Histopathology Liver--Cholestasis

Event: Caitlin's 1st operation to ruloe-out biliary atrsia versus neo- natal cholestasis

Enviado por "CONSULTORIO MÉDICO FLORES BUISSON"- MÁNCORA PERÚ Paciente de 65 años de edad que llega a la consulta médica el día de hoy, domingo 9 de noviembre de 2008, con dolor moderado en el hipocondrio derecho de varios años de evolución pero que se incrementó hace una semana. Asimismo, manifiesta dolor en la región umbilical de muchos años de evolución, que se mantiene según la paciente- de manera constante. Al examen, observamos una hernia umbilical, al parecer lobulada o dividida en dos partes. La hernia de la región externa mide 25.1 centímetros x 18.0 centímetros y la que ocupa la región media mide 12.0 centímetros x 10.0 centímetros. Patient 65-year-old of age who comes to the medical consultation today, Sunday, the 9th of November of 2008, with pain moderated pain in the right hypochondrium of "several years of evolution" but that it increased one week ago. Also, she shows pain in the umbilical region of "many years of evolution", that is supported according to the patient - in a constant way. To the examination, we observe an umbilical hernia, apparently divided into two parts. The hernia of the external region measures 25.1 centimeters x 18.0 centimeters and the one that occupies the average region measures 12.0 centimeters x 10.0 centimeters. Patient who comes to the medical consultation with moderated pain in the right hypochondrium of one year of evolution but it increased one week ago after eat duck. In the ultrasound scan of the region of the right hypochondrium (patient came having breakfast, that is to say, without previous preparation ) we can observe the liver of 123.8 millimeters high, as well as the porta vein with a diameter of 7.3 millimeters. On having observed the Gallbladder, we think that a side wall is increased in 2.7 mm (hyperechogenic) with several "echogenics points" in the interior ("Biliary Mud"). The measurements of the gallbladder were: 39.0 x 17.4 millimeters. We can appreciates an echogenic image in the interior that it would make think about stone. The stones are identified as echogenic foci casting acoustic shadowing but but this image did not appear and a re-evaluation is decided in 15 days. Acalculous cholecystopathy which means disease or condition of the gallbladder without the presence of gallstones. You might also call it functional gallbladder disorder or impaired gallbladder emptying. Some causes may be chronic inflammation, a problem with the smooth muscles of the gallbladder or the muscle of the Sphincter of Oddi being too tight. REMEMBER: Umbilical hernia is a congenital malformation, especially common in infants of African descent, and more frequent in boys. An Acquired umbilical hernia directly results from increased intra-abdominal pressure and are most commonly seen in obese individuals. Presentation:A hernia is present at the site of the umbilicus (commonly called a navel, or belly button) in the newborn; although sometimes quite large, these hernias tend to resolve without any treatment by around the age of 5 years. Obstruction and strangulation of the hernia is rare because the underlying defect in the abdominal wall is larger than in an inguinal hernia of the newborn. The size of the base of the herniated tissued is inversely correlated with risk of strangulation (i.e. narrow base is more likely to strangulate). Babies are prone to this malformation because of the process during fetal development by which the abdominal organs form outside the abdominal cavity, later returning into it through an opening which will become the umbilicus. Differential diagnosis Importantly this type of hernia must be distinguished from a paraumbilical hernia which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele.

