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Case Of Gallbladder Cancer With Extensive Lymphadenopathy Mimicking Klatskin Tumor. Practical Gastroenterology. 31(6): 83-85. June 2007.
This article presents a case report of a 58-year-old woman who presented with 3-week obstructive jaundice. She was found to have metastatic (stage IV) gallbladder adenocarcinoma, with a common bile duct (CBD) stricture mimicking Klatskin tumor. The authors present the differential diagnosis, along with the radiological images that make it a memorable case. Her symptoms include the triad of cholestasis, vague abdominal pain, and weight loss. The differential diagnosis included malignant CBD stricture, CBD stones, benign CBD strictures, primary sclerosing cholangitis, or compression of the CBD by either chronic pancreatitis or pancreatic cancer. They note that gallbladder cancer is an uncommon but highly fatal malignancy. The majority of cases are found incidentally in patients undergoing surgery for cholelithiasis; gallstones are present in 70 to 90 percent of patients with gallbladder cancer. 3 figures. 18 references.
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Catheter-Related Complications of Total Parenteral Nutrition. American Journal of Gastroenterology. 102: S97-S101. 2007.
This article describes the hepatobiliary complications that can occur with the use of total parenteral nutrition (TPN). The author reviews the background and incidence of TPN-associated liver disease; the risk factors associated with the development of TPN-associated liver disease; potential etiologies of TPN-associated liver disease including malnutrition, overnutrition, carnitine deficiency, choline deficiency, bacterial overgrowth, and methionine toxicity; and treatment options including medical treatment and nutritional treatment. Patients can only prevent hepatobiliary complications, including hepatic steatohepatitis, cirrhosis, and liver failure, if they eat. Eating allows the patient to preserve as much portal nutrient absorption as possible. A final section considers the problem of TPN-associated biliary disease, notably biliary tract stones and gallstones. 5 figures. 53 references.
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Endoscopy in Pregnancy. IN: Pregnancy in Gastrointestinal Disorders. 2nd ed. Bethesda, MD: American College of Gastroenterology. 2007. pp 10-17.
This chapter about endoscopy in pregnancy is from a monograph that presents updated information about pregnancy in women with gastrointestinal disorders. The authors stress that the spectrum of gastrointestinal diseases in the pregnant patient is virtually identical to that in nonpregnant women. However, options for evaluating pregnant patients are somewhat limited because barium studies and other radiographic techniques subject the fetus to the risks of radiation. However, endoscopy can play a crucial role in the diagnosis and treatment of various disorders in the pregnant patient. The chapter focuses on bringing readers up to date on the research in the area covered, the recommended treatments, and patient management concerns, notably issues of maternal and fetal safety. Topics include the use of upper endoscopy for diagnosing nausea, vomiting, esophagitis, ulcers, and gastritis; the use of lower endoscopy to evaluate rectal bleeding and inflammatory bowel disease (IBD); sigmoidoscopy and colonoscopy; endoscopic retrograde cholangiopancreatography (ERCP) used to evaluate gallstones; percutaneous endoscopic gastrostomy (PEG) placement to assist patients who cannot sustain adequate nutritional intake; and the use of sedation for endoscopic tests in women who are pregnant. The authors conclude that endoscopy appears to be safe in pregnancy. They recommend that procedures be performed after the first trimester if possible, following guidelines to minimize radiation and excessive sedation. Endoscopists are encouraged to consult with an obstetrician in challenging, complicated cases. 1 table. 17 references.
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Frequency of Gallstones After Renal Transplantation and Factors That Affect Gallstone Formation: A Comparative Study. Dialysis and Transplantation. 36(10): 533-542, 555. October 2007.
This article reports on a study of the frequency of gallstones in kidney transplant recipients, focusing on the effects of various factors on gallstone formation. The study included 182 patients who had undergone renal transplantation at the authors’ center in the last 12 years. Of these, 163 patients were followed up regularly; of these, 118 were using cyclosporine A (CsA). The median duration of patient follow-up was 36 months. All patients underwent abdominal ultrasonography and laboratory tests. Gallstones were diagnosed in five patients (3.1 percent). The frequency of gallstones was 3.4 percent in the CsA group and 2.2 percent in the non-CsA group. The CsA group had a significantly shorter gallstone-free follow-up period than the non-CsA group. The authors conclude that the use of CsA showed a trend toward increasing the risk of developing a gallstone sooner in the posttransplant period, particularly for young men. 1 figure. 4 tables. 24 references.
