Use of diagnostic imaging resources
Christopher Riley, Morton Warner, Carolyn Semple Piggot, Amanda Pullen, John Wyn Owen in Releasing Resources to Achieve Health Gain, 2018
This is a vast subject which can only be considered briefly. Looking back over the development of ultrasound, CT and more recently MRI, each method clearly has its own diagnostic niche. In the case of MRI, some situations which are optimally shown by this technique have already been described above. Magnetic resonance imaging has certainly not supplanted CT, which at present gives better detail in, for instance, the lungs, abdomen and bone. Magnetic resonance imaging, CT and ultrasound would all be capable of diagnosing accurately some conditions, for instance gallbladder disease. However, ultrasound gives a quick and usually very precise delineation of the gallbladder, with no hazards or contraindications. All three modalities are capable of diagnosing accurately liver metastases. Computed tomography and MRI are slightly more accurate than ultrasound, but if metastases are shown on an initial ultrasound scan then there is usually no need to proceed to another technique.
Abdominal surgery
Roy Palmer, Diana Wetherill in Medicine for Lawyers, 2020
The principles of abdominal surgery include taking a proper history, proper examination, appropriate explanation and consent, appropriate surgical procedures, and careful follow-up. The introduction of endoscopic techniques, laparoscopic techniques, and minimally invasive procedures for the treatment of many conditions has changed the practice of abdominal surgery. The introduction of medication for the treatment of peptic ulcers is one example of how a whole section of abdominal surgery has disappeared. The introduction of drugs to treat gallstones could affect the treatment of gallbladder disease in the future, although removal of the gallbladder and the treatment of stones remains the most effective form of treatment. Medicine, like many other ‘high-tech’ subjects, changes rapidly. Educating surgeons and the public remains an important function. Patients must have realistic expectations and should fully understand the principles of the surgical procedure and the expected outcome. Complications can occur even when the most experienced surgeons are operating and they do not by themselves represent negligence. All surgeons experience complications but it is the recognition of the complication and the appropriate management of that complication which differentiates the negligent surgeon from the surgeon who is carrying out his practice in accordance with standard clinical practice.
Effects of physical activity on the gallbladder and biliary tract in health and disease
Roy J. Shephard in Physical Activity and the Abdominal Viscera, 2017
Important factors contributing to the development of gallbladder pathologies include an excessive secretion of mucus, supersaturation of the bile with cholesterol and other chemicals that can crystallize out, an aggregation of the cholesterol crystals provoked by mucin and a reduction of gallbladder motility.[36, 22] As a young medical student, I was taught to suspect the presence of gallstones in a woman who was “fair, fat and forty”. Consistent clinical concomitants of gall bladder disease include a low level of habitual physical activity, obesity, non-insulin dependent (maturity onset) diabetes mellitus and hyperlipidaemia (the last sometimes due to attempts at rapid weight loss), as well as the female sex and the number of children that a woman has borne.[23, 24] The potential benefits of physical activity as a means of augmenting emptying of the gallbladder, reducing stasis and protecting against biliary disease have as yet received surprisingly little attention. Nevertheless, a survey of the published literature found 11 reviews (Table 3.1) that concluded with varying enthusiasm that regular physical activity was helpful in preventing gallbladder disease. Commonly, this opinion was based upon two or three cross-sectional comparisons between active and inactive groups of individuals. Utter and Goss[21] concluded that regular aerobic activity had a beneficial effect upon gallbladder function, although the exact mechanism underlying the benefit was unclear.
The relationship between UGT1A1 gene & various diseases and prevention strategies
Published in Drug Metabolism Reviews, 2022
Dan Liu, Qi Yu, Qing Ning, Zhongqiu Liu, Jie Song
The liver is the main drug-metabolizing organ that maintains the normal function of the living system. However, high-intensity liver burdens, such as alcoholism, medication, and infection, may impair the liver’s detoxification function, and other organ cells may also be negatively affected. Liver cells secrete bile every day. The gallbladder is the digestive organ in the human body. Its main function is to store and concentrate bile. Therefore, there is an old saying in Traditional Chinese medicine theory that liver and gallbladder assist each other, and are interconnected. Cholestasis or the formation of secondary stones is symptoms of gallbladder disease. Herein, we summarize the hepatobiliary diseases associated with UGT1A1, shown in Figure 2. And the corresponding treatment strategies reported in the literature are summarized, as shown in Table 1.
Erector Spinae Plane Block Enhances Multimodal Analgesia for Laparoscopic Cholecystectomy
Published in Journal of Investigative Surgery, 2022
Hao Tan, Hui-Fang Huang, I-Cheng Lu
Laparoscopic cholecystectomy has become the gold standard for the treatment of gallbladder disease, with the advantages being minimal invasiveness, less postoperative pain, and faster recovery. The enhanced recovery after surgery (ERAS) protocols for laparoscopic gastrointestinal surgery have shown beneficial outcomes, not only in terms of reducing opioid consumption, but also in reducing the number of adverse events and achieving a shorter hospital stay [2,3]. To our best knowledge, there are no reports of ERAS guidelines for minor abdominal procedures, such as laparoscopic cholecystectomy. We were thus interested to see how the authors used multimodal analgesia, which is one of the core elements of ERAS protocols, in their comparative study of EPS and STAP blocks [1]. The authors report using a routine multimodal analgesia regimen including a preoperative ESP or STAP block, intraoperative paracetamol and tenoxicam, postoperative intravenous paracetamol, and patient-controlled fentanyl analgesia. Our major concern with this study is that we found it partially against ERAS guidelines to use patient-controlled fentanyl analgesia and meperidine as a rescue in laparoscopic surgery. The purpose of multimodal analgesia is to reduce opioid consumption and associated adverse events for enhanced recovery after abdominal surgery [4].
Octreotide and Octreotide-derived delivery systems
Published in Journal of Drug Targeting, 2023
Mingliang Fan, Yue Huang, Xinlin Zhu, Jiayu Zheng, Mingwei Du
As a high-affinity receptor of OCT, SSTR2 isn’t exclusively expressed in the tumour tissue, it is also observed outside the tumour tissue in many other normal tissues. Fortunately, SSTR2 is prone to be desensitised to OCT in normal organs. Accordingly, OCT could cause some transient side effects in one or two weeks after injection, such as nausea, diarrhoea, abdominal cramps and reduced glucose tolerance [9]. SSTR2 desensitisation paves the way towards the clinical application of OCT and its derivatives. OCT may also induce a change in bile production and gall bladder contractility, even the liver injury with the manifestation of elevations in serum aminotransferase level. Gallstones might arise after a maintenance therapy but symptomatic gallbladder disease rarely occurs [10].
Related Knowledge Centers
- Biliary Colic
- Biliary Tract
- Gallstone
- Cholecystokinin
- Cholecystitis
- Gallbladder
- Pancreatitis
- Biliary Disease
- Sphincter of Oddi
- Signs & Symptoms