Estado nutricional, actividad física y consumo de comida chatarra asociados a colelitiasis en huánuco: estudio de casos y controles / Nutritional status, physical activity and consumption of junk food were associating to colelitiasis in huánuco: a case-control study

Resumen Objetivos: Determinar la asociación entre el consumo de comida chatarra, actividad física y estado nutricional en pacientes con colelitiasis a la ecografía (casos), comparados con controles aparentemente sanos sin colelitiasis a la ecografía, en consulta externa del Hospital EsSalud II Huánuco. Materiales y Método: Estudio de casos y controles. Se incluyeron 107 casos y 107 controles. El consumo de comida "chatarra" se valoró con la encuesta validada por RSEQ (Red deportiva estudiantil de Québec), la frecuencia del consumo (días por semana); la actividad física por el cuestionario IPAQ (Cuestionario Internacional de Actividad Física) y el estado nutricional mediante el índice de masa corporal. En el análisis estadístico se empleó el χ2, U de Mann Whitney y Odds Ratio (p < 0,05). Resultados: La edad y la procedencia no fueron significativos. El consumo de comida "chatarra" estuvo asociado a la colecistitis (OR 10,30; IC 95% 5,48-19,37). La actividad física moderada-vigorosa (≥ 600 MET) promovió el diagnóstico de colecistitis (OR 8,38; IC 95% 4,54-15,48) y el estado nutricional (sobrepeso o mayor), en forma significativa, promovía la colecistitis (OR 11,38; IC 95% 6,01-21,55). Ser femenino estuvo asociado al desarrollo de colecistitis (OR 2,06; IC 95% 1,19-3,55). Conclusión: El consumo de comida "chatarra", la actividad física moderada-vigorosa (≥ 600 MET), el estado nutricional (sobrepeso o mayor) y el género (femenino) fueron asociados al desarrollo de colelitiasis diagnosticados mediante ecografía.

Aim: To determine the association between junk food consumption, physical activity and nutritional status in patients with cholelithiasis on ultrasound (cases), compared with apparently healthy controls without cholelithiasis on ultrasound, in an outpatient EsSalud II Hospital, Huánuco Hospital, 2017. Materials and Method: Case-control study. 107 cases and 107 controls were included. The consumption of junk food was assessed with the survey validated by RSEQ (Québec Student Sports Network), the frequency of consumption (days per week); Physical activity through the IPAQ questionnaire (International Physical Activity Questionnaire) and nutritional status through the Body Mass Index. The chi-square, Mann Whitney U and Odds Ratio (p < 0.05) were used in the statistical analysis. Results: Gender, age and origin were not significant. None or low consumption of "junk" food were associated with cholecystitis (OR 0.097; 95% CI 0.052-0.182). Low physical activity (< 600 MET) did not promote the diagnosis of cholecystitis (OR 0.119; 95% CI 0.064-0.22) and the nutritional status (normal weight), significantly, did not promote cholecystitis (OR 0.09; 95% CI 0.05-0.167). Being male was associated with the non-development of cholecystitis (OR 0.48; 95% CI 0.281-0.838). Conclusión: Low or no consumption of "junk" food, low physical activity (< 600 MET), nutritional status (normal) and gender (male) were associated for the non-development of cholelithiasis diagnosed by ultrasound.

Colelitíase na infância e adolescência: abordagem diagnóstica e tratamento / Cholelithiasis in childhood and adolescence: diagnostic approach and treatment

Com exceção dos casos decorrentes de doença hemolítica crônica, a colelitíase biliar é pouco comum na infância e adolescência quando comparada aos adultos. No entanto, nas últimas décadas observou-se importante aumento da incidência da doença na pediatria, principalmente em adolescentes do sexo feminino. Os fatores de risco associados à colelitíase têm se assemelhado àqueles encontrados nos adultos e o cálculo de colesterol é o principal responsável pelo aumento da prevalência. Acredita-se que a maioria dos pacientes pediátricos com colelitíase biliar apresente sintomas inespecíficos; a cólica biliar típica é encontrada mais frequentemente em crianças mais velhas. O tratamento padrão para a colelitíase sintomática é o tratamento cirúrgico com retirada da vesícula biliar, sendo a colecistectomia videolaparoscópica preferível à cirurgia aberta devido ao menor tempo de recuperação e de internação hospitalar. Contudo, na colelitíase assintomática o tratamento deve ser individualizado, sendo indicada a cirurgia em casos selecionados. O objetivo desta revisão é apresentar os principais aspectos da doença calculosa biliar na infância e contribuir para maior suspeição clínica da doença entre os pediatras, aprimorando a abordagem diagnóstica e a definição terapêutica adequada.