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Gallstones. Bethesda, MD: National Digestive Diseases Information Clearinghouse. July 2007. 8 p.
This fact sheet provides a wealth of information about gallstones, which are small, pebble-like substances that develop in the gallbladder. Gallstones form when liquid bile stored in the gallbladder hardens. Bile is made in the liver and stored in the gallbladder until the body needs it. The fact sheet describes the different types of gallstones, symptoms and complications of gallstones, the causes of gallstones, diagnostic tests that may be used to confirm the presence of gallstones, and treatment strategies including surgery and nonsurgical therapies such as oral dissolution therapy and contact dissolution therapy. Gallstones are more common among older adults; women; American Indians; Mexican Americans; people with diabetes; those with a family history of gallstones; people who are overweight, obese, or who undergo rapid weight loss; and those taking cholesterol-lowering drugs. Gallbladder attacks often occur after eating a meal, especially one high in fat. The symptoms of gallstones may mimic those of other problems, including a heart attack, so an accurate diagnosis is important. Laparoscopic surgery to remove the gallbladder is the most common treatment. A final brief section describes the research aims in this area. The fact sheet concludes with a list of resource organizations through which readers can obtain additional information, and a description of the goals and activities of the National Digestive Diseases Information Clearinghouse. 1 figure. 1 table. 3 references.
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Gastrointestinal Issues in the Assessment And Management Of the Obese Patient. Gastroenterology and Hepatology. 3(7): 559-569. July 2007.
This article outlines gastrointestinal issues in the assessment and management of the obese patient. The authors caution that as the obesity epidemic spreads, physicians of all specialties will be called on to participate in the management of obesity. Gastroenterologists should learn to recognize, prevent, and treat gastrointestinal disorders related to obesity, and they must have an understanding of the risks and benefits of various management strategies. They may also be called on to assist in the evaluation and management of liver and gastrointestinal problems that may develop after bariatric surgery. Specific topics include gastroesophageal reflux disease, obesity and esophageal adenocarcinoma, gallbladder disease, pancreatitis, liver disease, gastrointestinal cancer, the indications for bariatric surgery, the role of preoperative endoscopy, roux-en-Y gastric bypass, banded gastroplasty, the intragastric balloon, sleeve gastrectomy, biliopancreatic diversion, jejunoileal bypass, gallstones, vomiting, pulmonary embolism, wound infection, rhabdomyolysis, hemorrhage, weight gain, and cancer. The author notes that upper gastrointestinal endoscopy is an all-important tool in the assessment and therapy of the complications of obesity and related surgical techniques. 1 table. 149 references.
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Acute Pancreatitis. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 362-370.
This chapter on acute pancreatitis is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. Specific topics covered in this chapter include the mortality of acute pancreatitis; the role of gallstones and alcohol in cases of acute pancreatitis; diagnostic tests used to confirm acute pancreatitis, including serum amylase or lipase, or radiographic (X ray) evidence; determination of severity by Ranson's score, APACHE-II criteria, or CT scan; and the use of prophylactic antibiotics in patients with acute necrotizing pancreatitis. The chapter concludes with a lengthy list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 3 figures. 2 tables. 35 references.
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Biliary Fistula, Gallstone Ileus, And Mirizzi's Syndrome. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 239-251.
This chapter on biliary fistula, gallstone ileus, and related major complications is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. A separate section of this chapter covers Mirizzi’s syndrome, a special complication of gallstone disease characterized by an impacted gallstone in the cystic duct or the neck of the gallbladder that compresses the adjacent bile duct and results in complete or partial obstruction of the common hepatic bile duct. Gallstone ileus is a mechanical bowel obstruction that is caused by impaction of one or more gallstones within the lumen of the intestinal system. The authors discuss the different types of biliary fistulas, the clinical presentation of gallstone ileus and Mirizzi’s syndrome, the diagnostic imaging studies that may be used to confirm the presence of gallstone ileus and Mirizzi’s syndrome, and treatment options, notably surgical strategies. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 6 figures. 3 tables. 114 references.
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Biliary Tract Disease. IN: Nilsson, K.R.; Piccini, J.P., eds. Osler Medical Handbook. Philadelphia, PA: Saunders. 2006. pp. 371-376.
