Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters

Aslam, Hafiz Muhammad; Saleem, Saima; Edhi, Muhammad Muzzammil; Shaikh, Hiba Arshad; khan, Jehanzeb Daniel; Hafiz, Mehak; Saleem, Maria

doi:10.1186/1755-7682-6-17

Cited by 15 publications

(19 citation statements)

References 16 publications

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“…The classic physical examination finding in a person with uncomplicated cholelithiasis during an acute episode of gallstone associated biliary colic is a positive Murphy's sign. A positive Murphy's sign is elicited when inspiratory arrest occurs during palpation of the subhepatic area (right upper quadrant of the abdomen) as the person inhales deeply . Although several physical examination findings can be indicative of cholelithiasis, lack of these findings does not exclude the diagnosis…”

Section: Physical Examinationmentioning

confidence: 99%

Cholelithiasis: Presentation and Management

Littlefield

Lenahan

2019

J Midwife Womens Health

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Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy's sign. Referred pain to the right supraclavicular region and/or shoulder, nausea, and vomiting are also frequently reported by persons with cholelithiasis. Cholelithiasis can result in complications, including cholecystitis (inflammation of the gallbladder) and cholangitis (inflammation of the bile duct). Lack of physical examination findings does not rule out a diagnosis of cholelithiasis. Laboratory tests such as white blood cell count, liver enzymes, amylase, and lipase may assist the clinician in diagnosing cholelithiasis; however, ultrasonography is the gold standard for diagnosis. Management is dependent on severity and frequency of symptoms. Lifestyle and dietary modifications combined with medication management, such as use of gallstone dissolution agents, may be recommended for persons who have a single symptomatic episode. If symptoms become severe and/or are recurrent, laparoscopic cholecystectomy is recommended. It is recommended that individuals with an established diagnosis of cholelithiasis be referred to a surgeon and/or gastroenterologist within 2 weeks of initial presentation regardless of severity or frequency of symptoms.

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Section: Physical Examinationmentioning

confidence: 99%

Cholelithiasis: Presentation and Management

Littlefield

Lenahan

2019

J Midwife Womens Health

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“…[10] The study concluded that radiological evaluation to determine the risk to laparoscopy has paramount importance and implications for surgical care. Aslam HMet al (2013) described the relative importance of clinical, [11] biochemical and ultrasonographic parameters in preoperative assessment for GB surgery. Cwik G et al (2013) found that many USG factors were more common in OC group vs LC group.…”

Section: Discussionmentioning

confidence: 99%

Role of Ultrasonography (USG) in Evaluation of Pericholecystic Adhesions in Gallstone Disease (GSD)

Wani¹,

Rastogi²,

Pratap³

et al. 2017

Ann. Int. Med. Den. Res.

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Background: In the recent era of laparoscopic and robotic surgeries, preoperative imaging has become very crucial in selecting the right operative technique in any pathological condition. Though laparoscopic cholecystectomy is widely accepted and practiced surgical technique yet it has limitations especially dense pericholecystic adhesions where the surgeon requires larger field of view for optimal dissection of gall bladder bed and for optimal control of bleeding. Though ultrasonography has been in wide use for preoperative evaluation of gall bladder stone disease yet very few studies have been conducted to evaluate its role in predicting pericholecystic adhesions responsible for difficult laparoscopic cholecystectomy. Prior knowledge of dense pericholecystic adhesions may help the surgeon in opting for open over laparoscopic cholecystectomy. Methods: Out of 70 patients with gall bladder stone disease that were enrolled in the study, complete data could be obtained in only 55 patients. All patients included in the study underwent ultrasonography of abdomen in fasting state and findings were recorded including pericholecystic adhesions & visualisation of Calot's triangle. The ultrasonographic findings were compared with that of the operative findings. Results: Our study revealed that ultrasonography has more than 70% sensitivity, more than 80% specificity and more than 76% accuracy in predicting pericholecystic adhesions which is the major cause of conversion from laparoscopic to open cholecystectomy. Conclusions: Ultrasonography can serve as an inexpensive imaging tool for predicting difficult laparoscopic cholecystectomy in patients with gall bladder stone disease by demonstrating signs of pericholecystic adhesions and nonvisualisation of normal-appearing Calot's triangle.

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“…Serum SGPT (IU/l) was 34.35+-16.79 in clip ligation and 34.56+-16.23 in suture ligation. Aslam et al 12 in 2013 found that in liver function tests, total bilirubin was elevated in 62(13.6%) patients while 392 (86.3%) had normal values. Alkaline phosphatase was elevated in 186(41.0%) patients while SGPT was found to be raised in 160(35.2%) patients of gallstone disease.…”

Section: Majority Of Patients Of Bothmentioning

confidence: 96%

Clip Occlusion Versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy – A Comparative Study

Kumar¹,

Seth²,

Sharma³

2020

IJCMR

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Introduction: Laparoscopic cholecystectomy today has been rapidly embraced worldwide as the procedure of choice for cholecystectomy. Conventionally, titanium clips are used to ligate the cystic duct. Recently, various methods of suture ligation of the cystic duct both intra corporeal and extra corporeal have been described during laparoscopic cholecystectomy. Only limited number of studies have been carried out prospectively to compare the various methods. The present study was thus designed to compare clip occlusion versus extra corporeal suture ligation (Roeder knot) of the cystic duct in laparoscopic cholecystectomy. Material and methods: This study was a single blinded randomized controlled trial conducted on 150 adult patients undergoing laparoscopic cholecystectomy. They were randomized into two groups of 75 each to compare the procedures of clip occlusion versus extracorporeal suture ligation (Roeder knot) of the cystic duct with respect to the operative time, complications, associated morbidity, operative cost and hospital stay. Results: There was no significant (p>0.05) difference in duration of surgery between the groups (Clip ligation=40.44±4.63 minutes, suture ligation=43.32±4.44 minutes). Bile leakage due to slippage of ligature was present in 2 (2.7%) patients with clip ligation as compared to 0% in suture ligation. This difference was found to be statistically significant (p=0.03). Obstructive jaundice due to accidental ligation of CBD was present in 2 (2.7%) patients with clip ligation as compared to 0% in suture ligation. This difference was also found to be statistically significant. (p=0.03). The cost of Clip ligation (Rs.369.07±8.08) was higher than suture ligation (Rs.300.00±0.00). Conclusion: The results of this study indicate that extracorporeal (Roeder's knot) is a safe, cost effective alternative with a low complication rate as compared to titanium clip ligation of the cystic duct in laparoscopic cholecystectomy.

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Assessment of gallstone predictor: comparative analysis of ultrasonographic and biochemical parameters

Cited by 15 publications

References 16 publications

Cholelithiasis: Presentation and Management

Cholelithiasis: Presentation and Management

Role of Ultrasonography (USG) in Evaluation of Pericholecystic Adhesions in Gallstone Disease (GSD)

Clip Occlusion Versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy – A Comparative Study

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