Excluding the cases resulting from chronic hemolytic disease, cholelithiasis is uncommon in childhood and adolescence when compared to adults. However, in recent decades there has been noted an increased incidence of the disease in pediatrics, especially in female adolescents. The risk factors associated with cholelithiasis have been similar to those found in adults and cholesterol stones are the main responsible for the increase of the prevalence. The majority of pediatric patients with cholelithiasis have no specific symptoms; typical biliary colic is found more often among older children. The standard treatment for symptomatic cholelithiasis is surgery to remove the gallbladder; the laparoscopic cholecystectomy is preferable to open surgery because of the shorter recovery time and hospital stay. However, in asymptomatic cholelithiasis treatment must be individualized and surgery is indicated in selected cases. The aim of this review is to present the main aspects of gallstone disease in childhood and contribute to greater clinical suspicion of the disease among pediatricians, improving the diagnostic approach and the appropriate therapeutic definition.

Diagnostic and therapeutic cholangioscopy in biliary diseases: a prospective study in Peru / Uso diagnóstico y terapéutico de la colangioscopía en enfermedades de la vía biliar: un estudio prospectivo en Perú

Introduction: Cholangioscopy is a test that allows the evaluation of the biliary epithelium. It is used for diagnosis and management of biliary diseases. Objectives: Determine the success rate of complete removal of difficult stones with the use of laser lithotripsy through cholangioscopy as well as its complications. Determine the visual impression accuracy of bile duct injuries. Materials and methods: This is a prospective and descriptive study. We included 39 patients between July 2016 and July 2017 with diagnosis of difficult stones in the biliary tract and indeterminate stenosis of the biliary tract that were submitted to cholangioscopy. Results: Success rate of complete removal of difficult stones was 65.3%, there was one complication. Two laser sessions were required in 4 of the 17 patients who obtained complete removal of the stones. The visual impression accuracy of lesions in the bile duct to determine malignancy coincided in all cases with the final diagnosis of the patient. Conclusions: Laser lithotripsy allows a safe and effective treatment of the difficult stones of the bile duct. Precession of visual impression of lesions in the bile duct is very high.

Introducción: La colangioscopía es un examen que permite evaluar la luz biliar, el epitelio biliar y sirve para diagnóstico y manejo de enfermedades de la vía biliar. Objetivos: Determinar la tasa de éxito de remoción completa de cálculos difíciles con el uso de litotripcia con láser a través de la colangioscopía asi como las complicaciones de ésta. Determinar la precisión de impresión visual de lesiones de la vía bilar. Materiales y métodos: Estudio prospectivo, descriptivo. Se incluyeron a 39 pacientes entre Julio 2016 a Julio 2017 con diagnóstico de cálculo difícil en la vía biliar y estenosis indeterminada de la vía biliar que fueron sometidos a colangioscopía. Resultados: La tasa de éxito de remoción completa de cálculos difíciles fue de 65,3% con una complicación. Se requirió de dos sesiones con láser en 4 de los 17 pacientes que obtuvieron remoción completa de cálculos. La precisión de impresión visual de lesiones en la vía biliar para determinar malignidad coincidió en todos los casos con el diagnóstico final del paciente. Conclusiones: La colangioscopía con uso de litotripcia con láser permite un tratamiento seguro y eficaz en los cálculos difíciles de la vía biliar. La precesión de la impresión visual de lesiones en la vía biliar es muy alta.