Biliary tract diseases comprise a range of disorders affecting the intrahepatic and extrahepatic bile ducts and the gallbladder. This chapter on biliary tract disease is from a handbook that provides the essentials of diagnosis and treatment, as well as the latest in evidence-based medicine, for residents working bedside, in-patient care. The chapter begins with a presentation of essential Fast Facts and concludes with Pearls and Pitfalls useful to the practicing internist. The body of the chapter is divided into sections: Epidemiology, Clinical Presentation, Diagnosis, and Management. The authors note that ductal obstruction is caused by gallstone impaction in more than 90 percent of cases and can lead to multiple conditions, including cholecystitis, choledocholithiasis, cholangitis, and pancreatitis. The authors focus on providing a framework for evaluating and treating diseases related to cholelithiasis. Specific topics covered in this chapter include the use of ultrasonography as the diagnostic imaging modality of choice for evaluating right upper quadrant pain and suspected gallstones; the symptoms that define cholangitis (biliary obstruction complicated by infection), including right upper quadrant tenderness, fever, and jaundice; treatment options for cholangitis, including emergency antibiotic therapy and biliary decompression; and acalculous cholecystitis as a cause of acute cholecystitis and occult fevers in the critically ill. The chapter concludes with a list of references, each labeled with a 'strength of evidence' grade to help readers determine the type of research available in that reference source. 1 figure. 1 table. 4 references.
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Choledocholithiasis. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 47-68.
This chapter about choledocholithiasis, defined as the presence of gallstones in the common bile duct, is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The authors of this chapter discuss the epidemiology of choledocholithiasis, the pathogenesis of cholesterol stones, pathogenesis of pigmented stones, primary and secondary bile duct stones, hepatolithiasis or intrahepatic duct stones, microlithiasis and biliary sludge, risk factors for choledocholithiasis, clinical manifestations, diagnostic tests used to confirm choledolithiasis, the endoscopic management of choledocholithiasis, notably endoscopic sphincterotomy, the use of extracorporeal shock wave lithotripsy (ESWL), biliary stenting for choledocholithiasis, and rare presentations of gallstone disease, including Mirizzi’s syndrome and hepatolithiasis. The authors conclude that, because of the high prevalence of gallbladder disease in the United States, secondary choledocholithiasis with cholesterol stones is frequently encountered. The therapy for choledocholithiasis has evolved from invasive open common bile duct explorations to endoscopic methods of stone extraction. The chapter is illustrated with black-and-white photographs. 6 figures. 2 tables. 56 references.
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Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. 384 p.
This comprehensive text covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. Designed as a practical guide for clinicians, the book offers 17 chapters: development and function of the pancreas, bile duct, and gallbladder; gallstones and gallbladder disorders; choledocholithiasis; bile duct injuries; ampullary disorders; cholangiocarcinoma; infections of the biliary system; acute pancreatitis; chronic pancreatitis; pancreatic ductal complications; solid pancreatic tumor; pancreatic cystic lesions; surgical approaches to pancreatic cancer; biliary tract surgery; imaging of the pancreatobiliary system using endoscopic ultrasound; magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography of the pancreatobiliary system; and the role of the interventional radiologist in diagnosis and treatment of pancreaticobiliary diseases. Each chapter includes black-and-white figures, tables, and photographs; references are provided. One section of full-color photographs is included. The text concludes with a detailed subject index.
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Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. 428 p.
This textbook provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The book was written by a multidisciplinary panel of international experts with extensive experience in this population of patients. The book offers 23 chapters in six sections: anatomy, pathophysiology, and epidemiology of the biliary system; diagnostic and therapeutic approaches for the biliary tree and gallbladder; specific conditions; the intrahepatic and extrahepatic bile ducts; intrahepatic cholestasis; and the pediatric population. Specific topics include noninvasive imaging, endoscopic diagnosis and treatment, percutaneous biliary imaging and intervention, radiation therapy, surgery, laparoscopic treatment, laparoscopic biliary injuries, treatment for biliary malignancies, the gallbladder, gallstones, acute cholangitis, cystic diseases of the biliary system, biliary complications of liver transplantation, primary sclerosing cholangitis, cholangiocarcinoma, primary biliary cirrhosis, and biliary disease in infants and children. Each chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. The book is illustrated with black-and-white photographs and line drawings; one section of color plates is included. The book concludes with the answers to the self-test study questions and a detailed subject index.
