Sonographic Evaluation of Gallbladder Motility in Children with Chronic Functional Constipation

BACKGROUND/AIMS: Studies in adults suggest that constipation may not be a purely colonic pathology and may be a component of a generalized gastrointestinal (GI) motor disorder in which proximal GI motility can be impaired. Pediatric data are scarce, and the natural history of the disorder remains undefined. We aimed to evaluate gallbladder motility in a subset of Asian children with chronic functional constipation. METHODS: Abdominal ultrasound was performed on 105 children, including 55 patients (aged 3 to 13 years) with chronic functional constipation who met the inclusion criteria and 50 age- and gender-matched controls. The gallbladder contractility index was calculated based on the preprandial and postprandial gallbladder areas. Preprandial and postprandial values for gallbladder volume and wall thickness were evaluated. RESULTS: The mean value of the contractility index for the patients (15.77+/-24.68) was significantly lower than the mean value for the controls (43.66+/-11.58) (p=0.001). The mean postprandial gallbladder volumes and areas were larger in children with gallbladder hypomotility (p<0.05). The mean duration of constipation (4.8 months) was significantly higher (p=0.004) in the children with gall-bladder hypomotility. CONCLUSIONS: Gallbladder motility is significantly impaired in children with chronic functional constipation. This study contributes to the understanding of the underlying pathophysiology, which will enable advancement in and improved management of children with chronic constipation and associated gallbladder hypomotility.

Gall bladder emptyng in diabetics with gall bladder disease

Gallbladder diseases increase 2-3 folds in diabetics than non diabetics, this explained by impairment of Gallbladder motility, at the same time non surgical approaches needs sufficient gallbladder motility, thence we arranged this study to determine the gallbladder emptying in diabetics [group I IDDM group II NIDDM] with gallbladder disease. 80 patients of both types of diabetes with gallbladder diseases as well as 13 healthy persons as a control subjected for estimatims of fasting and residual gallbladder volume and efection fraction by ultrasaugraphy at the end al this study we found a significant increase in the fasting and residual gallbladder volume as well as significant decrease in gallbladder ejection fraction which means that there is impairment in gallbladder motility which may explain the highe incidence of gallbladder diseases in diabetes and we suggest the addition of caspride for diabetes patients to prevent this impairment in gallbladder motility, to facilitate the choice of non surgical approaches to gallbladder diseases

effect of breast feeding on plasma cholecystokinin in neonates

this prospective study was conducted to evaluate the effect of breast-feeding on cholecystokinin in neonates. this study was conducted in King Abdul-Aziz University Hospital. Plasma concentration of cholecystokinin [CCK] was estimated in 41 neonates [19 boys, 22 girls]. The study was done in the neonates on the third day after delivery. Serum CCK was estimated by radioimmunoassy. it was found that CCK rises immediately after breast feeding and declines 10 minutes later. CCK rises immediately after breast-feeding and declines 10 minutes later

The effects of cholecystojejunostomy and biliary drainage on biliary motor / 华中科技大学学报（医学）（英德文版）

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.

Ultrasonographic assessment of gall bladder kinetics in the elderly.

BACKGROUND: The incidence of gallstones increases with age but the factors that influence gallstone formation in the elderly are poorly understood. Proposed factors include changes in bile composition and hypomotility of the gall bladder. Studies on gall bladder motility in the elderly have provided conflicting results, and none has been reported from India. AIM: To determine gall bladder contractility in healthy elderly subjects and compare it with that in young healthy volunteers. METHODS: Thirty healthy elderly (above the age of 60 years) and 30 young volunteers with no abdominal complaints were studied. Using real-time ultrasonography and the ellipsoid method, gall bladder volume was measured after overnight fast and at 10, 20, 30, 40, 50 and 60 minutes after a standard fatty meal. Residual volume, delta volume and ejection fraction were calculated. RESULTS: Mean fasting gall bladder volume in elderly subjects was higher than that in young subjects (13.5 [5.8] mL vs 10.9 [3.6] mL; p < 0.05). However, there was no difference in the 60-min postprandial residual gall bladder volumes in the two groups. Change in gall bladder volume and ejection fraction were also similar in the two groups. CONCLUSION: There was no difference in gall bladder emptying between elderly and young subjects though the fasting gall bladder volume was higher in the elderly.

Delay in gallbladder emptying during the perimenopausal period

A pilot study has ascribed an important role in gallbladder motility and emptying to the perimenopausal period. To assess the effect of this period on gallbladder emptying and cholelithogenesis, 25 women in the perimenopausal period without gallbladder disease were submitted to cholangiography and two ultrasound exams. The time for gallbladder emptying and the presence of cholelithiasis were assessed. All patients presented a delay in gallbladder emptying with no relationship to the pre- or postmenopausal period. This finding was not related to lithogenesis. Gallbladder emptying time is longer during the perimenopausal period

Diabetic autonomic neuropathy causing gall bladder dysfunction.