Vólvulo de vesícula biliar / Gallbladder volvulus

El vólvulo de la vesícula biliar es una enfermedad rara y poco frecuente de difícil diagnóstico de manera preoperatoria, ya que las manifestaciones clínicas son atribuidas a otras enfermedades. Se presenta un caso de una paciente femenina de 84años de edad que ingresó en el servicio de cirugía general con un cuadro de dolor abdominal a tipo cólico en hipocondrio derecho acompañado de náusea y vómitos con restos de alimentos. Se realizó examen físico y se indicó ultrasonido abdominal. Se interpretó como una colecistitis aguda litiásica. Se impuso un tratamiento con ceftriaxone. Dado su evolución no desfavorable, cinco días después de su ingreso se realizó la colecistectomía donde se encuentra órgano volvulado. La biopsia confirma colecistitis aguda gangrenada. La paciente evolucionó satisfactoriamente. Tres días posteriores a la cirugía egresó de la institución(AU)

Gallbladder volvulus is a rare and infrequent disease difficult to diagnose preoperatively, as clinical manifestations are attributed to other diseases. A case is presented of an 84-year-old female patient who entered the general surgery service with abdominal colicky pain to the right hypochondrium accompanied by nausea and vomiting with food remains. A physical examination was performed and abdominal ultrasound was indicated. It was interpreted as acute lithiasic cholecystitis. Ceftriaxone was prescribed. Given the unfavorable evolution five days after admission, the cholecystectomy was performed, where the volvulus was found. The biopsy confirms acute gangrenous cholecystitis. The patient evolved satisfactorily. Three days after the surgery he was discharged from the institution(AU)

Clinical Significance of Biliary Dilatation and Cholelithiasis after Subtotal Gastrectomy / 대한소화기학회지

BACKGROUND/AIMS: The well-organized study to support that increased cholelithiasis and bile duct dilatation can occur after gastrectomy has not been reported. The aim of this study was to determine the incidence of cholelithiasis and the degree of common bile duct (CBD) dilatation in patients undergoing subtotal gastrectomy, compared to those undergoing endoscopic treatment for gastric cancer. METHODS: Patients who diagnosed with gastric cancer and received treatment at six academic referral centers were investigated for the incidence and time of cholelithiasis and the degree of CBD dilatation after treatment by analysis of 5-year follow-up CTs. The operation group underwent subtotal gastrectomy without vagotomy, while in the control group endoscopic treatment was administered for gastric cancer. RESULTS: A total of 802 patients were enrolled in 5-year analysis (735 patients in the operation group and 67 patients in the control group). Cholelithiasis occurred in 47 patients (6.39%) in the operation group and 3 patients (4.48%) in the control group (p=0.7909). The incidences of cholelithiasis were 4.28% in Billoth-I and 7.89% in Billoth-II (p=0.0487). The diameter of proximal CBD and distal CBD increased by 1.11 mm and 1.41 mm, respectively, in the operation group, compared to 0.4 mm and 0.38 mm, respectively, in the control group (p<0.05). Patients with increased CBD dilatation more than 5 mm showed statistically significant increases in alkaline phosphatase and gamma-glutamyltransferase. CONCLUSIONS: The incidence of cholelithiasis was not increased due to subtotal gastrectomy without vagotomy, but the incidence was higher after Billoth-II compared to Billoth-I. In addition, significant change in the CBD diameter was observed after subtotal gastrectomy.

Colelitiasis fetal congénita / Congenital fetal cholelithiasis

La colelitiasis fetal es una patología poco frecuente, diagnosticada incidentalmente en el tercer trimestre del embarazo por medio de ecografía. Se ha reportado una incidencia entre 0,3 a 2,3% y una prevalencia de 1:200 a 1:1500. Potter fue el primero en reportar en 1928 un caso de colelitiasis congénita y neonatal, por medio de hallazgos anatomopatológicos que encontró en el período neonatal. En 1983 fue la colelitiasis fetal fue diagnosticada por primera vez por Beretsky y Lankin y desde entonces pocos autores han reportado sobre esta patología...

