[A new flocculation test in the differential diagnosis of hepatocellular and obstructive jaundice].
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Diagnosis, Differential↗
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Results for “Jaundice, Obstructive”
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The surgical management of obstructive jaundice.
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Health Services↗
[Obstructive jaundice in infants].
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Humans↗
Obstructive jaundice and portal vein obstruction--rare complications of peptic ulcer.
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Aged↗
Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy.
OBJECTIVE: This endoscopic retrograde cholangiopancreatography-(ERCP)based study estimates the potential role of laparoscopic cholecystojejunostomy for palliation of patients with malignant obstructive jaundice. SUMMARY BACKGROUND DATA: Traditional treatment of malignant obstructive jaundice has used a standard bilioenteric anastomosis. Laparoscopic biliary bypass via a gallbladder conduit currently is an established technique; it provides a low initial morbidity alternative to open procedures, similar to endoscopic stenting. No study has specifically addressed anatomic factors relevant to cholecystojejunostomy, such as prior cholecystectomy, stricture location in reference to the hepatocystic junction, and cystic duct patency in patients with malignant obstructive jaundice. METHODS: Retrograde cholangiograms were reviewed from consecutive patients with malignant obstructive jaundice and a control group without biliary disease who underwent ERCP during a 2-year period. Patients with either prior biliary surgery or hilar tumors were excluded. The presence of gallbladder or cystic duct filling was assessed. In patients with patent cystic ducts, the distance from obstruction to the cystic duct takeoff was classified as either greater or less than 1 cm. RESULTS: Nearly half the patients with malignant obstructive jaundice were ineligible for cholecystojejunostomies because of prior biliary surgery (29%) or hilar tumors (17%). Half (50 of 101) of the remaining potential candidates had patent hepatocystic junctions. Patients with ampullary carcinoma and patent hepatocystic junctions (5 of 9) were all ideal candidates for cholecystojejunostomies, having biliary obstruction more than 1 cm from the cystic duct takeoff. Two thirds of the remaining eligible patients (28 of 45) had obstructions less than 1 cm from patent hepatocystic junctions. CONCLUSIONS: Palliation of malignant obstructive jaundice by laparoscopic cholecystojejunostomy should only be attempted after direct cholangiography demonstrates a patent hepatocystic junction that is well separated from the malignant stricture. The majority of patients with malignant obstructive jaundice are ineligible for cholecystojejunostomies because of prior cholecystectomies, hilar obstructions, or tumor involvement of the hepatocystic junction. Nonoperative treatments will continue to be indicated for the majority of patients with malignant obstructive jaundice.
Aged↗
Brain oxidative stress induced by obstructive jaundice in rats.
The effect of experimental obstructive jaundice on the oxidative status of brain tissues in rats was examined. Twenty-four male Wistar rats were divided into 4 groups: Group I was the control, group II was the sham operated, and groups III and IV were bile duct ligated and killed on the 5th and the 10th day, respectively. Oxidative stress was assessed by measuring the thiol redox state (protein and nonprotein components) and lipid peroxidation level variations in samples from the cerebral cortex, midbrain, and cerebellar tissue in all animals. Results indicated the presence of oxidative stress in the jaundiced animals that was more pronounced on the 10th day as indicated by a decrease in reduced glutathione and protein thiol and an increase in protein disulphide and lipid peroxidation. A dramatic elevation of the level of total nonprotein mixed disulphide level was found specifically in the midbrain in the 10th day group. This suggests an accumulation of nonprotein disulfides other than oxidized glutathione, which remained unchanged, in this particular brain area. This study showed a correlation between experimental obstructive jaundice and the oxidative stress in the rats' brain, implying that a similar pathogenetic mechanism may play a key role in cholestatic liver disease, resulting in hepatic encephalopathy in humans.
Animals↗
[The mechanism of development of acute gastric ulceration following biliary drainage in obstructive jaundice].
