Stones biliary

O The most common causes of acute and chronic pancreatitis in adults are ethanol abuse and biliary stones. 

Treatment of chronic pancreatitis is aimed at removing the cause (ethanol abuse or biliary stones), providing analgesia, supplementing with pancreatic enzyme preparations, and implementing dietary restrictions. 

In patients with normal gallbladder function, effective agents for eradication of chronic carriage include amoxicillin (3 g divided three times a day in adults for 3 months), trimethoprim-sulfamethoxazole (one double-strength tablet twice a day for 3 months), and ciprofloxacin (750 mg twice daily for 4 weeks). In patients with anatomic abnormalities, such as biliary or kidney stones, surgery combined with antibiotic therapy is indicated. 

Biliary sludge A deposit of tiny stones or crystals made up of cholesterol, calcium bilirubinate, and other calcium salts. The cholesterol and calcium bilirubinate crystals in biliary sludge can lead to gallstone formation. 

Cholecystectomy Enteric gram-negative bacilli, anaerobes Cefazolin 1 g x 1 for high-risk patients Laparoscopic None High-risk patients only (acute cholecystitis, common duct stones, previous biliary surgeiy, jaundice, age >60 years, obesity, diabetes mellitus) IA... 

Biliary cholesterol saturation index (CSI) in nonacromegalic patients with cholesterol GBS (CH-GBS), acromegalic patients with Octreotide-associated GBS (OT-GBS), and stone-free patients before Octreotide treatment (No OT-GBS). "Hie value of CSI = 1.0 indicates the limit of cholesterol solubility points above the line are supersaturated, whereas those below the line are unsaturated with cholesterol. (All graphs show mean values SEMs.) Data taken from reference 18. 

When the proportion of biliary DCA, expressed as a percentage of total bile acids, was measured in the same three groups of individuals in the Octreotide studies, a similar pattern of results was found to that described above for bile lipids - namely, low values (approximately 12%) in the so-called controls and significantly higher values (approximately 24%) in the two groups of stone carriers. ... 

Age > 60, acute cholecystitis, prior biliary tract surgery, common duct stones, jaundice, or diabetes mellitus. 

It is important to avoid alarmist or defeatist extremes of attitude. Many treatments are dangerous, e.g. surgery, electroshock, drugs, and it is irrational to accept the risks of surgery for biliary stones or hernia and refuse to accept any risk at all from drugs for conditions of comparable seriousness. 

The periphery, e.g. distension or irritation of the gut, myocardial infarction, biliary or renal stone... 

In cases of mechanical jaundice, not only the location of the obstruction in the biliary tract is determinable, but usually the type and extent of the (partial or complete) obstruction as well. (s. fig. 8.14) As a result, a decision can often be taken during the same examination concerning causal or palliative treatment. The coagulation parameters should be within a range which renders papillotomy, stone extraction or tissue biopsy possible without danger to the patient. 

Barek, L., Orron, D.E., Behar, D.J. Hepatic abscesses due to occult biliary stones. J. Comput. Assist. Tomogr. 1987 11 31—34... 

Edelman, K. Multiple pyogenic hver abscesses communicating with the biliary tree treatment by endoscopic stenting and stone removal. Amer. J. Gastroenterol. 1994 89 2070-2072... 

Ceftriaxone does not seem to predispose to subsequent gallbladder stone formation, as assessed 6 and 12 months later (107). The pathogenesis relates to ceftriaxone s high rate of bihary excretion and the subsequent formation of calcium-containing precipitates (108). Thus, apart from the risk factors mentioned above, the risk of biliary sludge... 

The results of contact dissolution of gallstones using infusions of methyl-tert-butylether by percutaneous trans-hepatic gallbladder puncture have been assessed in 803 patients (3). Stones were dissolved in 724 of 761 patients in whom gallbladder puncture was successful. The 30-day mortality was 0.4%. Common comphcations were biliary leak, fever, leukocytosis, abdominal pain, and mild increases in transaminases. Toxic effects due to ether were not reported. 

Analysis of small renal and biliary stones has shown that sulindac or its metabolite was present in the material (SEDA-15,99), and the labehng of suhndac was revised in 1989 to warn physicians of this phenomenon. However, despite the presence of suhndac or its metabolites in some renal stones, patients taking long-term sulindac are not at risk of an increased incidence of renal stone formation compared with those taking other NSAIDs (38). 

The response of the liver to any form of biliary tree obstruction induces the synthesis of ALP by hepatocytes. Some of the newly formed enzyme enters the circulation to increase the enzyme activity in serum. The elevation tends to be more notable (greater than threefold) in extrahepatic obstruction (e.g., by stone or by cancer of the head of the pancreas) than in intrahepatic obstruction and is greater the more complete the obstruction. Serum enzyme activities may reach 10 to 12 times the upper reference limit and usually return to normal on surgical removal of the obstruction. A similar increase is seen in patients with advanced primary liver cancer or widespread secondary hepatic metas-tases. Liver diseases that principally affect parenchymal cells, such as infectious hepatitis, typically show only moderately (less than threefold) increased or even normal serum ALP activities (Table 21-3). Increases may also be seen as a consequence of a reaction to drug therapy. Intestinal ALP... 

Biliary obstruction due to stone, tumor, or primary biliary cirrhosis Zollinger-Ellison syndrome (causes hyperacidity) bacterial overgrowth and stasis administration of drugs, neomycin, and cholestyramine Ileal disease or resection... 

Cholelithiasis is a common occurrence in the SCD patient. It is the result of the chronic hemolysis that results in increased bilirubin production, leading to biliary sludge and/or stone formation. Cholecystitis, exemplified by pain in the right iliac fossa, can be confused with abdominal pain crisis. ... 

The biliary tract (gallbladder and bile ducts) is sterile in most healthy individuals, but in certain groups (age greater than 70 years, acute cholecystitis, jaundice, or common bile duct stones), it is likely to be colonized by aerobic gram-negative bacilli (particularly Escherichia coli and Klebsiella spp.) and enterococci. Patients with biliary tract bacterial colonization are at greater risk of intraabdominal infection. 

Stone, S. L., The effect of benemid on the hepatic extraction and biliary excretion of bromosulphalein. In Liver Function (R. W. Brauer, ed.), pp. 298-301. Waverly Press, Baltimore, Maryland, 1958. 

An obstruction or occlusion of the common bile duct affects the clearance of the Tc-IDA complex into the duodenum, resulting in an increased transit time and an abnormal scintigram. The absence of biliary tract visualization in the presence of normal hepatic extraction indicates an acute common bile duct obstruction from a stone in the common bile duct (Fink-Bennett 1995). 

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