• Title, Summary, Keyword: cholelithiasis

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A Case of Recurrent Liver Abscess Due to Choledochoduodenal Fistula (재발하는 간농양에서 총담관-십이지장 누공의 내시경적 치료 1예)

  • Hur, Jun Ho;Choi, Sun Taek;Sohn, Min Su;Lee, Ji Eun;Chung, In Hee;Ki, Sung Ho
    • Yeungnam University Journal of Medicine
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    • v.30 no.1
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    • pp.39-42
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    • 2013
  • Cholelithiasis, duodenal ulcer, duodenal perforation and tumor invasion may lead to choledochoduodenal fistula (CDF). CDF often has no specific symptoms and may be incidentally detected in an upper gastrointestinal radiographic study or endoscopy; but in some cases, it may be accompanied by recurrent cholangitis and liver abscess. In this paper, a case of recurrent liver abscess caused by CDF is reported. A 62-year-old female was admitted to the authors' hospital because of right upper quadrant pain and fever. The abdominal computed tomography showed a liver abscess in the right lobe. A duodenal fistulous orifice was detected with endoscopy, and a contrast was injected through the duodenal orifice using a catheter under fluoroscopy. The injection of the contrast revealed a fistulous track between the duodenal bulb and the common hepatic duct. In fistulas complicated by recurrent liver abscess, surgery or medical management may be needed. The CDF in this case study was treated via endoscopic clipping.

Functional Characterization of ABCB4 Mutations Found in Low Phospholipid-Associated Cholelithiasis (LPAC)

  • Kim, Tae Hee;Park, Hyo Jin;Choi, Ji Ha
    • The Korean Journal of Physiology and Pharmacology
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    • v.17 no.6
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    • pp.525-530
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    • 2013
  • Multidrug resistance 3 (MDR3) is expressed on the canalicular membrane of the hepatocytes and plays an important role in protecting the liver from bile acids. Altered ABCB4 gene expression can lead to a rare hepatic disease, low phospholipid-associated cholelithiasis (LPAC). In this study, we characterized 3 ABCB4 mutations in LPAC patients using various in vitro assay systems. We first measured the ability of each mutant to transport paclitaxel and then the mechanisms by which these mutations might change MDR3 transport activity were determined using immunoblotting, cell surface protein biotinylation, and immunofluorescence. Through a membrane vesicular transport assay, we observed that the uptake of paclitaxel was significantly reduced in membrane vesicles expressing 2 ABCB4 mutations, F165I and S320F. Both mutants showed significantly decreased total and cell surface MDR3 expression. These data suggest two missense mutations of ABCB4 may alter function of MDR3 and ultimately can be determined as LPAC-causing mutations.

Hepatobiliary Manifestation of Inflammatory Bowel Disease (염증성 장질환 환자의 간담도계 발현)

  • Seo, Kwang Il;Kang, Sang-Bum
    • The Korean Journal of Gastroenterology
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    • v.73 no.5
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    • pp.248-259
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    • 2019
  • The hepatobiliary system is one of the most common sites of extraintestinal manifestation in patients with inflammatory bowel disease (IBD). The progression of IBD can lead to a primary hepatobiliary manifestation and can occur secondary to multiple drugs or accompanying viral infections. Primary sclerosing cholangitis is the representative hepatobiliary manifestation of IBD, particularly in ulcerative colitis. Although most agents used in the treatment of IBD are potentially hepatotoxic, the risk of serious hepatitis or liver failure is low. The prevalence of HBV and HCV in IBD is similar to the general population, but the clinical concern is HBV reactivation associated with immunosuppressive therapy. Patients undergoing cytotoxic chemotherapy or immunosuppressive therapy with a moderate to high risk of HBV reactivation require prophylactic antiviral therapy. On the other hand, HCV has little risk of reactivation. Patients with IBD are more likely to have nonalcoholic fatty liver disease than the general population and tend to occur at younger ages. IBD and cholelithiasis are closely related, especially in Crohn's disease.