Upper gastrointestinal hemorrhage occurs occasionally in the time of surgery or biliary infection in patients with obstructive jaundice. In the present study, the influence of obstructive jaundice and biliary drainage on the rat gastric mucosa was examined. Serum t-Bil, GOT and Alp increased during obstructive jaundice, but decreased following biliary drainage. Hexose and fucose levels in gastric mucosa decreased during obstructive jaundice; both of them increased in the 1- and 2-week jaundiced groups, however, neither increased in the 3-week jaundiced group following biliary drainage. Prolonged obstructive jaundice demonstrated a marked increase of ulcer index (UI) and decrease of gastric mucosal blood flow (BF) following water immersion and restraint stress. Biliary drainage induced these changes in the 1- and 2-week jaundiced groups, but induced neither of these changes towards recovery in the 3-week jaundice group. Prostaglandin (PG) E2 induced significant decrease in isolated gastric vascular perfusion pressure in the 2-week jaundiced group; it did not, however, have this effect in the 3-week jaundiced group. In conclusion, it was speculated that differences between the 3-week and 2-week jaundiced groups were present in sensitivity to PGE2 in the gastric vascular system, and that different reactions of the gastric microcirculation resulted in different changes in the gastric mucosal state following biliary drainage.
Acute Disease↗
Renal functions in obstructive jaundice: a pre and post operative assessment.
Surgery in patients with surgical obstructive jaundice is known to be associated with increased risk of post-operative acute renal failure. A prospective study was carried out to evaluate the renal function in patients with obstructive jaundice. Renal functions of thirty two patients with jaundice secondary to mechanical obstruction of the biliary tract were evaluated pre-operatively and 7 days after surgical biliary decompression. Although no significant difference was seen in the mean values of pre and post operative renal function variables, two patients had overt renal failure, one with pre-operative cholangitis and acute tubular necrosis and another with carcinoma of the pancreas and postoperative acute renal failure. The overall satisfactory outcome in our obstructive jaundice patients may be related to pre-operative and intraoperative preparation with intravenous fluids and mannitol. It is concluded that patients with obstructive jaundice can be satisfactorily treated with special preoperative care including good hydration and mannitol therapy during anaesthesia and surgery.
Acute Kidney Injury↗
Contrasting liver function test patterns in obstructive jaundice due to biliary strictures [corrected] and stones.
BACKGROUND: Obstructive jaundice is believed to be characterized by abnormalities of alkaline phosphatase (ALP), rather than aspartate transaminase (AST). AIM: To compare liver function tests (LFTs) in obstructive jaundice due to malignant strictures with those of jaundice due to gallstones. METHODS: LFTs were measured immediately before endoscopic retrograde cholangio-pancreatography (ERCP) in 207 jaundiced patients. Group 1 (n = 69) had malignant strictures, group 2 (n = 97) had common bile duct stone(s), and group 3 (n = 41) appeared to have recently passed a stone. LFTs in groups 2 and 3 were also analysed at maximal liver enzyme derangement, maximum hyperbilirubinaemia and during acute pain episodes. RESULTS: Group 1 had higher median bilirubin, AST and ALP levels than groups 2 or 3 (p < 0.001). In group 1, median rise in ALP exceeded that in AST (4.3 x normal upper limit (NUL) vs. 2.6 x NUL, p < 0.01), but in groups 2 and 3, AST and ALP were similarly elevated (both approximately 2 x NUL). At the time of maximum enzyme derangement in groups 2 and 3, median AST elevation (4.4 x NUL, 185 IU/l) exceeded that for ALP (2.4 x NUL, 276 U/l), (p < 0.001), and this was also true at peak hyperbilirubinaemia in these groups (AST 3.6 x NUL, ALP 2.4 x NUL, p < 0.01. Similarly, severe pain episodes in groups 2 and 3 were accompanied by greater elevations in bilirubin and AST, but not ALP, compared with levels at ERCP. DISCUSSION: The conventional wisdom that ALP rises more than AST in obstructive jaundice holds true where the jaundice is due to strictures, but in obstructive stone disease, the rise in AST may equal that in ALP, or even exceed it during maximum jaundice and during painful episodes. Clinicians should consider the possibility of extrahepatic biliary obstruction, even when AST is the predominantly elevated enzyme.