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Epidemiology of Diseases of the Bile Ducts And Gallbladder. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 58-68.
This chapter on epidemiology is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The author reviews the prevalence and incidence of gallstones, the risk factors for gallstone disease, the composition of gallstones, the complications of gallstone disease, the risk factors for gallbladder cancer, and the risk factors for cholangiocarcinoma. Specific topics include acalculous cholecystitis, cholesterolosis, adenomatosis, polyps of the gallbladder, extrahepatic biliary atresia, choledochal cysts, Caroli’s disease, cystic fibrosis, and primary sclerosing cholangitis. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 1 figure. 2 tables. 107 references.
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Epidemiology of Gallbladder Stone Disease. Best Practice & Research Clinical Gastroenterology. 20(6): 1017-1029. 2006.
This article brings readers up-to-date on the epidemiology of gallbladder stone disease, a common occurrence in the United States. The author notes that the burden of disease is epidemic in American Indians (60 to 70 percent); a corresponding decrease occurs in Hispanics/Latinos of mixed Indian origin. Ten to 15 percent of Caucasian adults in developed countries harbor gallstones. Frequency is further reduced in African Americans, East Asians, and sub-Saharan Africans. In developed countries, cholesterol gallstones predominate; 15 percent are black pigment gallstones. Risk factors for gallstones include female gender, increasing age, and ethnicity or family. Modifiable risk factors include obesity, the metabolic syndrome, rapid weight loss, certain diseases—including cirrhosis and Crohn's disease—and gallbladder stasis, which can happen from spinal cord injury or from drugs such as somatostatin. The only established dietary risk is a high caloric intake. The author concludes that protective factors include diets containing fiber, vegetable protein, nuts, calcium, vitamin C, coffee and alcohol, plus physical activity. 1 table. 144 references.
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Gallstone Disease: Primary and Secondary Prevention. Best Practice & Research Clinical Gastroenterology. 20(6): 1063-1073. 2006.
This article reviews the primary and secondary prevention of gallstone disease. The authors first explore several risk factors for cholesterol gallstone formation, including prolonged fasting, rapid weight loss, total parenteral nutrition (TPN), and somatostatin treatment. In both asymptomatic and symptomatic gallstone patients, it has been claimed that treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) reduces the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Prophylactic cholecystectomy may be beneficial in certain subgroups of asymptomatic gallstone carriers. The authors stress that randomized, double-blind, placebo-controlled trials that could support these contentions are lacking. However, in the general population, high fiber intake, low saturated fatty acid consumption, and nut consumption are associated with reduced risk of gallstones. Also, moderate physical activity appears to prevent gallstones. 3 tables. 95 references.
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Gallstone Ileus: A Review. Mount Sinai Journal of Medicine. 73(8): 1132-1134. December 2006.
This article reviews the pathophysiology, clinical presentation, radiological findings, and treatment options of gallstone ileus. Gallstone ileus is usually preceded by an attack of acute cholecystitis, causing inflammation and adhesions in the area of the gallbladder bed. The adhesions and inflammation facilitate the formation of a fistula with the small or large intestine; the gallstone then moves through the fistula and has the potential of forming an obstruction (ileus). Gallstone ileus is a disease of the elderly, causing up to one-fourth of non-strangulation intestinal obstructions in patients older than 65 years. Radiological features on plain x rays include features of intestinal obstruction and pneumobilia and an aberrant gallstone. Treatment depends on the site of the impacted stone, but surgery is needed in many cases. The authors conclude that early diagnosis and treatment improve the outcome. 31 references.
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Gallstones and Gallbladder Disorders. IN: Lichtenstein, G.; Ginsberg, G.; Ahmad, N., eds. The Clinician’s Guide to Pancreaticobiliary Disorders. Thorofare, NJ: Slack Incorporated. 2006. pp 21-46.