Intervenciones de enfermería en la atención del adulto con colelitiasis y colecistitis crónica agudizada / Interventions Nursing Care Adult Chronic cholecystitis with cholelithiasis erxacerbated

Introducción. Los trastornos de la vía biliar afectan una proporción importante de la población mundial; más del 95% son atribuibles a la colecistitis aguda. La principal manifestación es el dolor agudo abdominal por lo que el 50% de los pacientes han tenido este síntoma al menos 48 horas antes de su ingreso.Método. Se realizaron cuatro búsquedas sistematizadas de información donde arrojo meta análisis, ensayos clínicos aleatorizados y/o estudios de cohorte publicados que dieron respuesta a las preguntas planteadas, de los cuales se seleccionaran las fuentes con mayor puntaje obtenido, en la evaluación de su metodología, las de mayor nivel en cuanto a gradación de evidencias y recomendaciones.Resultado. El signo de Murphy positivo en la colecistitis presenta una sensibilidad del 97%; el 95% de la colecistitis se asocia con la colelitiasis y aumenta riesgo de complicaciones, la Escala Visual Análoga (EVA) permite establecer una base de control y alivio del dolor y del 1 al 3% de las mujeres embarazadas presentan litios vesiculares.Conclusión. La colecistitis aguda ocurre entre los 30 y 80 años, siendo más frecuente en mujeres, es de importancia la valoración de los signos y síntomas, además de identificar complicaciones secundarias con la finalidad que el personal de enfermería elabore un plan de cuidados especifico ante los problemas reales del paciente, contemplando intervenciones en la ministración de medicamentos, preparación quirúrgica garantizando la seguridad del paciente y cuidados postquirúrgicos para minimizar factores de riesgo de infección y las recomendaciones del autocuidado para su egreso.

Introduction. The biliary disorders affect a significant proportion of the world population; more than 95% are attributable to acute cholecystitis. The main manifestation is abdominal pain so sharp 50% of patients have this symptom at least 48 hours before admission.Method. Four systematized information searches were performed which threw meta-analysis, randomized clinical trials and / or studies published cohort that provided answers to the questions, of which the sources were selected with the highest score obtained in the evaluation methodology ,the highest level as to grading evidence and recommendations.Result. The positive sign of cholecystitis Murphy has a sensitivity of 97%; 95% of cholecystitis and cholelithiasis associated with increased risk of complications, the Visual Analogue Scale (VAS) allows us to set a base control and pain relief and 1 to 3% of pregnant women have vesicular lithiums.Conclusion. Acute cholecystitis occurs between 30 and 80 years, being more common in women, it is important the assessment of signs and symptoms, and identify secondary complications in order that nurses develop a specific plan of care to actual problems of the patient, contemplating interventions in the ministration of medicines, surgical preparation ensuring patient safety and postoperative care to minimize infection risk factors and recommendations for self discharge.

Introdução. Os distúrbios biliares afetar uma proporção significativa da população mundial; mais de 95% são atribuíveis a colecistite aguda. A principal manifestação é a dor abdominal tão acentuada de 50% dos pacientes apresentam este síntoma pelo menos 48 horas antes da admissão.Método. quatro informações sistematizadas pesquisas onde eu jogo meta-análise, ensaios clínicos randomizados e / ou estudos publicados coorte que forneceram respostas para as perguntas, das quais as fontes foram selecionados com a maior pontuação obtida na metodologia de avaliação foram feitas, maior nível de evidências e recomendações de classificação.Resultado. O sinal positivo de colecistite Murphy tem uma sensibilidade de 97%; 95% de colecistite e colelitíase associada ao aumento do risco de complicações, a Escala Analógica Visual (VAS) permite que você defina um controle base e alívio da dor e 1 a 3% das mulheres grávidas têm lithiums vesiculares.Conclusão. colecistite aguda ocorre entre 30 e 80 anos, sendo mais comum em mulheres, é importante a avaliação de sinais e sintomas, e identificar complicações secundárias com as enfermeiras objectivo q desenvolver um plano específico de atendimento a problemas paciente real, contemplando intervenções no ministério de medicamentos, preparo cirúrgico, garantindo a segurança do paciente e cuidados pós-operatórios para minimizar os fatores de risco de infecção e recomendações para a auto descarga.

