Hepatobiliary Causes of Acute Abdominal Pain

The Gallstone Elimination Report

Gallstone Elimination Manual by David Smith

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Hepatitis, space occupying hepatic lesions, and biliary pathology such as cholecystitis or those char acteristics of the childhood (hydrops, choledochal cyst) may also cause abdominal pain.

Acute cholecystitis in children is relatively rare, but certain pediatric patients are prone to these diseases. Acute cholecystitis may be calculous or acalculous. The triad of right upper quadrant pain, vomiting, and fever is the usual clinical presentation (TsakayaNNiS et al. 1996). Jaundice occurs in 25%-45% of patients probably secondary to inflammation around the bile duct. US should be the primary screening in patients with these symptoms. US findings include gallbladder wall thickening and distension and, sometimes, gallstones. A gallbladder wall thickness over 3 mm is abnormal, although it can be observed in many conditions unrelated to cholecystitis such as hypoalbuminemia, ascites, and portal hypertension. The ultrasonographic Murphy's sign (maximal tenderness over the sonographi-cally-localized gallbladder) is a useful secondary sign. The presence of intraluminal membranes and echoes with or without gallbladder wall irregularity may indicate hemorrhagic or gangrenous cholecystitis (ChiNN et al. 1987).

Until recently, biliary lithiasis was considered infrequent in childhood, but the frequency of the diagnosis has been increasing. In children, up to 75% of gallstones are pigmented stones. Their etiology is often unknown (REscoRDa 1997). Symptomfree stones usually have a benign course and spontaneous resolution can occur. The most frequent clinical presentation is abdominal pain, with or without vomiting. Ultrasound is very accurate in the detection of calculi in the gallbladder, but less so in the intrahepatic and extrahepatic ducts (Fig. 1.77). MRCP can be used when choledocholithiasis needs to be excluded and ultrasound is negative.

Choledochal cysts are localized dilatations of the biliary ductal system. Five types have been described: type I (80%-90%), dilatation of the common bile duct (IA cystic, IB focal, IC fusiform); type II, diverticulum; type III, choledochocele; type IV, multiple cysts (IVA intra- and extrahepatic, IVB extrahe-patic); type V, Caroli disease. The pathogenesis is related to an anomalous relation of the common bile duct and the pancreatic duct, which allows reflux of pancreatic secretion into the biliary tree. It is more frequently seen in female and Asian infants. It may be found in all ages from neonate to adult, but is now frequently discovered during prenatal sonogram (BENya 2002). Clinical symptoms include episodic abdominal pain, jaundice, and a right upper quadrant mass. At US and MRCP this appears as a cyst a

Choledocholithiasis Ultrasound

Fig. 1.77a,b. Choledocholithiasis presenting as an acute abdomen in an 8-year-old boy. a Plain film shows a paraspinal calcification (arrow). b US demonstrates a calculus (arrow) in the distal choledochus (C) producing dilatation of the proximal bile duct

Fig. 1.77a,b. Choledocholithiasis presenting as an acute abdomen in an 8-year-old boy. a Plain film shows a paraspinal calcification (arrow). b US demonstrates a calculus (arrow) in the distal choledochus (C) producing dilatation of the proximal bile duct in the porta hepatis, separated from the gallbladder and communicated with the biliary ductal system (to differentiate extrahepatic biliary atresia) (Fig. 1.78). Complications include cholelithiasis, choledocholi-thiasis, pancreatitis, malignant degeneration, and cirrhosis.

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Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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