The accessory organs: Pancreas, liver and gallbladder
Paul Ong, Rachel Skittrall in Gastrointestinal Nursing, 2017
Cholelithiasis is a common condition. It affects 5%–22% of people in Western countries (Everhart et al., 1999; Aerts and Penninckx, 2003). Volzke et al. (2005) reported 10%–20% of Europeans and Americans have gallstones. Gallbladder disease is the leading cause of digestive-related hospital admissions in Western populations (Sandler et al., 2002) and cholelithiasis is one of the most prevalent diseases. However, although relatively common, only 10%–30% of people with gallstones go on to develop clinical symptoms such as biliary colic or other digestive symptoms associated with the disease (Keus et al., 2006). Shaffer (2005) also found an increase in the prevalence of gallstones with age. Shaffer reported that of women 70–79 years of age 57% have evidence of gallstones or have a history of cholecystectomy (Shaffer, 2005). Gallstones form when the concentration of cholesterol or bilirubin exceeds the solubility in the bile salt and phospholipid-rich bile. The formation of bile by the hepatocytes is the mechanism by which the liver removes excess cholesterol from the body. Bile consists of lipids, bile salts, phospholipids and cholesterol. The plasma membranes of hepatocytes have transporter proteins called ABC transporters which allow the movement of these lipids, in solution, through the membrane into the canalicular lumen (Oude Elferink et al., 2006).
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.
The Liver and the Biliary System
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Early presenting signs and symptoms of gallbladder cancer are similar to any gallbladder disease. Therefore, in most cases, the diagnosis of gallbladder cancer is not made clinically. Even at surgery, the diagnosis may be missed until the pathologist reports it. Radiological studies also do not differentiate between benign and malignant gallbladder disease. They only reveal a nonfunctioning gallbladder. If other anomalies are detected, it is due to the more advanced stages of the disease rather than accurate early diagnosis of the case. Sonography can detect some but again cannot differentiate between the carcinoma and a benign papillary lesion in the gallbladder. CT scanning will detect advanced cases but cannot differentiate between a thickened wall of the gallbladder due to tumor or due to a benign condition such as the inflammatory cases which are more common.
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].
Case report: an unwanted leftover after laparoscopic cholecystectomy
Published in Acta Chirurgica Belgica, 2018
Eline Stroobants, Peter Cools, Francis Somville
Laparoscopic cholecystectomy is the golden standard in the treatment of symptomatic gallbladder disease nowadays. The approach deals with mainly two specific complications, the first one is damage of the bile ducts and second a rupture of the gallbladder with or without spillage of gallstones. The first complication is linked to the competence and experience of the surgeon and diminishes with an increased amount of laparoscopic cholecystectomies performed. The spillage of gallstones is a lesser known complication and stays invariable during all those years of laparoscopic expertise [1]. Complications due to spillage can present themselves immediately post-surgery and up to 10 years after surgery [1]. The presented case shows that, however rare, spilled gallstones can be the reason of an important complication. The aim of this case report is to take a closer look on how to manage spilled gallstones.
Related Knowledge Centers
- Biliary Colic
- Biliary Tract
- Gallstone
- Cholecystokinin
- Cholecystitis
- Gallbladder
- Pancreatitis
- Biliary Disease
- Sphincter of Oddi
- Signs & Symptoms