Cholelithiasis in children: a single centre experience

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. Our objective is to describe epidemiological aspects, clinical aspects and aetiologies as well as to evaluate the management of cholelithiasis in our centre; a paediatric hospital in Sfax in Tunisia. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1979 and 2008 in the paediatric department of H‚di Chaker University Hospital [Sfax Tunisia]. Cholelithiasis was detected in 19 patients, including 9 males and 10 females. The median age at diagnosis was 7.8 years [range: 6months to 15 years]. The associated conditions were haemolytic diseases in seven cases; hepatobiliary diseases in five; growth hormone deficiency in two; and dehydration. Down syndrome, immunoglobulin A deficiency and hypocalcaemia in one case. However, in one patient no associated condition was detected. Ultrasound was used for diagnosis in all the patients. Thirteen patients had no cholelithiasis associated symptoms and 6 patients were symptomatizing. The most frequent symptoms were abdominal pain, either with or without vomiting or jaundice. Thirteen patients underwent surgery [open cholecystectomy in seven and laparoscopic cholecytectomy in six patients]. In a single patient, immediate surgery was indicated but was not possible because of haemodynamic instability. Cholelithiasis is an increasingly recognized disease in children. It is often associated with chronic haemolysis and hereditary hepatobiliary disease in Tunisia. Even though it is more frequently non-symptomatizing, the gallstones must be removed in the majority of cases

Biliary stones: an atypical cause of abdominal pain in paediatric age group

To identify Paediatric patients with biliary stone disease presenting to a tertiary care hospital in order to determine the etiology, presentation and management. Retrospective study of all cases of ultrasonographically proven biliary stones under the age of 15 years from January 1988 to December 2008. Data included their risk factors, complications, management and outcome. Total 32 patients were identified with biliary stones, treated in the hospital. Mean age at presentation was 8.25 +/- 3.33 years. Sixteen patients underwent cholecystectomy. Paediatric cholelithiasis is an atypical and under-diagnosed cause of abdominal pain in childhood. True prevalence of the disease may be higher than reported. Appropriate surgical intervention is required in patients with symptomatic and complicated biliary lithiasis

Cholelithiasis on imaging: an analysis of clinical presentations by age and gender in a jamaican population / La colelitiasis en imágenes: un análisis de presentaciones clínicas por edad y género en una población jamaicana

OBJECTIVE: This study is a descriptive analysis of the clinical presentations in which cholelithiasis was diagnosed on imaging over a five-year period at the University Hospital of the West Indies, Jamaica and how the clinical presentation varied with age and gender. METHOD: A retrospective review was done of all cases of cholelithiasis recorded in the reports of the Radiology section during the period January 1, 2002 to December 31, 2006. Patients'age and gender were noted. Each case was assigned to one of four clinical categories based on the clinical scenario at the time of referral for imaging: Acute abdomen-Incidental: (not referable to the biliary tract); Acute abdomen-Biliary (biliary colic/acute cholecystitis); Non-acute-Incidental: (not referable to the biliary tract) and Non-acute-Biliary (suspected cholelithiasis). The data were analyzed using post-hoc cross-tabulations, ANOVA, and post-hoc Tukey-tests. RESULTS: Three hundred and forty-four females and 137 males were diagnosed with cholelithiasis with the mean age at diagnosis being 49 and 50 years respectively. Females were diagnosed with cholelithiasis at higher rates in the context of acute abdominal symptoms both referable and unrelated to the biliary tract, while males were diagnosed at higher rates as an incidental finding in a non-acute presentation. There was no significant difference between the genders in the rate ofdiagnosis of cholelithiasis when this was suspected clinically in the non-acute setting. CONCLUSION: More females were diagnosed with cholelithiasis. There was no gender-related difference in the mean age at which cholelithiasis was diagnosed. There were statistically significant differences between the genders in the rates at which cholelithiasis was identified in different clinical scenarios.

