Subject(s)
Ribavirin , Ritonavir , Antiviral Agents , Hepatitis C, Chronic , Humans , Liver Failure, AcuteSubject(s)
Clinical Competence , Esophageal Achalasia/surgery , Esophagus/surgery , Learning Curve , Muscle, Smooth/surgery , Natural Orifice Endoscopic Surgery/education , Adult , Aged , Esophageal Achalasia/diagnosis , Esophageal Achalasia/physiopathology , Esophagus/physiopathology , Female , Humans , Male , Middle Aged , Muscle, Smooth/physiopathology , Natural Orifice Endoscopic Surgery/adverse effects , Natural Orifice Endoscopic Surgery/methods , Postoperative Complications/etiology , Recovery of Function , Treatment Outcome , Young AdultABSTRACT
AIM: To compare gallbladder (GB) emptying in patients with chronic hepatitis C and in those with HCV related cirrhosis. METHOD: 20 patients with HCV chronic hepatitis and 20 patients with HCV cirrhosis Child class A were enrolled in the study. The control group included 20 hospitalized patients free of liver disease. We excluded subjects with GB lithiasis or GB anomalies, and those with obesity and diabetes mellitus. In all patients, the following GB variables were measured: fasting volume (FV), minimal residual volume (RV), ejection fraction (EF), wall thickness and area under the emptying curve (AUC). The statistical analysis was performed using the Man-Whitney and Kruskal-Wallis tests and the Pearson correlation coefficient. RESULTS: In cirrhotic patients, the fasting GB volume (35.62 +/- 4.45cm3) and the residual volume (18.46 +/- 3.27cm3) were larger than in controls: 27.12 +/- 5.38cm3 and 7.28 +/- 3.15cm3, respectively (p < 0.00001). The GB EF was reduced in cirrhotics as compared to controls (p < 0.00001). The patients with HCV chronic hepatitis had a residual volume larger (14.18 +/- 6.11cm3 vs 7.28 +/- 3.15cm3; p = 0.0129), and an EF lower than controls (53.4 +/- 14.15cm3 vs. 72.76 +/- 9.96cm3) (p = 0.0005). The GB emptying curves showed a significantly slower emptying in cirrhotic and chronic hepatitis patients as compared to controls. We found a significant negative correlation in chronic hepatitis patients between EF, on one hand, and overweight and abdominal circumference, on the other. The GB wall was thicker in cirrhotics (5.1 +/- 0.32mm) as compared to controls (2.32 +/- 0.27mm) (p < 0.00001), and also in chronic hepatitis patients as compared to controls (p < 0.0001). CONCLUSION: A decrease in GB motility was present both in patients with HCV related cirrhosis and in those with chronic HCV hepatitis. This may be, partly, caused by an increase in GB wall thickness, and might be a risk factor for the development of gallstones.
Subject(s)
Gallbladder Emptying , Gallbladder/physiopathology , Gallstones , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/physiopathology , Liver Cirrhosis/physiopathology , Female , Gallbladder/pathology , Gallstones/epidemiology , Gallstones/etiology , Gallstones/pathology , Gallstones/physiopathology , Hepatitis C, Chronic/epidemiology , Hepatitis C, Chronic/pathology , Humans , Liver Cirrhosis/epidemiology , Liver Cirrhosis/etiology , Liver Cirrhosis/pathology , Male , Middle Aged , Risk Factors , Severity of Illness Index , Statistics, NonparametricABSTRACT
Budd-Chiari syndrome still represents a challenge for the hepatologist with regard to its causes and its most effective therapy. Polycythemia vera is considered to be the most frequent condition causing the Budd-Chiari syndrome (10-40% of cases). We present a 34-year-old patient in post-partum who was admitted for right upper abdominal quadrant pain and asthenia. Laboratory data, abdominal echography and angioMRI all raised the suspicion of BCS, but it was in the haematological department that polycytemia vera was diagnosed as the cause of the hepatic condition.
