Correlation of Mechanical Factors and Gallbladder Pain.pdfVIP

Computational and Mathematical Methods in Medicine, Vol. 9, No. 1, March 2008, 27–45 Correlation of mechanical factors and gallbladder pain W. G. LI†, X. Y. LUO*‡, N. A. HILL‡, A. SMYTHE{, S. B. CHIN†, A. G. JOHNSON{ and N. BIRD{ †Department of Mechanical Engineering, University of Sheffield, Sheffield S1 3JD, UK ‡Department of Mathematics, University of Glasgow, Glasgow G12 8QW, UK {Academic Surgical Unit, Royal Hallamshire Hospital, Sheffield S10 2JF, UK (Received 2 July 2007; revised 18 October 2007; in final form 31 October 2007) Acalculous biliary pain occurs in patients with no gallstones, but is similar to that experienced by patients with gallstones. Surgical removal of the gallbladder (GB) in these patients is only successful in providing relief of symptoms to about half of those operated on, so a reliable pain-prediction model is needed. In this paper, a mechanical model is developed for the human biliary system during the emptying phase, based on a clinical test in which GB volume changes are measured in response to a standard stimulus and a recorded pain profile. The model can describe the bile emptying behaviour, the flow resistance in the biliary ducts, the peak total stress, including the passive and active stresses experienced by the GB during emptying. This model is used to explore the potential link between GB pain and mechanical factors. It is found that the peak total normal stress may be used as an effective pain indicator for GB pain. When this model is applied to clinical data of volume changes due to Cholecystokinin stimulation and pain from 37 patients, it shows a promising success rate of 88.2% in positive pain prediction. Keywords: Gallbladder; Total stress; Gallbladder pain; G