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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Other investigations to consider include an abdominal radiograph which can show gallstones and gas in the gallbladder or biliary tree in severe disease. A CT scan of the abdomen is less helpful than an US scan but can demonstrate gallbladder inflammation and other differentials. An MRI scan of the abdomen is helpful in pregnant patients where a CT scan is not appropriate and views can be difficult on US scan. Cholescintigraphy involves the injection of dye that reveals gallbladder filling defects, helpful if after US scan the diagnosis is still unclear.
Liver and biliary system, pancreas and spleen
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
Nuclear medicine (NM) techniques are not often required in modern hepatobiliary investigation. NM dynamic assessment of the contractility of the gallbladder (cholescintigraphy) may be used to diagnose biliary dyskinesia, in which pain arises from the gallbladder in the absence of calculi due to disordered contractility, which will not be demonstrated on static imaging such as ultrasound or CT.
The pancreas
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Biliary type SOD should be considered and excluded in patients with the post-cholecystectomy syndrome. Pancreatic type SOD should be excluded in patients with recurrent acute pancreatitis of unexplained aetiology. The role of SOD in chronic pancreatitis is unclear. A careful history is essential. CT and MRCP can demonstrate dilatation of the biliary and pancreatic ducts. MRCP with intravenous secretin injection can particularly demonstrate pancreatic duct dilatation due to raised sphincter pressures. EUS may achieve the same end. Quantitative cholescintigraphy (HIDA scan) may demonstrate delayed biliary transit. The gold standard for diagnosing SOD is ERCP with manometry of the biliary and pancreatic sphincters, though many would say that this is not essential for diagnosis of type I SOD. ERCP with manometry is indicated if the pain disabling, noninvasive investigations have not shown structural abnormalities and conservative therapy has not helped. The variables customarily assessed at manometry are basal pressure and amplitude, duration, frequency, and propagation pattern of the phasic waves. Basal sphincter pressure higher than 40 mm Hg is the manometric criterion used to diagnose SOD.
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
The cause of the higher prevalence of gallstones in these individuals remains uncertain. Some hypothesize that gallbladder motility decreases, resulting in gallbladder stasis; however, studies have not supported this.9,10 Ultrasonographic studies in patients with SCI have shown normal gallbladder emptying, which occurs under parasympathetic control, and normal residual volumes. On the other hand, the gallbladder resting volume is decreased, associated with lower ejection fraction, especially in individuals with SCI above T10.11–13 Accordingly, cholescintigraphy studies have demonstrated lower gallbladder filling and ejection fraction.14,15
Evaluation of gallstone classification and their diagnosis through serum parameters as emerging tools in treatment: a narrative review
Published in Postgraduate Medicine, 2022
Bhavna Sharma, Shubha Rani Sharma
These stones can be diagnosed by imaging techniques such as ultrasound and oral cholecystogram. But in some cases, other techniques are also used which include CT scan, Cholescintigraphy (HIDA scan) and, Endoscopic retrograde cholangiopancreatography (ERCP). Surgical methods include laparoscopic cholecystectomy and open cholecystectomy [7]. To date, the benchmark of the treatment of gallstones is cholecystectomy though a contact dissolution therapy by the use of organic solvent as well as herbal solutions have been researched upon. The dissolution of radiolucent gallstones is carried out by a mixture, which consists of plant terpenes [8,9].
Strongyloides stercoralis and cytomegalovirus coinfection in a patient with a transplanted kidney
Published in Baylor University Medical Center Proceedings, 2022
Mohammad Amin Fallahzadeh, Nina T. Rico, Elham Vahhab, Huang He, Dina Abdelwahab Elhamahmi, Uriel Sandkovsky
Four days after discharge, she was readmitted with persistent nausea, vomiting, and diffuse abdominal pain. Physical exam revealed epigastric tenderness. Laboratory values included a normal white blood cell count, normal liver function tests, and normal bilirubin. Abdominal ultrasound suggested chronic cholecystitis, while cholescintigraphy was indicative of acute cholecystitis. Therefore, she was started on intravenous eravacycline, and intravenous ganciclovir was continued.