This chapter about gallstones and gallbladder disorders is from a comprehensive text that covers the epidemiology, pathophysiology, diagnosis, and management of disorders of the pancreatic and biliary systems. The authors of this chapter discuss gallbladder anatomy and physiology, gallstone pathophysiology, risk factors for gallstone formation, cholesterol stone formation, biliary sludge, pigment gallstones, acute calculous cholecystitis, acute acalculous cholecystitis, acalculous biliary pain, gallbladder cancer, the medical management of gallstones, acute calculous cholecystitis, Mirizzi’s syndrome, biliary-enteric fistula, gallstone ileus, emphysematous cholecystitis, gallbladder polyps, and porcelain gallbladder. For each condition, the authors provide a definition, a description of clinical manifestations and evaluation, and management approaches. The authors conclude that although gallstones are extremely common, most are asymptomatic. If a stone becomes dislodged problems can occur, including cholecystitis, cholangitis, fistula formation, or Mirizzi’s syndrome. The primary treatment for gallbladder disease is cholecystectomy. The chapter is illustrated with black-and-white photographs. 5 figures. 1 table. 74 references.
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Gallstones: Common, But Not to Be Ignored. Mayo Clinic Health Letter. 24(1): 1-3. January 2006.
This article reviews basic information about gallstones, a common condition that can cause painful attacks and lead to more serious complications. The author first reviews the anatomy and function of the gallbladder, which is part of the biliary system that helps break down fats and remove waste products from the body. Two common types of gallstones are cholesterol stones and pigment stones. The author reviews the risk factors for gallstone formation, which include gender (women are at higher risk), overweight, the use of certain weight-loss diets, age, family history, and ethnicity. The author covers symptoms that should prompt a visit to a health care provider, diagnostic tests that will be used to confirm the presence of a gallstone, and treatment options, including removal of the gallbladder. One sidebar briefly reviews gallbladder cancer, a very rare but invasive form of cancer. 2 figures.
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Hepatobiliary Complications of Inflammatory Bowel Disease. Practical Gastroenterology. 30(8): 19-33. August 2006.
This article outlines the hepatobiliary complications that may be associated with inflammatory bowel disease (IBD, including Crohn’s disease and ulcerative colitis). The author notes that the prevalence of hepatobiliary abnormalities in IBD range from 5 percent to 15 percent. Common hepatobiliary manifestations of IBD can include chronic active hepatitis, cirrhosis, steatosis, and primary sclerosing cholangitis. The author outlines a recommended initial approach to the patient, then discusses primary sclerosing cholangitis (PSC), differential diagnosis, autoimmune hepatitis, cholelithiasis (gallstones), chronic viral hepatitis, and medication-induced hepatotoxicity (including that due to 5-ASA drugs, thiopurines, infliximab, and methotrexate). A final section considers some of the more rare hepatic complications of IBD, including liver abscess, and hepatic amyloidosis. The author concludes that PSC is the classic IBD-related liver disease and occurs most often in patients with ulcerative colitis. Readers are cautioned that patients with IBD are as likely as other patients to develop non-IBD-related liver disorders, so a diligent search for common causes of any hepatobiliary disease should be performed. 1 figure. 2 tables. 34 references.
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Liver Disease and IBD. New York, NY: Crohn's and Colitis Foundation of America.. 2006. 2 p.
Some of the complications of inflammatory bowel disease (IBD, including Crohn’s disease and ulcerative colitis) are related to the liver and the biliary system, both of which are closely linked to the intestine. This fact sheet reviews the different types of liver disease that may be encountered in people with IBD, including fatty liver disease (hepatic steatosis), primary sclerosing cholangitis (PSC), gallstones, pancreatitis, and chronic active hepatitis. For each condition, the fact sheet explains why it might develop and offers basic suggestions for treatment. Low energy and fatigue tend to be the most common symptoms of IBD-related liver diseases. Symptoms of more advanced liver disease include itching, jaundice, fluid retention, fatigue, and a feeling of fullness in the upper abdomen. The treatments for these conditions in people with IBD are the same as in those people without IBD. Serious liver disease involving the liver affects only about 5 percent of people with IBD.
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Natural History And Pathogenesis of Gallstones. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 219-228.
This chapter on the natural history and pathogenesis of gallstones is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The author focuses on the recent major advances in the understanding of gallstone pathogenesis and the improvements and availability of imaging studies, both of which have improved the understanding of the epidemiology and natural history of cholelithiasis. Topics include the pathogenesis of gallstone formation, the different risk factors of gallstone formation, the natural history of asymptomatic and symptomatic gallstones, and current medical treatment options for patients with symptomatic gallstone disease. Treatment options described include oral gallstone dissolution therapy, extracorporeal shock wave lithotripsy, and topical dissolution therapy. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 2 figures. 1 table. 70 references.