Extraction Method of Significant Clinical Tests Based on Data Discretization and Rough Set Approximation Techniques: Application to Differential Diagnosis of Cholecystitis and Cholelithiasis Diseases (데이터 이산화와 러프 근사화 기술에 기반한 중요 임상검사항목의 추출방법: 담낭 및 담석증 질환의 감별진단에의 응용)

  • Son, Chang-Sik;Kim, Min-Soo;Seo, Suk-Tae;Cho, Yun-Kyeong;Kim, Yoon-Nyun
    • Journal of Biomedical Engineering Research
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    • v.32 no.2
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    • pp.134-143
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    • 2011
  • The selection of meaningful clinical tests and its reference values from a high-dimensional clinical data with imbalanced class distribution, one class is represented by a large number of examples while the other is represented by only a few, is an important issue for differential diagnosis between similar diseases, but difficult. For this purpose, this study introduces methods based on the concepts of both discernibility matrix and function in rough set theory (RST) with two discretization approaches, equal width and frequency discretization. Here these discretization approaches are used to define the reference values for clinical tests, and the discernibility matrix and function are used to extract a subset of significant clinical tests from the translated nominal attribute values. To show its applicability in the differential diagnosis problem, we have applied it to extract the significant clinical tests and its reference values between normal (N = 351) and abnormal group (N = 101) with either cholecystitis or cholelithiasis disease. In addition, we investigated not only the selected significant clinical tests and the variations of its reference values, but also the average predictive accuracies on four evaluation criteria, i.e., accuracy, sensitivity, specificity, and geometric mean, during l0-fold cross validation. From the experimental results, we confirmed that two discretization approaches based rough set approximation methods with relative frequency give better results than those with absolute frequency, in the evaluation criteria (i.e., average geometric mean). Thus it shows that the prediction model using relative frequency can be used effectively in classification and prediction problems of the clinical data with imbalanced class distribution.

Calcium-Dependent Cell Damage Induced by Bile Acid

  • Kim, Joo-Young;Kim, Kyung-Hwan;Lee, Min-Goo
    • Proceedings of the Korean Biophysical Society Conference
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    • pp.24-24
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    • 2002
  • The mechanism of how cholelithiasis increases the risk of acute pancreatitis remains obscure. When gallstones obstruct the lower biliary tract, bile acids can enter the pancreas either by luminal diffusion or by interstitial leakage. Here we provide the first evidence that bile acids can be transported into pancreatic acinar cells through the membrane transporters and induce cell death by impairing intracellular Ca$\^$2+/ signals.(omitted)

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An Opinion on Cholelithiasis by Ultrasonography in Life Insurance Medicine (초음파(超音波)를 이용(利用)한 담낭결석(膽囊結石)의 보험의학적(保險醫學的) 소견(所見))

  • Moon, Soo-Hyung;Kim, Soo-Hee;Kim, Kang-Seuck
    • The Journal of the Korean life insurance medical association
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    • v.2 no.1
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    • pp.182-194
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    • 1985
  • Cholelithiasis, one of the digestive, disease is one of the subject to have to be solved in the medical field because it is very important health problem in clinic and gives people much pain. The formulative process of gall stone is not certainly known yet, but an approach to the size, location, bile sludge of gall ston and the existence of pus is very contributive to the cure and prediction of the disease. As above, the early diagnosis of gall stone is very important. A few study on the possessing rate of gall stone in normal Korean Group is reported. But no report has submitted to the Korean Life Insurance Medical Association until now. We, the Medical Dept. of Dae Han Kyouk Life Insurance Co. Ltd., practiced ultrasonic examination for the recent 17 months and obtained 84 data of gall stone potency out of 4201 examples. We analyzed them on the basis of sex, age, gall stone incidence rate and the results are as follows; 1) The possessing rate of gall stone in female showed 1.22 times higher than in in male. 2) The older the medical examined group grow, the more the frequency of gall stone incidence increase regardless of sex. 3) Our report coincides with foreign one in sex and age, but in total gall stone incident frequency our country has 2%, which is much less than foreign one.

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Prognostic Relevance of Human Telomerase Reverse Transcriptase (hTERT) Expression in Patients with Gall Bladder Disease and Carcinoma

  • Deblakshmi, Raj Kumari;Deka, Manab;Saikia, Anjan Kumar;Sharma, Bir Kumar;Singh, Nidhi;Das, NN;Bose, Sujoy
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.7
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    • pp.2923-2928
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    • 2015
  • Background: Gallbladder carcinoma (GBC) has been stated as an Indian disease, with the highest number of cases being reported from certain districts of northeast India, which has an ethnically distinct population. Unfortunately there are no scientific reports on the underlying molecular mechanisms associated with the pathogenesis of the disease from this region. Aim: The present study evaluated the role of differential expression of human telomerase reverse transcriptase (hTERT) in the development of gall bladder anomalies. Materials and Methods: Blood and tissue samples were collected from patients undergoing routine surgical resection for clinically proven cases of gallbladder disease {cholelithiasis (CL, n=50), cholecystitis (CS, n=40) and GBC (n=30) along with adjacent histopathologically proved non-neoplastic controls (n=15)} with informed consent. Whole blood was also collected from age and sex matched healthy controls (n=25) for comparative analysis. Differential hTERT mRNA expression was evaluated by semi-quantitative rt-PCR and real-time PCR based analysis using ${\beta}$-actin as an internal control. Evaluation of differential hTERT protein expression was studied by Western blot analysis and immunoflourescence. Statistical analysis for differential expression and co-relation was performed by SPSSv13.0 software. Results: Gallbladder anomalies were mostly prevalent in females. The hTERT mRNA and protein expression increased gradiently from normal

