Gallstones cholecystectomy

The variant was found In a 22 year old woman with chronic hemolytic anemia characterized by a persistent retlculocytosls, development of gallstones requiring cholecystectomy, frequent episodes of jaundice, dark urine, and falling PCV value. Her mother, maternal grandfather, and sister have a similar clinical picture In all patients red cell enzymes are elevated with a retlculocytosls of about 10%, and 2,3-DPG levels are normal ... 

Dissolution of radiolucent, noncalcified gallstones when cholecystectomy is not recommended treatment of biliary cirrhosis PO 8-10 mg/kg/day in 2-3 divided doses. Treatment may require months. Obtain ultrasound image of gallbladder at 6-mo intervals for firsf year. If gallsfones have dissolved, confinue fherapy and repeat ultrasound within 1-3 mo. 

Bile should be collected from the gall bladder of patients undergoing cholecystectomy for symptomatic gallstone disease. Samples should be stored in sterile dark conditions at -80°C until analysis is performed. 

In the reported study, serum samples were withdrawn from healthy people and gallstone patients after cholecystectomy, and stored at -20°C. Bile samples were obtained from gallstone patients during laparoscopic cholecystectomy. Bile samples should be sterilised and stored at 4°C. 

Acute and chronic cholecystitis has been reported after floxuridine hepatic artery infusion (3). Chemotherapy in this patient was associated with persistent epigastric pain with radiation to the back which was not accompanied by any fever or white blood cell elevation. Cholecystectomy showed a shrunken, thickened fibrotic gallbladder that was filled with thick, pasty, hemorrhagic material. There were no gallstones. 

Studies of the relation between diuretic use and cholecystitis have yielded conflicting results. A significant association of thiazide use with acute cholecystitis was reported in a case-control study (18). However, others examined the association between the use of thiazides and cholecystectomy and failed to show a relation between the use of thiazides and gallstone disease, except possibly in women who are not overweight (19). 

Monoctanoin, an esterified glycerol, is used to solubilize cholesterol gallstones that are retained in the biliary tract after cholecystectomy. 

A recent study by Freedman et al. noted a moderately increased risk of EAC in patients who underwent cholecystectomy (CCK). There was no association of CCK with see of the esophagus. Patients with gallstone disease, who did not undergo CCK, did not have an increased incidence of EAC or SCC of the esophagus. It is postulated that after CCK, patients have increased reflux of bile and pancreatic juice from the duodenum to the stomach. This then reaches the esophageal mucosa, on which it has a toxic effect. Such toxic effects can predispose to the formation of EAC. Further studies are needed to identify a link between bile reflux and EAC. 

Shaffer, E.A., Braasch, J.W., Small, D.M. Bile composition at and after surgery in normal persons and patients with gallstones. Influence of cholecystectomy. New Engl. J. Med. 287, 1317-1322 (1972)... 

Barkun JS, Barkun AN, Sampahs JS, et al. Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet 1992 340(8828) 1116-9. 

NIH. Consensus development panel. Gallstones and laparoscopic cholecystectomy. (National Institutes of Health Consensus Development Panel on Gallstone and Laparoscopic Cholecystectomy). JAMA 1993 269(8) 1018—24. 

R. D. Adler, A. L. Metzger, and S. M. Grundy, Biliary lipid secretion before and after cholecystectomy in American indians with cholesterol gallstones. Gastroenterology, 66 1212-1217 (1974). 

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