Although gallstones and their complications account for most cholecystectomies, a consistent 15% of these operations are performed in patients without gallstones. In these patients, the majority of cholecystectomies are performed as treatment for 1 of 2 distinct clinical syndromes: acalculous…
Many options are available for the treatment of patients with symptomatic gallstone disease. Improvements in endoscopic, radiologic, and chemical therapies for gallstones have enhanced the overall management of these patients. Nevertheless, surgery remains the most important therapeutic option. Laparoscopic cholecystectomy…
Acknowledgment The authors acknowledge the contributions of Drs. Jeffrey D. Browning and Jayaprakash Sreenarasimhaiah to this chapter in previous editions of the book as well as the contributions of colleagues in the gallstone field. This work was supported in part…
Bile formation is essential for intestinal lipid digestion and absorption, cholesterol homeostasis, and hepatic excretion of lipid-soluble xenobiotics, drug metabolites, and heavy metals. The process of bile formation depends on hepatic synthesis and canalicular secretion of bile acids, the predominant…
Anatomy and Physiology The gallbladder is a distensible pear-shaped reservoir, the function of which is to store bile and deliver it to the duodenum for digestion (see Chapter 62 ). It is located along the undersurface of the liver and…
In this chapter, the embryologic and anatomic characteristics of the bile ducts and gallbladder are reviewed, with a focus on information useful for diagnosing and treating biliary tract disease and understanding the anomalies and congenital malformations of these structures. Biliary…
Since the first report of ERCP and endoscopic biliary sphincterotomy in 1974, there have been numerous advances in ERCP techniques. Less invasive diagnostic modalities including EUS, CT, and MRCP have replaced diagnostic ERCP. However, therapeutic ERCP remains useful for the…
Pancreatic cancer The most common malignancy arising from the pancreas is a ductal adenocarcinoma. Pancreatic adenocarcinoma is a highly lethal malignancy representing 3% of all cancer cases in the USA but representing 7% of all cancer deaths. There were approximately…
Chronic pancreatitis is a syndrome, encompassing a spectrum of conditions which culminate in a similar phenotype. The traditional definition of chronic pancreatitis has been based on histology, demonstrating chronic and irreversible damage to the pancreas. Chronic inflammation, fibrosis, and eventual…
Incidence and Burden of Disease The human and financial burden of acute pancreatitis (AP) continues to grow, and it is now one of the most common reason for hospitalization with a GI condition. Many studies demonstrate a variable yet consistent…