Changes of Blood Chemistry by Experimental Cystic Duct Obstruction (실험적 담도폐색에 의한 혈액화학치의 변화)

  • Lee, Hae-Beom;Lee, Byung-Gon;Chon, Seung-Ki;Kim, Nam-Soo
    • Journal of Veterinary Clinics
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    • v.25 no.5
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    • pp.363-369
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    • 2008
  • The aim of this study was to establish an experiment animal model for easy diagnosis and monitoring effect of treatment of cholelithiasis by cholesterol and mixed gall stone. In 12 adult beagle dogs, five dogs there were in the control group and seven dogs in the experiment group with ligated cystic duct. General clinical signs were recorded, CBC and blood chemistry were examined. Control group and experiment group were evaluated every 2 weeks for a period of 20 weeks. The results were (1) Total blirubin, cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST) activity were significantly higher in the experiment group with ligated cystic duct than control group during 2-8 weeks. (2) Total alkaline phosphatase (TALP) activity was significantly higher when compare with control group during 2-8 weeks. Bone alkaline phosphatase(BALP) activity was increased slightly between 2 and 8 weeks but was decreased between 10 and 20 weeks. (3) Blood urea nitrogen (BUN) was decreased between 2 and 8 weeks. After 10 weeks, this was in normal range. (4) On complate blood count (CBC), $Ca^{2+}$ and P were not changed until 20 weeks. (5) On clinical signs in experimental group, they observed a depression, yellow color of mucus membrane and conjunctiva, xanthinuria and xanthochromic. The present study showed that the experimental animal model with ligated cystic duct was a useful model to study biliary tract disease.

Cholestasis beyond the Neonatal and Infancy Periods

  • Khalaf, Racha;Phen, Claudia;Karjoo, Sara;Wilsey, Michael
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.19 no.1
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    • pp.1-11
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    • 2016
  • Cholestasis results from impairment in the excretion of bile, which may be due to mechanical obstruction of bile flow or impairment of excretion of bile components into the bile canaliculus. When present, cholestasis warrants prompt diagnosis and treatment. The differential diagnosis of cholestasis beyond the neonatal period is broad and includes congenital and acquired etiologies. It is imperative that the clinician differentiates between intrahepatic and extrahepatic origin of cholestasis. Treatment may be supportive or curative and depends on the etiology. Recent literature shows that optimal nutritional and medical support also plays an integral role in the management of pediatric patients with chronic cholestasis. This review will provide a broad overview of the pathophysiology, diagnostic approach, and management of cholestasis beyond the neonatal and infancy periods.

Is it Necessary to Submit Grossly Normal Looking Gall Bladder Specimens for Histopathological Examination?

  • Tayeb, Muhammad;Rauf, Fozia;Ahmad, Khurshid;Khan, Faiz Muhammad
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.4
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    • pp.1535-1538
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    • 2015
  • Background: The objectives of the study were to: 1) determine the frequency of incidental malignancy in unsuspected/grossly normal looking gall bladders; 2) determine the frequency of malignancy in suspected/grossly abnormal looking gall bladders. Materials and Methods: This prospective, cross sectional study was carried out at a tertiary care hospital in Pakistan, during a four year period (Jan 2009-dec2012). All the cholecystectomy cases performed for gallstone diseases were examined initially by a surgeon and later on by a pathologist for macroscopic abnormalities and accordingly assigned to one of the three categories i.e. grossly normal, suspicious, abnormal/malignant. Frequency of incidental carcinoma in these categories was observed after receiving the final histopathology report. Results: A total of 426 patients underwent cholecystectomy for cholelithiasis, with a 1:4 male: female ratio. Mean age of the patients was 45 years with a range of 17-80 years. The frequency of incidental gallbladder carcinoma was found to be 0.70 %(n=3). All the cases of gallbladder carcinoma were associated with some macroscopic abnormality. Not a single case of incidental carcinoma gallbladder was diagnosed in 383 'macroscopically normal looking' gallbladders. Conclusions: Incidental finding of gall bladder cancer was not observed in any of macroscopically normal looking gall bladders and all the cases reported as carcinoma gallbladder had some gross abnormality that made them suspicious. We suggest histopathologic examination of only those gall bladders with some gross abnormality.