Search

The intrahepactic lithisis is unusual in the Occidental hemisphere. The prevalence in Venezuela in unknown. We study all the edoscipic retrograde cholangiography carried for lithiasic pathology, in the Servicio de Gastroenterología, Hospital Universitario de Caracas, since January 1993 until April 1995. Over 342 patients, 9 were intrahepatic lithisis (1.16%). Seven cases of Caracas and two refered of the rest of the country. The sex was female in seven patients and males in two. The age range was 15 to 67 years old. The clinic feature much frequent was abdominal pain. The diagnosis was ultrasound and endoscopic retrograde cholangiography. The treatment was endoscopic with sphincterotomy and removal stones and surgical with resection in two cases, and choledocotomy in the other four cases.

We have done a clinical study in patients with benign biliary disease and indication for surgery, with the aim of analyzing some parameters of gastric secretion, biliary and pancreatic function, and gastrointestinal hormones in relation to the quantity and quality of the dietary fat (monounsaturated and polyunsaturated fatty acids), acting on the postoperative enteral ingestion, modifying the lipid source by its elaboration. In the present work we show the results derived from the analysis of the gastric and duodenal juices in relation to the type of fat administered, with a global description of the study being necessary. The studied sample consisted of 20 patients diagnosed with simple gallstones, who were divided into two groups (n = 10) according to the usual ingestion of fats: olive oil (Olive Group) or sunflower oil (Sunflower Group). A control group (n = 10) has also been considered, without taking into account their dietary habits. The patients were subjected to surgery, and after the immediate postoperative period they were fed, orally, with an enteral diet prepared with commercially available formulae (modular EDA); as a lipid source we have added olive oil, rich in monounsaturated fatty acids, for the Olive Group, and sunflower oil, rich in polyunsaturated oil, for the Sunflower Group. In the control group cream was added as lipid source (mono and polyunsaturated fatty acids). The caloric value of the diet is calculated based on the caloric value of its components (protein: 17%, carbohydrate: 53%, lipid 30%). The daily caloric requirements are determined based on the daily basal metabolism, according to the Harris-Benedick formula.(ABSTRACT TRUNCATED AT 250 WORDS)

We have performed a clinical study involving patients with symptomatic gallstones and indications for surgery, to analyze the biliary and pancreatic response to the quality of dietary fat (degree of unsaturation). As part of the investigative method, we have designed a clinical protocol adapted to the needs of the study, in this respect, we have used gastrointestinal intubation to obtain independent samples of gastric and duodenal juices, by means of a long nasoduodenal tube or a modified Dreimlich tube, placed manually in the intraoperative period, during the cholecystectomy. The characteristics of the tube are such that its manipulation is difficult, which led to situations postoperatively and during sampling, which may alter or invalidate the obtained drainage material. In the present study we define the protocol and the phases of the investigation, and we reflect on the usefulness of the Dreimlich tube as a method, analyzing its advantages and disadvantages.

The role of gallbladder motility (GBM) in gastrointestinal diseases has been frequently ignored. Recently however, the introduction of new diagnostic methods and data on the normal physiology of gallbladder emptying and refilling have placed this interesting area of gastrointestinal motility where it justly deserves. In this way it has been possible to recognize and further study the pathophysiologic mechanisms involved in some clinical situations with a higher-than expected frequency of gallstones (GS). It has also been possible to identify with more clarity the role GBM has in the chain of events that lead to GS development and thus, to plan prevention or therapeutic strategies. The discovery of new drugs with effects on GBM have also permitted to further advance in the knowledge of normal physiologic mechanisms and to have access to possible future treatments. Also pathologic entities have been clearly defined, such as chronic acalculous cholecystitis. In this review we present recent knowledge on normal GBM physiology and its clinical applications as well consequences of its dysfunction.

The aim of this work was to study the influence of cholelithiasis and cholecystectomy on duodenogastric biliary reflux. Total bile acid concentration (TBAC) in fasting gastric juice was measured in 23 consecutive patients with cholelithiasis and functioning gallbladder before and at least 3 months after cholecystectomy (group 1) and in 14 healthy volunteers (group II). In group two, TBAC was 8.5 +/- 2.8 uMol/l (mean +/- sem), the preoperative value in group I was 32.8 +/- 8.9 uMol/l and the postoperative value 69.9 +/- 14 uMol/l (p < 0.002 compared with group II and < 0.035 compared with preoperative values). These results suggest that cholelithiasis, even with a functioning gallbladder is associated with a significant increase in bile reflux to the stomach, with raises further after cholecystectomy.

We review the pathogenesis of cholesterol gallstones, which occur in five steps: 1) metabolic; 2) chemical; 3) nucleation, 4) growing and maturation of gallstones; 5) clinical. It is emphasized that in the third step it could occur an arenous precipitate formed by cholesterol crystals, calcium bilirrubinate granules, calcium phosphate, or fatty acids anions and calcium, and mucin, called "biliary sludge", which has been associated with cholecystitis and pancreatitis. We describe the gallbladder motor abnormalities that occur during the lithogenesis and the diagnostic approach through scintigraphy and real time ultrasound. We review the pancreatobiliary dyskinesia, a condition associated with the postcholecystectomy syndrome. This later condition can result from anatomic stenosis or dyskinetic dysfunction of the sphincter of Oddi. Likewise, it is pointed out that at the present time, the manometric evaluation of the sphincter of Oddi is the gold standard in the diagnostic approach of this condition.

