Incidence and Prevalence of Bile Duct and Gallbladder Disease in Patients with Diabetes in the U.S.

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1559-P
Author(s):  
AYAD K. ALI ◽  
OMOLARA R. ADETUNJI
Keyword(s):  
Bile Duct ◽  
Gallbladder Disease ◽  
Patients With Diabetes ◽  
The U.S

Gallstones and Biliary Tract Emergencies

2020 ◽  
Author(s):  
Luis F. Lobon ◽  
Michael Billington
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Acute Cholecystitis ◽  
Biliary Tract ◽  
Bile Ducts ◽  
Gallbladder Disease ◽  
Diagnosis And Treatment ◽  
Hepatic Bile ◽  
Ascending Cholangitis

Patients with diseases of the biliary tract (which includes the hepatic bili canaliculi, hepatic bile ducts, common bile duct, and gallbladder) typically present with symptoms that include abdominal pain, nausea, vomiting, and jaundice. This review covers the pathophysiology, assessment and stabilization, diagnosis and treatment, and disposition and outcomes for common biliary tract emergencies (cholelithiasis, acute cholecystitis, choledocholithiasis, and ascending cholangitis).  This review contains 5 figures, 11 tables, and 34 references. Keywords: Cholelithiasis, gallbladder disease, acute cholecystitis, gallstones, choledocholithiasis, ascending cholangitis

MO050GLYCEMIC CONTROL AND THE RISK OF AKI IN PATIENTS WITH DIABETES AND CKD: PARALLEL POPULATION-BASED COHORT STUDIES IN U.S. AND SWEDEN ROUTINE CARE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yang Xu ◽  
Aditya Surapaneni ◽  
Jim Alkas ◽  
Alexander Chang ◽  
Morgan Grams ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Cohort Studies ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Time Varying ◽  
Baseline Hba1c ◽  
Patients With Diabetes ◽  
Swedish Cohort ◽  
The U.S

Abstract Background and Aims Patients with diabetes and chronic kidney disease (CKD) have increased susceptibility to acute kidney injury (AKI), but the underlying mechanisms are not well known. We here explore the association between glycemic control and risk of AKI. Method We created two parallel observational cohort studies of Swedish (SCREAM project, Stockholm, 2006-2011) and U.S. (Geisinger Heath system, Pennsylvania, 1996-2018) adult patients with diabetes mellitus and confirmed CKD stages G3-G5. Glycemic control was evaluated through repeated HbA1c measurements, which were categorized into 5 levels of glycemic control intensity, with HbA1c 6-6.9% as referent category, and continuously using cubic splines. We evaluated the association between baseline and time-varying HbA1c levels with AKI (defined as increase in creatinine >=0.3 mg/d over 48 hours or 1.5x creatinine over 7 days) using Cox proportional hazards regression and, in sensitivity analyses, Fine and Gray competing risk models accounting for death. Results In the Swedish cohort, there were 13932 patients with median age 76 years, 51% women, median eGFR 50.8 (Interquartile Range (IQR) 41.4-57.1) ml/min/1.73. In the U.S. cohort, there were 26520 patients with median age 71 years, 55% women and 52.1 (IQR 43.4-57.5) ml/min/1.73 m2. During a median of 2.3 and 3.1 years of follow up, 3172 and 8671 AKI events were recorded in the Swedish and US cohorts, respectively. The adjusted association between baseline HbA1c and AKI was similar in both cohorts, with the lowest risk between 6-6.9% and higher risk at higher levels of HbA1c. Compared to baseline HbA1c 6-6.9%, baseline HbA1c>9% associated with a 1.28 fold (95% CI 1.11-1.47) higher risk of AKI in the Swedish cohort, and a 1.14 (95% CI 1.04-1.25) higher risk in the U.S. cohort. Conversely, baseline HbA1c<6% did not associate with AKI. When using time-varying HbA1c, AKI risk was higher for HbA1c>9% (HR 1.18, 95% CI 1.03-1.37 in Swedish cohort and 1.27, 1.17-1.37 in U.S. cohort); AKI risk was also higher for HbA1c<6% in the U.S. cohort (1.12, 1.04-1.19), but not in the Swedish cohort (1.06, 0.97-1.16)). Conclusion Higher A1c was associated with AKI in adults with diabetes and CKD, suggesting that better glycemic control may also reduce risk of AKI.

scholarly journals A Successful Model for Laparoscopic Training in Mongolia

2013 ◽  
Vol 97 (4) ◽  
pp. 363-371 ◽  
Author(s):  
Gabriela Vargas ◽  
Raymond R. Price ◽  
Orgoi Sergelen ◽  
Byadran Lkhagvabayar ◽  
Pandaan Batcholuun ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gallbladder Disease ◽  
Operating Experience ◽  
Medical Community ◽  
Duodenal Injury ◽  
Common Bile Duct Injury ◽  
Successful Model

Abstract The benefits of laparoscopic surgery have not been available to the majority of Mongolians. Mongolian surgical leaders requested assistance in expanding laparoscopy. A capacity-building approach for teaching laparoscopic cholecystectomy throughout Mongolia is reviewed. A laparoscopic cholecystectomy training program was developed. The program included a didactic course and an intensive 2-week practical operating experience. Courses were taught in Ulaanbataar and at 3 of the 4 regional diagnostic referral and treatment centers from 2006 to 2010. During this training period, a total of 303 teaching laparoscopic cholecystectomies were performed. There was one common bile duct injury and one duodenal injury. The conversion rate was 2.0%. This program has been successful in creating a self-sustaining practice of training. The traditional surgical approach to gallbladder disease in Mongolia has been challenged and has, in turn, been a stimulus for improvement in the medical community.

scholarly journals S1235 Disparities in the Incidence of Liver and Bile Duct Cancers in Hispanics at the U.S.-Mexico Border Region

2021 ◽  
Vol 116 (1) ◽  
pp. S569-S569
Author(s):  
Alejandro Robles ◽  
Marc Zuckerman ◽  
Sherif Elhanafi ◽  
Abhizith Deoker ◽  
Jorge Cervantes
Keyword(s):  
Bile Duct ◽  
Border Region ◽  
Mexico Border ◽  
The U.S

Predictors of Preferences for Use of MK-1293 Pens among Patients with Diabetes—Findings from a Multinational Study in the U.S., Canada, and U.K.

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2272-PUB
Author(s):  
BERHANU ALEMAYEHU ◽  
ALLISON M. NGUYEN ◽  
MARCO DIBONAVENTURA ◽  
BIJAL SHAH-MANEK ◽  
CHITRA KARKI ◽  
...  
Keyword(s):  
Multinational Study ◽  
Patients With Diabetes ◽  
The U.S

Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S. Diabetes Care 2013;36:3843–3849

Diabetes Care ◽  
2013 ◽  
Vol 37 (1) ◽  
pp. 312.1-312
Author(s):  
Robert A. Vigersky ◽  
Karen Fitzner ◽  
Jenifer Levinson ◽  
Keyword(s):  
Diabetes Care ◽  
Patients With Diabetes ◽  
The U.S

scholarly journals Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland

2010 ◽  
Vol 92 (4) ◽  
pp. 302-306 ◽  
Author(s):  
P Sanjay ◽  
C Kulli ◽  
FM Polignano ◽  
IS Tait
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Teaching Hospital ◽  
Gallbladder Disease ◽  
Critical View ◽  
Operative Cholangiography ◽  
Critical View Of Safety ◽  
Calot’S Triangle ◽  
Laparoscopic Cbd Exploration ◽  
Cbd Exploration

INTRODUCTION There is debate on optimal techniques that reduce bile duct injury during laparoscopic cholecystectomy (LC). A national survey of Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) members was carried out to determine current surgical practice for gallstones, including the use of intra-operative cholangiography (IOC) or critical view of safety to reduce the risk of bile duct injury. SUBJECTS AND METHODS An anonymous postal survey was sent to all 417 AUGIS members. Data on grade of surgeon, place of work (district general hospital, teaching), subspecialty, number LC per year, use of IOC, critical view of safety, and management of stones detected during surgery were collated. RESULTS There was a 36% (152/417) response – 134 (88%) from consultant surgeons (36, HPB; 106,OG; 64, DGH; 88, teaching hospital). Of these, 38% performed > 100 LC per year, 36% 50–100 LC per year, and 22% 25–50 LC per year. IOC was routine for 24%; and selective for 72%. Critical view of Calot's triangle was advocated by 82%. Overall, 55% first clip and divide the cystic artery, whereas 41% first clip and divide the cystic duct. Some 39% recommend IOC and 23% pre-oper-ative MRCP if dilated common bile duct (CBD) is noted on pre-operative ultrasound. When bile duct stones are identified on IOC, 61% perform laparoscopic CBD exploration (LCBDE), 25% advise postoperative ERCP, and 13% perform either LCBDE or ERCP. Overall, 88% (n = 134) recommend index cholecystectomy for acute pathology, and this is more likely in a teaching hospital setting (P= 0.003). Laparoscopic CBD exploration was more likely to be performed in university hospitals (P< 0.05). CONCLUSIONS A wide dissection of Calot's triangle to provide a critical view of safety is the technique most commonly recommended by AUGIS surgeons (83%) to minimise risk of bile duct injury, in contrast to 24% that recommend routine IOC. The majority (88%) of AUGIS surgeons advise index admission cholecystectomy for acute gallbladder disease.

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