OBJETIVO: Este estudio constituye un análisis descriptivo de las presentaciones clínicas en las que se diagnosticó colelitiasis a partir de imágenes médicas por un período de cinco años en el Hospital Universitario de West Indies, Mona, Jamaica. También se analiza como la presentación clínica varió de acuerdo con la edad y el género. MÉTODO: Se llevó a cabo una revisión retrospectiva de toda la serie de casos de colelitiasis registrados en los reportes de la Sección de Radiología, durante el período del lero de enero de 2002 al 31 de diciembre de 2006. Se señaló la edad y el género de los pacientes. Cada caso fue asignado a una de cuatro categorías clínicas sobre la base del escenario clínico en el momento de la remisión para el examen mediante imagen: Abdomen agudo - Incidental: (no referible al tracto biliar); Abdomen agudo - Biliar: (cólico biliar/colecistitis aguda); No agudo - Incidental: (no referible al tracto biliar) and No agudo - Biliar: (sospecha de colelitiasis) Los datos fueron analizados utilizando tabulaciones cruzadas post-hoc, ANOVA, y el Turkey-test post hoc. RESULTADOS: A trescientos cuarenta y cuatro hembras y 137 varones, se les diagnosticó colelitiasis, siendo la edad promedio en el momento del diagnóstico 40 y 50 años respectivamente. A las mujeres se les diagnosticó colelitiasis con tasas más elevadas en el contexto de los síntomas abdominales agudos tanto referibles como no relacionados al tracto biliar, mientras que los varones fueron diagnosticados con tasas más altas como hallazgo incidental en una presentación no aguda. No hubo diferencia significativa entre los géneros en la tasa de diagnóstico de colelitiasis cuando se sospechaba clínicamente de ella en el escenario no agudo. CONCLUSIÓN: Más mujeres fueron diagnósticadas con colelitiasis. No hubo diferencias en relación con el género en la edad promedio a la que la colelitiasis fue diagnosticada. No hubo diferencias estadísticamente significativas entre el género en las tasas en las cuales la colelitiasis fue identificada en diferentes escenarios clínicos.

Síndrome de Bouveret: Resolución endóscopica y quirúrgica de cuatro casos clínicos / Bouveret syndrome: Report of four cases

Bouveret syndrome is a duodenal obstruction caused by a biliary stone. Aim: To report patients with Bouveret syndrome. Material and Methods: Retrospective review of medical records of patients with Bouveret syndrome treated between 1976 and 2006. Results: We report three women and one man with a mean age of 62.5 years. None had a previous diagnosis of cholelithiasis. AH presented with colicky pain in the right upper quadrant and vomiting, suggesting gastric retention. The diagnosis was suspected after a barium meal in two patients and with a CT scan on the other two. The endoscopical extraction or fragmentation of stones was attempted in three patients but was successful only in one. Three patients were operated and a stone impacted in the first portion of the duodenum was identified, along with a cholecystoduodenal fistula. A duodenostomy and stone extraction was performed. One patient was subjected to a cholecystectomy fistula repair and gastrojejunoanastomosis. No patient died and all were discharged within 8 to 12 days after surgery. Conclusions: Bouveret syndrome is an uncommon complication of cholelithiasis. Endoscopy can be diagnostic and therapeutic. Surgery is the other therapeutic option.

Ectopic partial intrahepatic gall bladder with cholelithiasis--a rare anomaly.

The study was aimed to view the developmental anomalies of gall bladder (GB) in Nepalese cadavers. Forty GBs were studied for any anomalies during routine cadaveric dissection at the Department of Anatomy, Manipal College of Medical Sciences, Nepal. The study found that the congenital anomalies of GB are very rare. Only one case of ectopic partial intrahepatic GB with cholelithiasis was observed, which to our knowledge is the first reported case in Nepal. Awareness of GB anomalies is important to surgeons, radiologists, and clinicians in general. An ectopic partial intrahepatic GB can make cholecystectomy hazardous, when indicated.

Colelitíase assintomática: quando operar? / Asymptomatic cholelithiasis: when make surgery?

A colelitíase pode apresentar-se de três formas: assintomática, sintomática e complicada. A forma assintomática, cuja conduta é controvertida, vem sendo identificada com maior freqüência. Com o objetivo de apurar as condutas de gastroenterologistas e cirurgiões frente ao diagnóstico de colelitíase assintomática e chegar a um consenso, enviamos um questionário com 21 quesitos a especialistas, sendo 23 gastroenterologistas, 108 cirurgiões gerais e 101 cirurgiões do aparelho digestivo. Houve ampla concordância entre os especialistas quanto à indicação de colecistectomia nos seguintes quesitos: confiam no diagnóstico da ultra-sonografia; cálculos abaixo de 0,5cm, assim como acima de 2cm; vesícula em porcelana; pacientes abaixo de 20 anos; portadores de anemia falciforme e diabetes e concomitante à laparotomia por causa não biliar, utilizando a mesma incisão. Apenas cirurgiões gerais e do aparelho digestivo indicam colecistectomia: nos pacientes assintomáticos acima de 60 anos; na presença de obesidade mórbida, de dois ou mais fatores de risco para calculose; na cirurgia abdominal com necessidade de ampliar a incisão; nos pacientes com sintomas dispépticos e endoscopia normal, refratários ao tratamento clínico ou com sintomas atípicos; na mulher com perspectiva de futura gravidez e conforme o desejo do paciente. Em pacientes assintomáticos acima de 70 anos, apenas os cirurgiões do aparelho digestivo indicam colecistectomia. Os profissionais concordam com a não-indicação de colecistectomia nos candidatos a transplante hepático. Verificamos, portanto, que há concordância na conduta em 11 dos 21 quesitos pesquisados (52,3%),havendo divergência nos itens restantes (47,7%). Deste modo, é plausível afirmar, em concordância com a literatura, ainda não ser possível estabelecer um protocolo de condutas frente à colelitíase assintomática que satisfaça a clínicos e cirurgiões.

