Role Of Ultrasonography In Diagnosis Of Various Biliary System Pathologies

Background:Discuss the role of ultrasound in detecting various gallbladder and biliary tract pathologies in patients presenting as right upper quadrant/epigastric pain/obstructive jaundice especially in emergency situations and demonstrating the incidence of various gallbladder and biliary tract pathologies. Material And Methods:A retrospective observational study of 85 patients having upper abdominal/epigastric pain/obstructive jaundice was carried out at SVP Hospital, ahmedabad. Ultrasound was performed by using MINDRAY RESONA 6 machine. Both curvilinear and linear probes were used for the scanning.Result:The study included 85 patients with 50 female patients and 35 male patients.Most common pathology found was gallbladder calculus (47%). Female gender (72.5%) wasmore prone for having gallstones than male gender (27.5%). Gallstones were commonly associated with diffuse wall thickening and most common pathology associated with diffuse wall thickening was acute calculus and acalculous cholecystitis with both havinga frequency of 30 % each. Gallstones were found a common risk factor for gallbladder perforation as well as gallbladder malignancy. Common pathologies presenting with obstructive jaundice were CBD stones and CBD stricture in which distal CBD was the commonest site for the stones (39%) as well as stricture (50%).In paediatric age group presenting with jaundice common pathologies were choledochal cyst and biliary atresia.Conclusion:Ultrasound is a non-invasive, least expensive,highly sensitive imaging modality and free from radiation for the assessment of the gallbladder and biliary tree pathologies especially in emergency situations

Modified sham feeding and Congo red test in determining completeness of vagotomy.

Gastric acid response to modified sham feeding was evaluated in 14 patients with duodenal ulcer prior to vagotomy and in 18 patients after vagotomy. Nine patients in the latter group had recurrent ulcer, suggesting inadequate vagotomy. Based on values in the 32 tests (14 pre and 18 postoperative), cut-off levels of six secretory indices were selected to provide a specificity of 1.00 for the presence of ulcer. When applied separately to the 18 postoperative patients and to the 13 patients who underwent the endoscopic congo red test, observed volume of 75 ml/h and peak volume of 90 ml/h following sham feeding gave specificity, sensitivity and efficiency of 1.00 each in determining inadequate vagotomy. The endoscopic congo red test done in 13 post-vagotomy cases showed a sensitivity of 1.00, and high specificity (0.89) and efficiency (0.92). Measurement of crude gastric juice response to modified sham feeding is a convenient bedside test to confirm inadequate vagotomy. The endoscopic congo red test is also useful, especially as a screening test, and has the added advantage that it can be used intra-operatively.

Variations in normal hepatobiliary scintigraphy in Indian population.

Hepatobiliary scintigraphy was performed with Tc99m iminodiacetic acid (IDA) analog, in 100 apparently healthy adults, to study the variations in the normal hepatobiliary scintigraphy. Gall bladder (GB) was visualised in 43% at 15 min; 87% at 30 min, 90% at 45 min and 99% at 60 min and the small intestine (SI) was visualised in 24% at 15 min, 69% at 30 min, 76% at 45 min and 92% at 60 min. Left hepatic duct was prominent in 45%. Reciprocal relation between SI and GB was observed in 21%.