In the high altitude environment the oxygen and air density are decreased, the temperature and humidity are low, there es an increase in radioactivity. These environmental factors influence on the human body; it has been known for many years that people born and living at high altitude have different morphological and physiological characteristic than those at low altitude. The digestive mechanism for adaptation or acclimation to high altitude has interested physiologist and clinicians for many years. The objective of this article is to present a brief overview of the digestive physiology and pathology in the high altitude.

The development of gallstones into the gallbladder is a dynamic event that comprises many contributing factors. In this work we reviewed the main factors such as physico-chemical properties of the major components of bile, with the purpose of obtain better understanding of the pathogenesis of cholesterol gallstones.

In the recent 5 years, several important conceptual changes in the understanding of cholesterol gallstone formation have occurred. This article discusses the molecular basis of the disease, as we understand it today. The discovery of a vesicular carrier of biliary lipids and the metabolic regulation of biliary cholesterol secretion have markedly modified our understanding of the pathogenesis of cholelithiasis, giving more emphasis to molecular and cell biology aspects, rather than to physicochemistry, as occurred in the late seventies (micellar theory). The critical step in gallstone formation is cholesterol crystallization and it occurs after vesicle aggregation and fusion. This process is probably dependent of hepatic glycoproteins secreted into bile, presumably associated to the vesicular carrier of biliary cholesterol. Risk factors such as sex, obesity, sexual hormones, and diet seem to modify either biliary cholesterol secretion, and/or nucleation (crystallization) in the gallbladder, and/or gallbladder motility. It seems most likely that gallstones is a multifactorial disease, dependent of an interactions between environmental and genetic, or ethnic, factors.

There are many discrepancies between reports about gallbladder motility in gallstones disease. We studied gallbladder volume and contraction in 65 patients with asymptomatic gallstones and compared with 65 healthy controls by ultrasonography. The mass of the stones was less of the 25% of the gallbladder volume. We related stone size and number with its motor function. The results of the gallbladder contraction (GC) in the control group was 79.5% (DS = 9.5) and in the cholelithiasis group was 59.9% (DS = 19) with (p < 0.01). We found that the cholelithiasis group was heterogeneous and on closer inspection the patients fell into two subgroups separated by the inferior limit of normal GC (60%). The subgroup I (41 patients) had a fasting volume (FV) of 26.6 ml (DS = 14.1), a postprandial volume (PV) of 6.5 ml (DS = 3.8) and a GC of 75.3% (DS = 8.5). The subgroup II (24 patients) had a FV of 27.3 ml (DS = 20.3), a PV of 16.9 ml (DS = 15) and a GC of 40.5% (DS = 11.8). There was significant differences in PV and GC (p < 0.01). We concluded that defective gallbladder emptying is evident in a subgroup of patients but gallbladder contraction may be normal in patients with cholelithiasis and there are, not correlation between GC and the number and size of the stones.

The study of gallbladder motor function has increased due to the development of the new exploratory techniques and by the resurgence of the theory that points out the importance of abnormalities of gallbladder motility in the origin of gallstones. This paper reviews the anatomical and functional basis of gallbladder contraction, its neurohormonal control and the physiological, pharmacological and pathological factors that influence its emptying and produced stasis. The information obtained by different methods used to investigate gallbladder motility and the consequences of its motor dysfunction are analyzed.

Lecithin is, at present, a contradictory drug to increase the solubility degree of bile cholesterol. Our main purpose in this work was to study the lipidic bile composition of gallstone patients under lecithin treatment, in order to value its action on biliary lipids and cholesterol saturation rate. Men and women with gallstones and radiologically functioning gallbladder were included. They were divided into 2 groups: "A", including 12 patients and "B", 13. In both groups, percentage values of cholesterol, phospholipids, total bile acids and cholesterol saturation rate were determined, before and after the administration of lecithin, everyday during a period of 30 years, 8 grams on group "A" and 2 grams placebo, on group "B". No significant differences were found in the studied samples. Before and after the administration of 8 grams of lecithin orally. Total bile acids: 67--78 +/- 4,42, 72,07 +/- 4,61 p greater than 0,05; cholesterol; 15,88 +/- 2,29, 1689 +/- 2,87 p greater than 0,05; phospholipids 16,25 +/- 3,10, 12,04 +/- 2,29 p greater than 0,05; cholesterol saturation rate; 1,70 +/- 0,24, 2,10 +/- 0,36 p greater than 0,05. It is concluded that lecithin orally administered on patients with the established characteristics and diet and the used methodology results in a useless treatment to increase the solubility of bile cholesterol.