Aged↗
[Biliary intervention for malignant obstructive jaundice. Treatment through PTCD fistula].
Currently, diagnosis of obstructive jaundice has become easier with CT and USEG, and percutaneous transhepatic cholangio -drainage (PTCD) for obstructive jaundice has also become much safer using USEG control. We have performed PTCD in 277 cases, from December 1976 to May 1989 at Saitama Cancer Center with specially designed thin needle. And using a PTCD fistula, we have been attempted radiotherapy for 7 cases of the bile duct cancer using Remote After Loading System (RALS), and hyperthermia for 5 cases of bile duct cancer using antenna of microwaves. From autopsy cases, we evaluated treated lesion pathologically, and we obtained the following results. Dosage of biliary RALS need up to 50 Gy at the point of 1 cm from 60Co ++source. Biliary hyperthermia using microwave seem to be unsuccessful, and further improvement to the antenna of microwave were necessary. Furthermore, we have attempted biliary endoprosthesis 27 cases, for better quality of life to the patients with malignant obstructive jaundice. These method seems to be effective in prolonging patient's lives, comparing of cases in which PTCD of an external fistula has been performed.
Adult↗
Evaluation of various diagnostic signs on percutaneous transhepatic cholangiography in obstructive jaundice.
Twenty patients of obstructive jaundice were subjected to percutaneous transhepatic cholangiography (PTC) of which 17 were operated on. Patients were divided in 4 groups according to the site of obstruction. The diagnostic signs observed were: Complete block with interface having convexity downwards (4), convexity upwards (3), biconcave caudal cut off (6), smooth edged cut off (one), irregular edged cut off (one) and non-specific appearance (one); incomplete block with interface having convexity upwards (one); biconcave caudal cut off (2) and multiple smooth central filling defects (2). In one case there was incomplete obstruction at two sites giving rise to two different signs. PTC was 100% correct in accurately telling the site of lesion. As regards the nature of the lesion the diagnosis on PTC was found correct in 15 out of 17 cases (88.5%).
Cholangiography↗
[Value of preoperative drainage of the bile ducts in obstructive jaundice].
Hepato-biliary surgery for obstructive jaundice is associated with high morbidity and mortality rates. Experimental and clinical studies on obstructive jaundice revealed endotoxaemia, coagulation disorders and depressed immune function. Many studies have been carried out to identify the operative risk factors. The serum bilirubin level seemed to be a significant factor. Biliary decompression via a percutaneous or endoscopic retrograde approach was therefore proposed to improve the surgical outcome. The first retrospective studies have suggested a reduction of morbidity and mortality. Subsequent randomized studies have not confirm the benefit of preoperative biliary drainage because of procedure-related complications. The article reviews the literature on preoperative biliary drainage and proposes the indications, choice of method and optimal duration of biliary drainage.
Animals↗
Obstructive jaundice caused by hepatocellular carcinoma.
Hepatocellular carcinoma can be complicated by obstructive jaundice with tumor growing into the extrahepatic bile duct. This complication is an autopsy finding in most reported cases and, rarely, is recognized ante mortem. We report two patients with hepatocellular carcinoma who presented initially with obstructive jaundice. Clotted blood and tumor, which caused bile duct obstruction, was removed operatively and the biliary tract was drained in both patients. We conclude that blood clot and fleshy debris removed from the common bile duct at operation for obstructive jaundice suggests the possibility of hepatocellular carcinoma; the differential diagnosis of jaundice and fever in patients known to have hepatocellular carcinoma should include intrabiliary tumor causing obstruction and cholangitis; and the association of obstructive jaundice and hepatocellular carcinoma may occur more often than previously recognized.
Adolescent↗
Surgical bypass is still relevant in the palliation of malignant obstructive jaundice.
Malignant tumours of the biliopancreatic system causing obstructive jaundice are not curable in most of the patients, and palliation plays a very important therapeutic role. The role of surgery in palliation of malignant obstructive jaundice has been questioned in the light of availability of endoscopic techniques. In developing countries, however, exploratory laparotomy and palliative surgery (when possible) is the only option available as sophisticated instruments and the expertise to use them is limited to a very few centres. This was a retrospective study of 83 consecutive cases with malignant obstructive jaundice admitted to the Department of Surgery, NSCB Government Medical College, Jabalpur, MP, India from January 1996 to December 2000.
