General surgery
Janesh K Gupta in Core Clinical Cases in Surgery and Surgical Specialties, 2014
A6: What treatment options are appropriate? Supportive: adopting a low-fat diet may reduce the frequency and severity of attacks of biliary colic.Medical: medical options to dissolve gallstones have been tried unsuccessfully in the past.Surgical: most patients with symptomatic gallstones should have the gallbladder removed (cholecystectomy). Laparoscopic cholecystectomy can be performed successfully in 95 per cent of patients, with 5 per cent requiring open surgery (either planned open surgery, or due to an intra-operative decision to convert from a laparoscopic technique).
Abdominal Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
Pain originating from the gallbladder classically presents as a positive Murphy’s sign, but this is generally only appreciated in acute cholecystitis, a condition that occurs when the cystic duct becomes blocked. Pain is usually in the right upper quadrant and radiates to the right scapula and is associated with nausea and vomiting. Fever is usually also present along with leukocytosis. Symptoms of biliary colic are also very similar to those of cholecystitis; however; the pain symptoms generally subside after several hours, whereas pain from cholecystitis can persist longer until more definite therapy is begun (i.e., antibiotics, cholecystectomy, etc.). Last, cholangitis, an infection of the bile ducts, can have similar presenting signs/symptoms. This infection generally produces significantly high fevers, chills, rigors, and abnormal liver enzyme values. Jaundice will often accompany this infection. The cornerstone of therapy involves systemic antibiotics and prompt decompression of the biliary tree. This is usually accomplished via endoscopic retrograde cholagiopancreatography or percutaneous transhepatic catheter drainage.
Cholelithiasis and Nephrolithiasis
John K. DiBaise, Carol Rees Parrish, Jon S. Thompson in Short Bowel Syndrome Practical Approach to Management, 2017
Although many patients with SBS and gallstones are asymptomatic, approximately 10% will eventually develop episodic biliary pain and/or gallstone-related complications [3,25]. Biliary colic is the main complaint in approximately 75% of symptomatic patients; most do not have concomitant abnormal laboratory or physical exam findings. As such, a high index of clinical suspicion and early referral for diagnostic testing are needed. Right upper quadrant abdominal ultrasound is often the initial test of choice; however, magnetic resonance cholangio-pancreatography should be considered if there is an inconclusive ultrasound, a high index of suspicion, or high pretest probability of choledocholethiasis in the face of a negative ultrasound.
Hepatitis E virus genotype 3 is associated with gallstone-related disease
Published in Scandinavian Journal of Gastroenterology, 2019
Miriam Karlsson, Heléne Norder, Maria Bergström, Per-Ola Park, Marie Karlsson, Rune Wejstål, Åsa Alsiö, Anders Rosemar, Martin Lagging, Åsa Mellgren
All six patients with acute HEV were diagnosed with a clinically relevant surgical diagnose. Four of the six HEV infected patients (patients A–D) had a gallstone-related diagnosis. Three of them presented with acute biliary pancreatitis, acute abdominal pain together with an elevated amylase (three times normal level). They all had verified gallstones and underwent cholecystectomy within two weeks. One patient (patient D) had cholecystolithiasis with biliary colic and had an acute cholecystectomy. The remaining two patients with acute HEV infection had differing conditions. Patient E had symptoms consistent with mechanical bowel obstruction and underwent a laparotomy, relieving these symptoms, but liver enzymes remained elevated after surgery. Patient F presented with jaundice without abdominal pain, and an abdominal computed tomography (CT) scan demonstrated a pancreatic malignancy.
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.
Related Knowledge Centers
- Appendicitis
- Colic
- Cholecystokinin
- Pancreatitis
- Abdomen
- Cystic Duct
- Gallstone
- Hormone
- Peptic Ulcer Disease
- Gastroesophageal Reflux Disease