludge generally layers in the dependent position, with less dense bile more anterior. Occasionally sludge can appear as a viscous mass, referred to as “tumefactive sludge”,14,15 which typically changes shape very slowly with different patient positions (Figure 7). Because focal gallbladder sludge typically has a “soft echogenic pattern” and no acoustic shadow, it may be difficult to differentiate from a mass. Repeat examinations may be necessary to demonstrate change in its position or shape.14 A relationship of sludge to the formation of stones has been postulated, but is still unproven. Sludge has rarely formed ball-like masses resembling stones.6 Milk-of-cal-cium bile may resemble sludge but is usually more echogenic5,16 or radiodense (Figure 8; Chapter 5, Figure 5B).
Prophylactic cholecystectomy in individuals with spinal cord injury: A systematic review
Published in The Journal of Spinal Cord Medicine, 2023
Fernanda Barros Viana, Júlia Barros Viana, Paulo Sérgio Seabra Beraldo
According to retrospective studies, the prevalence of gallstone disease in individuals with SCI is approximately 30%.4,19 Time since injury may affect the incidence of calculous disease of the biliary tract. One study5 compared the ultrasound of individuals with SCI within six months from the injury onset with able-body subjects. The results showed 19,2% with gallbladder sludge in the SCI group compared with none of the control group and 7,7% with gallstone compared with 3,85% of the control population. All the patients who developed gallstones had a post-injury duration longer than four months.5 In the general population, the prevalence of gallstones is 20%, according to more recent studies,7 and it tends to increase due to the obesity epidemic.
Emergency response plan for methane and chlorine with dispersion modelling using CAMEO
Published in International Journal of Occupational Safety and Ergonomics, 2022
Chinnakannu Jayakumar, Steffy Isac, D. M. Reddy Prasad
An emergency is a condition that is caused by an incident that can cause serious injury, loss of life or extensive damage to plants and property. Emergency conditions arise by powers that are either man-made or naturally occurring [14]. The wastewater is collected at the sewage treatment plant (STP) and transferred to a treatment facility where contaminants are reduced prior to discharge. There is a reduced risk to public health and the environment when these systems operate as intended. However, there may be increased risks in the event of an emergency, as hazardous and flammable gases are stored and used in the plant [15,16]. Domestic sewage contains various sludge. This is digested by a sludge digester, which produces methane (CH4), carbon dioxide (CO2), hydrogen sulphide (H2S), etc. The produced gases are stored in a gas holder. The composition of wastewater digester gas varies, though the primary constituents are methane and carbon dioxide. Trace amounts of nitrogen (N2), oxygen (O2), and hydrogen sulphide may also be present. While the gas compensation will fluctuate depending on temperatures and the process itself, the methane-rich gas (∼60–70% methane) becomes an attractive energy source. A major emergency is created due to the leakage of the stored gas. Since methane has the highest composition (60–75%) compared to all other gases, it is taken for further analysis.
Efficacy of endoscopic ultrasound after removal of common bile duct stone
Published in Scandinavian Journal of Gastroenterology, 2019
Yeon-Ji Kim, Woo Chul Chung, Ik Hyun Jo, Jaeyoung Kim, Seonhoo Kim
The presence of remnant biliary stone or sludge after ERCP could be the main cause of symptomatic CBD stone recurrence rather than de novo choledocholithiasis or stone from the gallbladder, because recurrence mostly occurs within the first 3 years and ERCP with fluoroscopy fails to completely remove biliary stone or sludge [12–14]. Moreover, a previous study showed that small biliary stone or sludge was impossible to be identified using ERCP with fluoroscopy [15]. The clinical significance of biliary sludge is similar to that of CBD stones, and biliary sludge seems to be an early stage of choledocholithiasis [16]. In this study, it was so small that ERCP procedure could not confirm to remove it, and we expected that remnant biliary sludge was naturally emitted through endoscopic sphincterotomy. It is noteworthy to mention that remnant biliary stone or sludge on EUS was detected in a considerable percentage of patients (36.9%) despite sufficient CBD stone removal by experienced endoscopists. Judging from this, another treatment modality is required. EUS is the most anticipated, reasonable test and is known to be reliable with high sensitivity and specificity (>94%) [8].