Adult↗
Changes of insulin and somatostatin and their relationship to liver regeneration in experimental obstructive jaundice.
The liver is a parenchymal organ that has a substantial capacity to regenerate after damage. Obstructive jaundice is a common surgical disease and potentially risky. A successful outcome of operations depends upon the hepatic regeneration reserve. Insulin is one of factors responsible for hepatotrophic regeneration and somatostatin has a reversal suppressive action. Experimental obstructive jaundice was introduced and relieved. In addition, serum insulin and somatostatin concentrations were measured. We used immuno-histochemical study of pancreatic tissue by immunogold to express the tissue relative insulin and somatostatin concentrations. Nucleolar organizer regions (NORs) were used to predict the nucleolar activity of liver cells. In our studies, we observed the serum concentrations of insulin and somatostatin were similar to the relative tissue concentration in pancreatic tissues. The relative tissue gold-particle score of insulin in group A (rats with common bile duct tied), was CONT: T4: T7: T14 = 100%: 90.5%: 68.3%: 46.2%; of somatostatin was 100%: 120%: 118.2%: 115.5% respectively. In group B (common bile duct tied for 4 days then relieved), the gold-particle score of insulin was T4: T4R4: T4R7: T4R14 = 90.5%: 62.8%: 72.2%: 95.4%; of somatostatin was 120.2%: 114.3%: 108.1%: 106.2% respectively. In group C (common bile duct tied for 7 days then relieved), the gold-particle score of insulin was T7: T7R4: T7R7: T7R14 = 68.3%: 53.3%: 73.5%; of somatostain was 118.2%: 109.4%: 104.6%: 102.1% respectively. The mean numbers of AgNORs in group A revealed CONT: T4: T7: T14 = 2.24 +/- 0.24: 3.02 +/- 0.96: 3.26 +/- 1.02:3.08 +/- 0.84, group B was T4: T4R4: T4R7: T4R14 = 3.02 +/- 0.96: 3.03 +/- 0.73: 3.36 +/- 1.12: 3.72 +/- 1.46, and group C showed T7: T7R4:T7R7: T7R14 = 3.26 +/- 1.02: 3.26 +/- 0.84: 3.31 +/- 1.24: 3.54 +/- 1.24. In conclusion, our studies suggested: (1) liver regeneration appeared promptly after obstructive jaundice developed, but prolonged cholestasis inhibited this process. (2) Insulin levels gradually fell during the process of obstructive jaundice. Those levels elevated when cholestasis was improved. Nevertheless, both insulin and hepatic regeneration power could not reflect the initial improvement of cholestasis simultaneously. It took a longer time for the improvement of cholestasis and the recovery of the liver function. (3) Patho-physiologically, somatostatin had a weak influence on hepatic regeneration during obstructive jaundice. (4) Our studies provided clues that early biliary drainage might improve hepatic regeneration capacity. Supplement of insulin during the obstructive jaundice might be helpful for the improvement of hepatic regeneration power.
Animals↗
Obstructive jaundice alters CD44 expression in rat small intestine.