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Sex-Based Differences in Pancreatic and Biliary Disease. Practical Gastroenterology. 30(04): 49-67 p. April, 2006.
This article reviews the sex-based differences in pancreatic and biliary disease. The authors discuss algorithms for expediting diagnosis and treatment based on gender differences. The authors consider the hypotheses that anatomic, physiologic, and hormonal factors may contribute to sex-based differences in pancreatic and biliary diseases. Benign processes such as gallstones and gallbladder disease, choledochal cysts, and sphincter of Oddi dysfunction are significantly more common in females. Cystic neoplasia of the pancreas with malignant potential is also seen predominantly in females—more than 80 percent. By comparison, males are more commonly afflicted by primary sclerosing cholangitis (PSC), acalculous cholecystitis, and intraductal papillary mucinous neoplasms. Alcohol and gallstones account for approximately 70 percent of all cases of pancreatitis. The relative risk of developing acute pancreatitis due to gallstones is greater in men; however, there is a higher prevalence of gallstones in women, and gallstone pancreatitis is more common in women. 4 tables. 7 references.
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Smoking And Your Digestive System. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2006. 4 p.
This fact sheet reminds readers of the interrelationship between smoking and the digestive system. Smoking can harm all parts of the digestive system, contributing to common disorders such as heartburn and peptic ulcers. Smoking increases the risk of Crohn’s disease, a type of inflammatory bowel disease, and may be a contributor to gallstones. Smoking also damages the liver. The fact sheet reviews each of these connections, describing the symptoms of these disorders and the physiological role of smoking. The fact sheet concludes that some of the effects of smoking on the digestive system appear to be of short duration. The effects of smoking on how the liver handles drugs disappear when a person stops smoking. However, people who no longer smoke still remain at risk for Crohn’s disease. Readers are referred to the Office on Smoking and Health at the National Center for Chronic Disease Prevention and Health Promotion at 1–800–232–1311 or www.cdc.gov/tobacco. A final section offers a brief description of the National Digestive Diseases Information Clearinghouse (NDDIC), a Federal Government agency that provides information about digestive diseases to people with digestive disorders and their families, health care professionals, and the public.
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Symptoms and Diagnosis of Gallbladder Stones. Best Practice & Research Clinical Gastroenterology. 20(06): 1017-1029. 2006.
This article reviews the symptoms and diagnosis of gallstones, including the natural history of silent gallstones, the risk of developing symptoms, and complications of the disease. The authors highlight the importance of colic-like pain as a specific gallstone symptom and discuss the role of laboratory tests and differential diagnosis. They describe the diagnostic features of gallstone disease, including indications, sensitivity, specificity, and limitations of different test investigations under special circumstances. The authors conclude that in the majority of cases, gallstone patients remain asymptomatic during their life. Once pain has appeared, gallstone patients are at high risk for pain recurrence in the following year. The clinical presentation of gallstone disease might also depend on ongoing complications, such as cholecystitis or pancreatitis; thus, both medical history and ancillary investigations are essential to avoid misdiagnoses. The most accurate diagnostic tool to detect gallstones is transabdominal ultrasonography. 3 tables. 115 references.
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Acute And Chronic Cholecystitis. IN: Clavien, P.; Baillie, J., eds. Diseases of the Gallbladder and Bile Ducts: Diagnosis and Treatment. 2nd ed. Williston, VT: Blackwell Publishing Inc. 2006. pp 229-238.
This chapter on acute and chronic cholecystitis is from a textbook that provides a comprehensive and critical approach to both established and new diagnostic and therapeutic modalities for diseases of the gallbladder and bile ducts. The authors discuss the pathogenesis of acute and chronic cholecystitis; the clinical presentation of gallbladder infection, including infection due to gallstones; the diagnostic tests that may be used to confirm cholecystitis; complications of acute and chronic cholecystitis; surgical and nonsurgical treatment options; and recommendations for cholecystectomy in patients with acute cholecystitis. The chapter includes a summary of objectives, a list of suggested readings, extensive references, and a set of self-test questions that focus on the material covered in the chapter. 4 figures. 53 references.