OBJECTIVE: The objective of the study was to study gall bladder volume in fasting and 45 minutes post-prandial, by real time ultrasound in healthy controls and diabetic patients with and without autonomic neuropathy and to compare them. METHOD: Age, Sex and body mass index (BMI) matched 50 healthy subjects and 10 patients with insulin dependent diabetes mellitus and 40 patients with noninsulin dependent diabetes mellitus were evaluated according to National diabetes Data Group of National Institute of Health (1979) criteria: 1. Fasting (overnight) venous plasma glucose concentration of > 140 mg/dl on two separate occasions. 2. Following ingestion of 75 gms of glucose, venous plasma glucose concentration of > 200 mg/dl at second hour and at one other occasion during two hour test. Autonomic neuropathy was assessed by the presence of symptoms like dysphagia, abdominal fullness, nausea, vomiting, diarrhea +/- nocturnal, faecal incontinence or constipation, dysuria, urinary incontinence, the gustatory sweating, impotence etc. and were confirmed by standing test for orthostatic hypotension, hand grip test, Valsalva test and deep breaths test. RESULT: The study showed that: 1. Patients of diabetes mellitus had statistically significant larger fasting gall bladder volumes and these values were highly significant amongst patients with autonomic neuropathy. 2. Patients of diabetes mellitus and statistically significant larger post fatty meal gall bladder volume and these values were highly significant in patients with autonomic neuropathy. CONCLUSIONS: We therefore conclude that impaired gall bladder contraction was found amongst patients of diabetes mellitus with autonomic neuropathy. The mechanism responsible for cholecystoparesis is attributed to vagal neuropathy. Incomplete gall bladder emptying leads to sequestration of cholesterol and nidus formation. Therefore gall bladder functions should be evaluated routinely in such patients and early intervention is recommended.

Reproducibility of the ultrasound method for measurement of gallbladder volume

Nos ultimos anos a motilidade da vesicula biliar tem sido muito estudada. Como o metodo ultra-sonografico pode ser empregado em estudo de esvaziamento vesicular, reprodutibilidade deste método foi investigada no presente trabalho. A reprodutibilidade do método ultra-sonografico para a medida do volume da vesicula biliar foi considerada altamente aceitavel (r=0,97). Por ser inócua e näo exigir material radioativo, a ultra-sonografia constitui-se numa atraente opçäo para o estudo da motilidade vesicular em condiçöes associadas com aumento na frequência de colelitiase

Estudio del volumen y de la cinética del vaciamiento vesicular en mujeres nuligestas en embarazadas y puérperas / Study of gallbladder volumen and emptying kinetics in non-pregnant, in pregnant and in puerperium women

Gallbladder stats apparently plays an important role in the pathogenesis of cholelithiasis during pregnancy. On the other hand, gallstones diagnosed immediatly after delivery disappear spontaneously during late puerperium in one third of these patients. Gallbladder emptying was assessed by biliary scintigraphy and ultrasonography in normal, multiparous volunteers. The two methods had an excellent correlation: thence, we used ultrasonography to determine gallbladder volume and contraction in pregnant and puerperal women. Fasting and postpandrial residual volumes were significantly larger during pregnancy, while the kinetics of gallbladder emptying was similar in nulliparous and pregnant women. During puerperium, gallbladder volume returned to the values observed in nulliparae; but the kinetics of emptying was significantly faster, suggesting an increased sensitivity of gallbladder muscle to physiologic stimuli

Gall bladder dysmotility in diabetes mellitus--an ultrasound study.

Fifty two diabetic patients and 15 healthy control subjects were prospectively studied for their gall bladder function by ultrasound examination. The fasting gall bladder volume (FGBV) was calculated by using ellipse formula from the dimension of gall bladder shadow seen on ultrasound screen in two different cuts. The contractility of gall bladder was measured by calculating post prandial ejection fraction (EF) of the gall bladder. The mean FGBV and EF in 52 diabetic patients was found to be 20.7 +/- 10.7 cc and 47.5 +/- 20.1%, which was not significantly different from that in normal controls. Age, sex, obesity, diabetic control and presence of dyspeptic symptoms had no impact in FGBV and EF. Diabetic symptoms had no impact in FGBV and EF. However, diabetics with longer duration of disease had poorer gall bladder contractility (p < 0.05). Patients with autonomic neuropathy (AN) had significantly larger FGBV but normal contractility. Our results suggest that (a) long standing diabetics may have poor gall bladder emptying predisposing to gall stone formation (b) patients with autonomic neuropathy have reduced tone of fasting gall bladder but normal contractility.

Gall bladder volume and function in obese individuals

This study was carried out on 50 obese and 50 average weight females with normal laboratory investigations. Gallbladder volumes were measured in fasting state and 1 1/2 hours after a liquid fatty meal by ultrasonography. The incidence of gall stones in the obese group was 28% compared to 2% in non-obese group. The fasting gallbladder volume in the obese group was [32.7 +/- 8.9] which was significantly higher than non-obese group [16.1 +/- 2.7] and the postprandial volume was also higher in the obese [14.6 +/- 5.02] than non-obese group [2.9 +/- 1.07]. The cases with morbid obesity had significantly larger fasting volume than the rest of obese females [39.3 +/- 12.3 versus 27.7 +/- 4.9] and also larger postprandial volume [25.7 +/- 6.7 versus 11.7 +/- 4.03]. The incidence of gall stones in the morbidly obese was 40% compared to 14.3% in the rest of obese females. The volumes of gallbladder were also significantly higher in android obesity group compared to gynoid obesity, with a higher incidence of gall stones in the android group. It is concluded that gallbladder contractility is impaired in obese females especially in morbid obesity and android obesity