Enviado por "CONSULTORIO MÉDICO FLORES BUISSON"- MÁNCORA - PERÚ Paciente que llega a la consulta médica con dolor moderado en el hipocondrio derecho de un año de evolución pero que se incrementó hace una semana luego de comer pato. En la ecografía de la región del hipocondrio derecho (paciente llegó desayunando, es decir, sin preparación previa) podemos observar el hígado de 123.8 milímetros de altura, así como la vena porta con un diámetro de 7.3 milímetros. Al observar la vesícula biliar, encontramos que una pared lateral se encuentra engrosada en 2.7 mms (hiper-ecogénica) con varios puntos ecogénicos en su interior (Barro Biliar). Las medidas de la vesícula biliar fueron: 39.0 x 17.4 milímetros. Se aprecia una imagen ecogénica en su interior que haría pensar en cálculo pero no se logra observar la "sombra acústica posterior" típico de los cálculos y se decide una rePaciente que llega a la consulta médica con dolor moderado en el hipocondrio derecho de un año de evolución pero que se incrementó hace una semana luego de comer pato. En la ecografía de la región del hipocondrio derecho (paciente llegó desayunando, es decir, sin preparación previa) podemos observar el hígado de 123.8 milímetros de altura, así como la vena porta con un diámetro de 7.3 milímetros. Al observar la vesícula biliar, encontramos que una pared lateral se encuentra engrosada en 2.7 mms (hiper-ecogénica) con varios puntos ecogénicos en su interior (Barro Biliar). Las medidas de la vesícula biliar fueron: 39.0 x 17.4 milímetros. Se aprecia una imagen ecogénica en su interior que haría pensar en cálculo pero no se logra observar la "sombra acústica posterior" típico de los cálculos y se decide una re-evaluación en 15 días. Patient who comes to the medical consultation with moderated pain in the right hypochondrium of one year of evolution but it increased one week ago after eat duck. In the ultrasound scan of the region of the right hypochondrium (patient came having breakfast, that is to say, without previous preparation ) we can observe the liver of 123.8 millimeters high, as well as the porta vein with a diameter of 7.3 millimeters. On having observed the Gallbladder, we think that a side wall is increased in 2.7 mm (hyperechogenic) with several echogenics points in the interior ( Biliary Mud ). The measurements of the gallbladder were: 39.0 x 17.4 millimeters. We can appreciates an echogenic image in the interior that it would make think about stone. The stones are identified as echogenic foci casting acoustic shadowing but but this image did not appear and a re-evaluation is decided in 15 days. Patient who comes to the medical consultation with moderated pain in the right hypochondrium of one year of evolution but it increased one week ago after eat duck. In the ultrasound scan of the region of the right hypochondrium (patient came having breakfast, that is to say, without previous preparation ) we can observe the liver of 123.8 millimeters high, as well as the porta vein with a diameter of 7.3 millimeters. On having observed the Gallbladder, we think that a side wall is increased in 2.7 mm (hyperechogenic) with several echogenics points in the interior ( Biliary Mud ). The measurements of the gallbladder were: 39.0 x 17.4 millimeters. We can appreciates an echogenic image in the interior that it would make think about stone. The stones are identified as echogenic foci casting acoustic shadowing but but this image did not appear and a re-evaluation is decided in 15 days.

Pruritus Research (click more for details) A review of the scientific literature reveals three clinical trials investigating the use of cannabinoids in the treatment of pruritus. Writing in the August 2002 issue of the American Journal of Gastroentrology, investigators from the University of Miami Department of Medicine reported successful treatment of pruritus with 5 mg of THC in three patients with cholestatic liver disease.[1] Prior to cannabinoid therapy, subjects had failed to respond to standard medications and had lost their ability to work. Following evening cannabinoid administration, all three patients reported a decrease in pruritus, as well as "marked improvement" in sleep and were eventually able to return to work. Resolution of depression was also reported in two out of three subjects. "Delta-9-tetrahydrocannabinol may be an effective alternative in patients with intractable cholestatic pruritus," investigators concluded. The following year, British researchers reported in the June 2003 issue of the journal Inflammation Research that the peripheral administration of the synthetic cannabinoid agonist HU-211 significantly reduced experimentally-induced itch in 12 subjects.[2] Investigators had previously reported that topical application of HU-210 on human skin reduced experimentally-induced pain and acute burning sensations.[3] Full text link: http://www.norml.org/index.cfm?Group_ID=7014 The authour: For patients and their physicians, let this report serve as a primer for those who are considering using or recommending medicinal cannabis. For others, let this report serve as an introduction to the broad range of emerging clinical applications for cannabis and its various compounds. Paul Armentano Deputy Director NORML | NORML Foundation Washington, DC January 24, 2008 * The author would like to acknowledge Drs. Dale Gieringer, Gregory Carter, Steven Karch, and Mitch Earleywine, as well as NORML interns John Lucy, Christopher Rasmussen, and Rita Bowles, for providing research assistance for this report. The NORML Foundation would also like to acknowledge Dale Gieringer, Paul Kuhn, and Richard Wolfe for their financial contributions toward the publication of this report. ** Important and timely publications such as this are only made possible when concerned citizens become involved with NORML. For more information on joining NORML or making a donation, please visit: http://www.norml.org/join. Tax deductible donations in support of NORML's public education campaigns should be made payable to the NORML Foundation. http://norml.com/index.cfm?Group_ID=7002 _______________________________________ Prohibition: "Prohibition...goes beyond the bounds of reason in that it attempts to control a man's appetite by legislation and makes a crime out of things that are not crimes. A prohibition law strikes a blow at the very principles upon which our government was founded." -- Abraham Lincoln December 1840