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Gallbladder and Bile Ducts. IN: Digestive Disorders 2005. Palm Coast, FL: Medletter Associated. pp 24-29. 2005.
This chapter on the gallbladder and bile ducts is from a White Paper on digestive disorders, including conditions that affect the esophagus, stomach, gallbladder, bile ducts, small intestine, and large intestine. This chapter covers normal anatomy of the gallbladder and bile ducts, and the causes, symptoms, diagnosis, and treatment of gallstones. Risk factors for gallstones include genetics, age older than 50, obesity, pregnancy, use of some medications, rapid weight loss, prolonged total intravenous nutrition, and diseases of the terminal ileum. Between 70 and 80 percent of gallbladder stones produce no symptoms and are discovered incidentally during imaging studies or postmortem examinations. Abdominal ultrasound is the easiest way to diagnose stones inside the gallbladder. Asymptomatic gallstones do not require treatment. Treatment options for patients with symptoms include cholecystectomy (removal of the gallbladder), or gallstone dissolution with shockwave therapy. One chart summarizes the potential use of probiotics, or friendly bacteria, for a variety of digestive disorders, including infectious diarrhea, antibiotic-associated diarrhea, pouchitis, irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). One sidebar considers a new research study that supports the hypothesis that dietary fiber may protect against the development of gallstones.
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Is It IBS or Something Else?. Digestive Health Matters. 14(2): 4-5. Summer 2005.
This article focuses on how irritable bowel syndrome (IBS) is diagnosed and distinguished from other disorders. Although physicians can usually identify IBS from the patient's symptoms, sometimes with the addition of routine blood tests and a colon evaluation, patients can worry if they are not familiar with the diagnosis of IBS. Typical patterns of abdominal discomfort or pain, bowel habit disturbance, and bloating point to a diagnosis of IBS. The article includes a table of the Manning and Rome criteria for IBS symptoms. The author discusses the conditions that may be investigated as part of an IBS diagnosis, including colorectal cancer, gallstones, inflammatory bowel disease (IBD, including ulcerative colitis and Crohn's disease), celiac disease (gluten intolerance), and gynecological disorders. The author concludes by reminding readers that sometimes IBS is present along with another disorder that can also cause bowel habit disturbance or abdominal pain. 7 references.
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Gallbladder and Biliary Disease. IN: U.S. Department of Health and Human Services. Action Plan for Liver Disease Research. Bethesda, MD: National Digestive Diseases Information Clearinghouse. 2004. pp. 145-152.
Diseases of the gallbladder and biliary tree include gallstones, acute cholecystitis, acalculous cholecystitis, primary sclerosing cholangitis (PSC), biliary atresia, choledochal cysts, gallbladder cancer, and cholangiocarcinoma. These serious diseases can cause considerable morbidity and mortality. This chapter on gallbladder and biliary disease is from the Action Plan for Liver Disease Research that was developed to advance research on liver and biliary diseases. The Action Plan was undertaken to identify areas of scientific opportunity to help direct research resources at the National Institutes of Health (NIH) toward practical goals in the prevention, diagnosis, and management of liver and biliary diseases. In this chapter, the authors first note that gallstones are by far the most common cause of gallbladder disease. They review the epidemiology, development, and risk factors for gallstones, then outline recent research advances in the areas of understanding gallstone formation, and the management of patients with gallbladder and biliary disease. The authors provide specific research goals in the areas of the pathogenesis and diagnosis of gallstones, the pathogenesis and management of PSC, gallbladder cancer, and biliary tract and gallbladder imaging. A final section considers the steps that would assist in achieving these research goals. One chart summarizes the short (0 to 3 years), intermediate (4 to 6 years), and long-term (7 to 10 years) goals of research on these topics. 2 figures. 1 table.
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Gallstones. [Calculos en La Vesicula]. Arlington, VA: American College of Gastroenterology. 2004. 2 p.
This brief patient education fact sheet, from a series on common gastrointestinal (GI) and medical problems in women, reviews gallstones. Gallstones are solid clumps of cholesterol crystals and other substances that may be of variable size. The fact sheet reviews the common causes or triggers of gallstones, the gallbladder and its role in digestion, the formation of gallstones, the different types of gallstones, symptoms of gallstones, diagnostic considerations, and treatment options, including surgery, laparoscopic surgery, and dissolution therapy. The fact sheet is available in English or Spanish. 2 tables.
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