1/8. Fibropolycystic disease of the hepatobiliary system and kidneys.This complicated case of fibropolycystic disease of the hepatobiliary system and kidneys was ably and incisively analyzed by Professor Sheila Sherlock. Her clinical acumen was revealed by her ability to differentiate congenital hepatic fibrosis, Caroli's disease, and adult polycystic disease of the liver and kidney. Interesting histologic features of this case included hepatic fibrosis with intact limiting plates anc central veins and the presence of bile plugs in the ducts, but the absence of bile statsis in the parenchyma. A percutaneous transhepatic cholangiogram demonstrated the dilated intrahepatic and extrahepatic ducts. Washing out the "gunk" from the biliary tract by T-tube drainage has great limitations in this type of case. Therefore, Dr. Adson suggested irrigation of the biliary ductal system using tubed placed transhepatically, plus a wide choledojejunostomy. Dr. Sherlock questioned this surgical approach. The use of chenodeoxycholic acid for this "gunk" was suggested. In spite of the dilated ducts and pathologic changes in the liver, the patient was not jandiced and did not have stones in her biliary tract. The genetics of this patient's problems was discussed.- - - - - - - - - - ranking = 1keywords = bile, duct (Clic here for more details about this article) |
2/8. role of hepatobiliary scintigraphy in the evaluation and management of post-cholecystectomy pain due to biliary dyskinesia.Imaging with technetium-99m analogs of imminodiacetic acid has been shown to be useful in the diagnosis of various hepatobiliary diseases. The biliary ductal dilatation is usually late response of obstruction. With the development of TC-99m IDA scintigraphy, however, the functional aberrations associated with obstruction can be detected prior to the development of ductal enlargement identifiable by US & CT. We report a case of post-cholecystectomy pain due to biliary dyskinesia diagnosed by 99m TC-HIDA hepatobiliary imaging.- - - - - - - - - - ranking = 0.32665646382816keywords = duct, obstruction (Clic here for more details about this article) |
3/8. Hepatic scintigraphy in Caroli's disease.Caroli's disease (communicating cavernous ectasia of the intrahepatic bile ducts) is manifested on the 99Tc-sulfur colloid images as multiple focal defects in the liver. Since several other conditions have a similar presentation, intravenous or transhepatic cholangiography may be of assistance in reaching the correct diagnosis.- - - - - - - - - - ranking = 1.8875121299864keywords = bile duct, bile, duct (Clic here for more details about this article) |
4/8. Congenital dilatation of the intrahepatic bile ducts (Caroli's disease).Caroli's disease (congenital dilatation of the intrahepatic bile ducts) was diagnosed in an 11-year-old girl with the aid of intravenous cholangiography. Recurrent abdominal pain, fever, and intermittent obstructive jaundice are the most common symptoms and usually develop during childhood or young adulthood. Operative cholangiography has been the most valuable method of diagnosing the condition and determining the location and extent of the disease process.- - - - - - - - - - ranking = 9.437560649932keywords = bile duct, bile, duct (Clic here for more details about this article) |
5/8. The dilated common duct sign. A potential indicator of a sphincter of oddi dyskinesia.The cholescintigraphic findings of a sphincter of oddi dyskinesia (SOD) in a 45-year-old woman with persistent right upper quadrant pain and biliary colic are reported. After an overnight fast, the patient was injected with 5 mCi of Tc-99 disofenin and .02 micrograms/kg of cholecystokinin (CCK) post maximal gallbladder filling. Pre and postcholescintiscans were obtained and gallbladder ejection fractions determined. The hepatobiliary scan was normal, except for a delay in biliary-bowel transit. The gallbladder responded normally to CCK, however, the sphincter of oddi responded abnormally, as there was a paradoxical response to CCK manifested by a marked dilatation of the common bile duct. We postulate that this dilatation (the dilated common duct sign) was due to an inappropriate response of the smooth muscle of the sphincter of oddi (contraction vs relaxation) to CCK and was the cause of this patient's biliary colic. The dilated common duct sign should alert the physician to the possibility of a Sphincter of Oddi dyskinesia.- - - - - - - - - - ranking = 2.7069443814207keywords = bile duct, bile, duct (Clic here for more details about this article) |
6/8. Continuous measurement of common bile duct pressure with an indwelling microtransducer catheter introduced by duodenoscopy: new diagnostic aid for postcholecystectomy dyskinesia--a preliminary report.morphine was given to two patients suspected of having postcholecystectomy dyskinesia to induce spasm of sphincter of oddi and was successful in reproducing pain, while common bile duct pressure was continuously monitored with an indwelling high fidelity microtransducer catheter introduced by duodenoscopy. The rise of intracholedochal pressure was found to coincide exactly with the occurrence of the pain, thus suggesting the biliary origin of the symptom. The common bile duct pressure started to rise immediately after the injection of morphine, and the pressure waves initially showing biphasic variation of respiratory origin became irregular in shape and height, probably reflecting the spasm of the sphincter; these changes were well related to the intensity of the pain. Endoscopic sphincterotomy gave complete relief. A repeat morphine-induced pressure study after the sphincterotomy confirmed the disappearance of both the pain and the irregular waves.- - - - - - - - - - ranking = 11.325072779918keywords = bile duct, bile, duct (Clic here for more details about this article) |
7/8. gallbladder hypokinesia: an unusual cause of duodenal obstruction.gallbladder hypokinesis is an uncommon condition and a potential etiologic factor in the formation of gallstones and the development of cholecystitis. It is associated with a number of different conditions, but gallbladder hypokinesia as a cause of small bowel obstruction is unreported. In the case presented below, we saw a postoperative partial upper small bowel obstruction due to hypokinesia of the gallbladder. The investigations, management, and subsequent recovery are described. A review of the literature failed to reveal any similar occurrence.- - - - - - - - - - ranking = 0.16053714005021keywords = obstruction (Clic here for more details about this article) |
8/8. Caroli's disease with intrahepatic gall-stones and salmonella infection.At operation for small bowel intussusception, a 26-year-old man was found to have an enlarged liver and spleen. Subsequent investigations suggested bile passage infection associated with numerous intrahepatic gall-stones but symptomatic cholangitis did not present until 5 months later. Retrograde cholangiography showed cavernous ectasia of the bile ducts which contained gall-stones.- - - - - - - - - - ranking = 2.114368046175keywords = bile duct, bile, duct (Clic here for more details about this article) |