Cholelithiasis can present in three ways: asymptomatic, symptomatic and complicated. management of asymptomatic patients is often controversial. With the aim of identifying the of gastroenterologists and surgeons facing the diagnosis of asymptomatic cholelithiasis and establish a consensus, we sent a questionnaire with 21 questions to 23 gastroenterologists, 108 surgeons and 101 surgeons general of the digestive tract. Participants in the study agreed on the indication of cholecystectomy in the following situations: ultrasonographic diagnosis of cholelithiasis; gallstones below 0.5 cm, and above 2cm; porcelain gallbladder; patients below 20 years; carriers of sickle cell anemia and diabetes, and concomitant laparotomy due to other than a biliary reason, using the same incision. Only surgeons general and digestive tract surgeons indicate cholecystectomy: in asymptomatic patients over 60 years, in morbidly obese, in the presence of two or more risk factors for cholelithiasis; abdominal surgery with the need to enlarge the incision; in patients with dyspeptics symptoms and normal endoscopy, refractory to clinical treatment or with atypical symptoms, in women with prospect of future pregnancies, and a patient's wish. In asymptomatic patients over 70 years, only the surgeons of the digestive tract indicate cholecystectomy. Professionals agree on the non-cholecystectomy indication of the candidates for liver transplantation. We note, therefore, that there is agreement on of the 21 itens surveyed subjets(52.3%), with divergence in the remaining items (47.7%). Thus, in agreement with the literature, it is not yet possible to establish a consensus for treatment of asymptomatic cholelithiasis.

Carcinoma gall bladder : an institutional experience.

This is a retrospective study of histologically proven cases of carcinoma of the gall bladder presenting to Bhaktapur Cancer Hospital and Om Hospital and Research center, Nepal, over a period of four years, from January 1999 to December 2003. The aim of this study was to review outcome of management and staging of cancer of gall bladder presenting to a specialist cancer centre. Sixty Eight patients presented over this time period; 57% presented with biliary tract symptoms and 49% had a history of chronic cholelithiasis. Twenty one patients presented with apparently resectable disease, but only those undergoing radical surgery demonstrated long term survival. Adjuvant therapies did not have any influence on outcomes. Palliative treatments, notably chemotherapy, showed some response. Besides radical surgery in truly operable cases, current treatments make little impact on this disease. Gall bladder cancer is one of the common biliary tract malignancy and demonstrates marked geographical variation. Its incidence appears to be reasonably common in Nepal. Treatment options have limited efficacy. Randomised data is urgently needed and a number of potential trials are suggested.

Isolated cystic duct lymph node tuberculosis.

Tuberculosis of the cystic duct lymph node without involvement of gall bladder is exceedingly rare. Cholelithiasis is a usual accompaniment. A case of 65-year-old woman was diagnosed to have cholelithiasis. Laparoscopic cholecystectomy was performed and a prominent cystic lymph node was excised for biopsy. Histopathology surprisingly reported tuberculosis of cystic duct lymph node without affecting the gall bladder. Thereupon, she was treated with antituberculous chemotherapy.

