1/6. Cystic dilatation of the intrahepatic bile ducts.Two cases of cystic dilatation of the intrahepatic biliary tree in Black patients are described. Both patients presented with extremely short histories of abdominal pain, and one patient had an associated jaundice. Biliary tree pathology was confirmed by physical examination and biochemical investigation in one patient while in the second patient cystic dilatation of the biliary tree was an incidental finding.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. gallbladder and biliary tract disease in the intensive care unit.intensive care unit patients present a difficult challenge in the diagnosis and treatment of complications related to the biliary tract. Altered mental status interferes with the patient's ability to communicate symptoms and give a reliable physical examination. Laboratory data are often nonspecific in diagnosing complications of biliary tract disease because of the high incidence of cholestasis in intensive care unit patients. Likewise, routine radiographic evaluation has a marked decreased sensitivity and specificity in evaluating biliary tract disorders. Taken together, these factors often lead to a delay in diagnosis of biliary tract problems in the intensive care unit patient. Intervention in these patients is associated with high morbidity and mortality when compared to the ambulatory setting. This article reviews the clinical presentation, differential diagnosis, and management options of biliary tract complications in this complex patient population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. gallstones presenting as mental and physical debility in the elderly.Within 1 year six elderly patients (aged 80-89 years) were admitted because of non-specific deterioration in mental or physical well-being. In no instance was hepatobiliary disease suspected at the time of hospital admission. One patient presented with intermittent confusion only. The other five were referred with "falls" or having "gone off legs", with malaise, confusion, or incontinence. All had raised alkaline phosphatase levels of 159-1230 IU/l, which led to investigation of the biliary tree. At endoscopic retrograde cholangiopancreatography all were shown to have biliary disease (three common duct stones, one gallbladder calculus, one an abscess, and one a widely dilated common bileduct ). With appropriate treatment (endoscopic sphincterotomy for two, surgery for two, and antibiotics alone for two), all showed a gratifying return of mobility and mental function. Biliary disease is a treatable cause of chronic ill health in the elderly and should be excluded, even in the absence of "classical" symptoms, when there is abnormal liver function.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
4/6. Definitive diagnosis of choledochal cyst by 99mTc-pyridoxylideneglutamate sequential scintiphotography.Sequential supine scintiphotography of the abdomen was performed after intravenous administration of 99mTc-pyridoxylideneglutamate (99mTc-PG) to verify the presence of choledochal cyst in an 18-month-old boy who presented with a mass in the right upper quadrant of the abdomen. The total body radioactivity effect, which is similar to the total body opacification during intravenous cholangiography or urography, was clearly demonstrated as a cold area corresponding to the cyst and assisted in the diagnosis. The specific finding was sequential filling of the gallbladder and cyst. In view of the relatively low radiation dose and good physical characteristics of 99mTc for imaging, 99mTc-PG sequential scintiphotography is useful for the definitive preoperative diagnosis of choledochal cyst in infants and children.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. ascariasis--its complications, unusual presentations and surgical approaches.Serious complications of ascariasis are varied and occur at all stages of worm development. The acute condition within the abdomen heralds the presence of intestinal, pancreatic, or biliary tract obstruction secondary to the physical presence of the adult parasites. Larvae may be responsible for acute respiratory disease, either as a direct allergic phenomenon or as a pneumonic infiltrative process secondary to fellow traveler bacteria. Deposition of ova in the liver allows for intrahepatic and pericholangitic abscesses with resultant parenchymal destruction and scarring. Though primary therapy is medical, specific indications for surgical intervention are discussed. These unusual but life-threatening sequelae are typified in the case presentation of a critically ill child.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Spontaneous perforation of the extrahepatic bile ducts in infancy.An additional case of spontaneous perforation of the bile duct in infancy is reported. review of the literature reveals a characteristic history and physical findings in all infants with this entity. Treatment should be prompt and should consist of simple drainage of the area of perforation. Recovery is to be expected in all those patients in whom bile is sterile.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |