1. Gall Bladder disease in Children Laredo Medical Center March 29 th 2011 Francisco Cervantes, MD Khalid Ghazy,MD

2. Pathophysiology Two forms of cholecystitis Calculous and Acalculous. In the pediatric population(Most gallbladders that are removed for acute cholecystitis show evidence of chronic inflammation. Calculous : cholesterol crystals and/or calcium bilirubinate→ stone →inflammation→ chronic obstruction→ decreased contractile → biliary stasis→ further inflammation of the gallbladder wall

3. Pathophysiology Acalculous: similar manner but from different etiologic most often associated with systemic illness→ Increased mucous production, dehydration, and increased pigment → increase cholesterol saturation and biliary stasis→ hypofunction→ biliary sludge → obstruction → inflammation, edema → compromised blood flow and bacterial infection

4. Laredo Pediatrics and Neonatology 15 cases between 2009-2010 Age at presentation 11 years -19years. The Average 14.08 years 8 Male and 7 Female BMI 90 and over

6. BMI in Adults

7. Body Mass Index –Age Percentiles

8. Cholecystectomy 6 patients underwent Cholecystectomy. 3 patients indication for surgery (GB sludge) 3 Patients Indication ( Cholelithiasis). 2 patients had Diagnostic Liver biopsy during surgery which confirmed FL. But no fibrosis

9. Ultrasound Fatty liver F L + GB Sludge GB Sludge Chronic Cholecystitis, cholelithiasis GB Septation 25252

10. Lipid Profile FemaleMale Cholesterol ≥ 20022 HDL ≤ 4034 LDL ≥ 12522 Triglyceride ≥ 16014

11. Liver Profile Liver EnzymeFemale NumberMale Number SGOT≥ 46 150≥ 0 SGPT≥41 4≥47 2 GGT≥28 3≥32 2 Bilirubin≥0.8 2≥ 0.8 3

12. Alk Phosphatase in NL BMI

14. BMIMale # of Patient # U/S request % Positive Female # of Patient # U/S request % Positive NR1474015190 Risk1773537.32651921.1 ≥ 951282842.9982429.2 ≥ 972188448.81865158.8 ≥ 991949246.71506045 Total86424344.985016341.7 Total number 406 U/S requested 43.6 % were positive for Fatty liver. 3.7 % of U/S were Gall Bladder disease positive Criteria for selection were liver enzymes elevation and BMI

15. FL Ultrasound

16. Any Questions ?