cholecystokinin and Bile-Duct-Diseases

Topics: Acute Disease; Adult; Bile Duct Diseases; Bile Ducts; Child; Cholecystitis; Cholecystokinin; Cholestasis, Extrahepatic; Cystic Duct; Humans; Imino Acids; Iodine Radioisotopes; Radionuclide Imaging; Rose Bengal; Technetium; Technetium Tc 99m Lidofenin

Fifteen patients with history of biliary colic, induceable by cholecystokinin, but normal oral cholecystogram and ultrasonogram were studied prior to and after cholecystectomy. Fasting duodenal bile, obtained preoperatively after administration of cholecystokinin, and gallbladder bile obtained at operation were analyzed. The lipid composition as well as the cholesterol saturation were within the range seen in gallstone-free subjects. The total lipid concentration of gallbladder bile was normal, whereas that of duodenal bile was reduced by about 50%, indicating a less efficient gallbladder emptying. In 10 of the 15 patients, the analysis of the excised gallbladder displayed macro- or microscopic abnormalities; two patients had cholesterol gallstones. At re-examination 9-27 months after the operation, 12 of the patients were completely symptom-free and two patients reported a clear improvement while on still had unchanged symptoms. It is concluded that cholecystectomy is the treatment to prefer in patients with "acalculous" biliary pain, induceable by cholecystokinin.

Topics: Adult; Bile; Bile Duct Diseases; Cholecystectomy; Cholecystokinin; Cholelithiasis; Colic; Female; Gallbladder; Humans; Lipid Metabolism; Male; Middle Aged; Pain

Two tests of cystic duct patency were compared in 37 patients with suspected acute cholecystitis. Ultrasound (US) measurement of gallbladder contraction induced by 40 Ivy dog units of cholecystokinin (CCK) was followed by the radionuclide (RN) test for cystic duct patency. In all 13 patients in whom US showed significant gallbladder contraction after CCK, the cystic duct was proved to be patent by the RN test. The gallbladder did not contract significantly in 24 patients. Eleven of these patients had acute cholecystitis, with evidence of cystic duct obstruction, and 12 had patent cystic ducts and final diagnoses other than acute cholecystitis. The measurement of contraction of the gallbladder in response to CCK is a valuable improvement over simple US when cystic duct obstruction is excluded; failure of contraction is not specific, and independent evaluation of cystic duct patency is required.

Topics: Adult; Aged; Bile Duct Diseases; Cholecystitis; Cholecystokinin; Cholelithiasis; Cystic Duct; Gallbladder; Humans; Middle Aged; Radionuclide Imaging; Ultrasonography