HYPOTHESIS: CD44 is an adhesion molecule expressed by neutrophils, lymphocytes and epithelial cells. CD44 is involved in cell-cell and cell-matrix binding. In addition to lymphocyte trafficking, CD44 also plays a crucial role in the maintenance of intestinal villus integrity. We hypothesize that obstructive jaundice may alter CD44 expression in the rat small intestine and oral glutamine intake can restore the altered CD44 expression in the small intestine of the rat undergoing obstructive jaundice. MATERIALS AND METHODS: In a prospective animal model study at a university hospital, 41 Sprague-Dawley rats were randomized to 4 groups. Group A (n = 13, control) underwent a sham operation. Group B (n = 12, obstructive jaundice for 1 week) underwent common bile duct ligation. Group C (n = 8, obstructive jaundice for 2 weeks) underwent common bile duct ligation. Group D (n = 8, obstructive jaundice for 2 weeks) underwent common bile duct ligation with oral glutamine intake daily. After 1 and 2 weeks, segments of the proximal jejunum and distal ileum were harvested from groups A and B and groups C and D, respectively. Immunohistochemical expression of CD44 on the cell surface was then evaluated and recorded. Comparisons among the 4 groups were performed. RESULTS: In the 1-week obstructive jaundice group, 173.8 +/- 24.0 cells/1,000 enterocytes of the proximal jejunum expressed surface CD44, while 137.0 +/- 13.8 cells were stained in the control group (p < 0.001). In the 1-week obstructive jaundice group, 169.8 +/- 20.7 cells/1,000 enterocytes of the distal ileum expressed surface CD44, while 119.5 +/- 20.8 cells were stained in the control group (p < 0.001). In the 2-week obstructive jaundice group, the number of cells expressing surface CD44 were significantly decreased both in jejunum (112.1 +/- 17.0, p = 0.002) and ileum (100.1 +/- 12.5, p = 0.028) when compared with those of the control group. With daily oral glutamine intake in group D, the number of cells expressing surface CD44 in the jejunum (149.3 +/- 29.7) was restored to that of the control group (p = 0.302) and the number of cells expressing surface CD44 in the ileum (140.4 +/- 23.0) was even higher than that of the control group (p = 0.045). CONCLUSION: Obstructive jaundice for 1 week initially upgraded CD44 expression in the rat small intestine and the CD44 expression later became significantly depressed after obstructive jaundice for 2 weeks. Oral glutamine intake daily could effectively restore the CD44 expression in the small intestine of the rat undergoing obstructive jaundice for 2 weeks.
Animals↗
Studies of the mechanisms of gastric bleeding under obstructive jaundice. Role of biogenic amines.
Mechanisms of gastric bleeding under obstructive jaundice were studied in adult male Wistar rats. Following ligation of the common bile duct, mucosal noradrenaline significantly decreased in both the pyloric and fundic gland areas of the gastric mucosa by 20 days after the operation. Serotonin increased only in the pyloric gland area, and histamine increased in the fundic gland area. Urinary excretion of free noradrenaline significantly increased after the ligation. Three weeks after the ligation, restraint and water immersion experiments were conducted. Under water immersion, gastric blood flow significantly reduced in rats with obstructive jaundice compared to controls. Acid output decreased in both groups. Gastric bleeding was noted in the fundic gland area significantly earlier in the ligated rats than in the non-ligated rats. Administration of noradrenaline s.c. 30 minutes before immersion significantly blocked the reduction in gastric blood flow and protected the gastric mucosa against acute bleeding under immersion. These results suggested that prolonged obstructive jaundice may deplete noradrenaline in the gastric mucosa, and that gastric mucosal ischemia caused by this sympathetic dysfunction plays an important role in the formation of acute gastric bleeding under obstructive jaundice.
Animals↗
Two cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice.
We recently treated two cases of chronic pancreatitis with obstructive jaundice due to compression of the common bile duct by pancreatic pseudocyst. The two cases were males admitted with the complaint of icteric skin color. The first, a 46-year-old male, admitted with the complaint of icteric skin color. He was treated by operative cystojejunostomy after percutaneous drainage of the pseudocyst and percutaneous transhepatic biliary drainage. The other case was a 58 year-old male who admitted with the complaint of icteric skin color. He had an infected pseudocyst in the pancreas and was endoscopically treated. Both of them were discharged with favorable clinical course and normal laboratory findings after the treatment. The former patient remained well 11 months after treatment, but the latter patient died from necrotizing pancreatitis and septic shock 6 months after treatment. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct rather than due to compression of the bile duct by the pseudocyst. In a patient with secondary pancreatic infection or obstructive jaundice following pancreatic disease, differentiating between these two conditions is an important aspect of accurate diagnosis and therapy. Herein we report two unusual cases of chronic pancreatitis with pseudocyst complicated by obstructive jaundice.
Cholestasis↗