Study of gall bladder contractility and prevalence of gallstones in Egyptian patients with liver cirrhosis

Gall bladder stones are considered a public health problem allover the world. Many factors have been proposed to explain the increased incidence of gallstones in liver cirrhosis as alcoholism, changes in total bile acid pool, decreased cholesterol secretion, hemolysis secondary to hypersplenism, increased oestrogen levels and changes in gall bladder and sphincter of Oddi motility, but the exact mechanism has not been yet elicited. Our objective was to study gall bladder contractility and prevalence of gallstones in patients with liver cirrhosis in addition to analysis of the effect of portal hypertension on these two parameters. Eighty patients with chronic liver disease were enrolled [60 patients with liver cirrhosis and 20 patients with pure hepatosplenic schistosomiasis]. Ultrasonographic diagnosis of gallstones with evaluation of gall bladder contractility and portal hypertension were done. An increase in the number of subjects with gallstones with an increase of gall bladder fasting volume and residual volume with a decrease in gall bladder ejection fraction in the patients than the controls. Also there was an increase in the percentage of patients with gallstones among those with higher grades of portal hypertension. Patients with liver cirrhosis have higher frequency of gallstones with diminished gall bladder contractility and higher measures of portal hypertension

Open and mini cholecystectomy [comparative study]

Cholelithiasis is the most common biliary pathology. Patients complain of recurrent attacks of epigastric or right hypochondrial pain, often radiating to the right side of back, associated with nausea and vomiting. To compare the 2 procedures i.e. conventional and mini cholecystectomy regarding postoperative pain, hospital stay and cosmetics. The study was carried out in Nishtar Hospital, Multan from May 2006 to June 2007. A total of 60 cases [30 cases underwent conventional cholecystectomy and other 30 cases underwent mini cholecystectomy]. Out of 60 patients, 18 [30%] were of < 40 years, 18 [30%] between 41-50 years and remaining 24 [40%] were of > 50 years. 48 [80%] patients were female while 12 [20%] were male. Among 30 patients of conventional cholecystectomy average hospital stay was 6.5 days while among 30 patients of mini-cholecystectomy average hospital stay was 3.3 days. Among 30 patients of conventional cholecystectomy severe postoperative pain was found in 18 [60%], moderate postoperative pain in 9 [30%] while mild postoperative pain in 3 [10%] of patients. In remaining 30 patients of mini-cholecystectomy severe postoperative pain was found in 12 [40%], moderate postoperative pain in 6 [20%] while mild postoperative pain in 12 [40%] of patients. Among 30 patients undergoing conventional cholecystectomy, all the patients developed bad looking scar while in remaining 30 patients undergoing mini-cholecystectomy, all patients developed good looking scar. Mini-cholecystectomy is associated with less patients discomfort and decreased incidence of postoperative complications, short hospital stay, good cosmetic results. Mini-cholecystectomy also has the advantage that it neither requires expensive new equipment nor the acquisition of novel skills by the surgeon

Prevalencia de colelitiasis en niños y adolescentes: Hospital Militar Dr. Carlos Arvelo 2203-2005 / Cholelithiasis prevalence in children and adolescent: Military Hospital 2003-2005

La colelitiasis en niños y adolescentes está siendo reconocida más frecuentemente ahora que en el pasado, debido al consenso de los métodos, diagnósticos por imágenes en estos últimos años. Determinar la prevalencia de la colelitiasis en niños y adolecentes en el Departamento de Pediatría del Hospital Militar. Estudio retrospectivo descriptivo de 21 pacientes que ingresaron a nuestro Departamento, con diagnóstico de colelitiasis o colecistitis aguda litiásica, entre Diciembre 2003 a Diciembre 2005. Se analizaron por: edad, sexo, cuadro clínico, diagnóstico, tratamiento y complicaciones. La edad predominante se ubicó entre los 12 y 16 años. 14/21 (66,66 por ciento) pacientes fueron del sexo femenino, 8 de las cuales eran obesas, el 76,19 porciento 16/21, el síntoma clínico predominante fue el dolor abdominal recurrente 76,19 por ciento 100 por ciento 21/21 se les hizo ecografía y permitió el diagnóstico en el 100 porciento de los casos. Fueron intervenidos quirúrgicamente 17 pacientes, en 15/21 se practicó colecistectomía abierta. debe considerarse el diagnóstico en niños y adolescentes con dolor abdominal recurrente que tengan factores de riesgo tales como la obesidad. El tratamiento de elección sintomática es la intervención quirúrgica.