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Results for “Jaundice, Obstructive”

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PubMed1999

Perioperative hepatic functional risk assessed with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin liver scintigraphy in patients undergoing pancreaticoduodenectomy complicated by obstructive jaundice.

CONCLUSION: Liver scintigraphy with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) can be used to predict outcome of biliary drainage and hepatic function after pancreaticoduodenectomy in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice. BACKGROUND: Preoperative obstructive jaundice has been reported as a crucial risk factor for serious postoperative complications in patients undergoing pancreaticoduodenectomy. The aim of the present study was to investigate whether Tc-GSA liver scintigraphy can assess hepatic functional risk in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice. METHODS: Liver scintigraphy was performed before biliary drainage in 18 patients with obstructive jaundice. The maximum removal rate of Tc-GSA (GSA-Rmax; standard normal value > or = 0.60) was calculated. These patients underwent pancreaticoduodenectomy with wide lymphadenectomy. The efficacy of preoperative biliary drainage was assessed with the decrease in serum bilirubin concentration in the first week after biliary drainage. Postoperative liver function was assessed with the increase in serum bilirubin concentration, which was the difference between the immediate preoperative and maximal postoperative bilirubin concentrations. RESULTS: Serum bilirubin decreased more in the first week after biliary drainage in patients with GSA-Rmax > or = 0.60 (7.64 +/- 1.09 mg/Dl/wk) than in patients with GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/DL/wk, p = 0.042). Postoperative bilirubin increased less in patients with GSA-Rmax > or = 0.60 (0.81 +/- 0.30 mg/dL) than in patients with GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/DL, p = 0.0012). Multivariate analysis showed that GSA-Rmax significantly predicted the postoperative bilirubin increase (p = 0.020).

Adult↗

PubMed1992

[Changes in lysosomal enzymes and cell damage of the liver in obstructive jaundiced rats].

The changes of hepatic lysosomal enzymes and the hepatic cellular damage were investigated in rats with obstructive jaundice, phospholipase A2 (PL-A2) which is a strong labilizer of lysosomal membrane was added in the lysosomal fraction of rat's liver with various concentration. The activities of cathepsin D and beta-glucuronidase those were released by PL-A2 from lysosomal fraction were measured. The values of both lysosomal enzyme activities showed positive relation to the concentration of PL-A2, and were remarkably increased in obstructive jaundiced rats than in normal rats. We also measured the activity of cathepsin D released by Triton X-100 from lysosomal fraction of normal and jaundiced rat liver. The amount of lysosomal enzyme was more increased in obstructive jaundiced liver than in normal liver. Fragility score as the indicator for lysosomal membranous fragility was calculated as the ratio of cathepsin D released by PL-A2 to that released by Triton X-100. Fragility score was more increased in obstructive jaundiced rats than in normal rats. In conclusion, these data suggest that the fragility of lysosomal membrane could be enhanced in obstructive jaundiced liver.

Animals↗

PubMed2006

Obstructive jaundice due to hepatobiliary cystadenoma or cystadenocarcinoma.

Hepatobiliary cystadenomas (HBC) and cystadenocarcinomas are rare cystic lesions. Most patients with these lesions are asymptomatic, but presentation with obstructive jaundice may occur. The first patient presented with intermittent colicky pain and recurrent obstructive jaundice. Imaging studies revealed a polypoid lesion in the left hepatic duct. The second patient had recurrent jaundice and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cystic lesion at the confluence of the hepatic duct. In the third patient with intermittent jaundice and cholangitis, cholangioscopy revealed a papillomatous structure protruding into the left bile duct system. In the fourth patient with obstructive jaundice, CT-scan showed slight dilatation of the intrahepatic bile ducts and dilatation of the common bile duct of 3 cm. ERCP showed filling of a cystic lesion. All patients underwent partial liver resection, revealing HBC in the specimen. In the fifth patient presenting with obstructive jaundice, ultrasound examination showed a hyperechogenic cystic lesion centrally in the liver. The resection specimen revealed a hepatobiliary cystadenocarcinoma. HBC and cystadenocarcinoma may give rise to obstructive jaundice. Evaluation with cross-sectional imaging techniques is useful. ERCP is a useful tool to differentiate extraductal from intraductal obstruction.

Adult↗

PubMed1977

[Abnormal lipoprotein (LP-X) in the first months of life with particular reference to obstructive jaundice (author's transl)].

Abnormal lipoprotein (LP-X) represents a specific parameter for the presence of obstructive jaundice in the adult. Since LP-X has also been detected in the serum of newborn infants, both full-term and premature, and in early infancy, in the absence of clinical evidence of obstructive jaundice, extensive investigations were undertaken in infants during the neonatal period to clarify this phenomenon. The present study reports the data obtained in over 2000 sera from over 370 infants (mature newborn and premature newborn and young infants), tested more or less continuously by means of the Rapidophor method, initially on a qualitative, and subsequently, on a semi-quantitative basis. LP-X appears within the first fortnight in newborn infants, irrespective of the mode of feeding. The LP-X concentration was correlated to the birth weight. Premature infants displaying signs of immaturity possessed markedly higher LP-X levels than mature newborn infants. LP-X was not correlated to the alkaline phosphatase level, nor to the gammaglutamyl transferase activity; the bilirubin level, likewise, had no connection with the LP-X concentration. Patients with proven obstructive jaundice showed distinctly higher LP-X concentrations (greater than 56 mg/100 ml), whereby the rise in LP-X level in some cases preceded the appearance of the clinical manifestations of obstructive jaundice. The following hypotheses are advanced in order to explain the presence of LP-X during the neonatal period and are discussed on the basis of clinical observations in adults, the physiological conditions in the newborn infant and the results of the present study: The liver, which occupies the central position amongst metabolic organs, also in the case of the lipoproteins, is at a physiological stage of organic and functional maturation during this early period of life. Under these circumstances, a pseudo-obstructive mechanism on the basis of insufficient excretion of biliary lipoproteins, in conjunction with a simultaneous "physiological" deficiency of lecithin: cholesterol acyl transferase could lead to the appearance of LP-X in the serum. Catabolism of the resultant LP-X cannot take place owing to an inadequate activity of lipoprotein lipase. Functional immaturity can be presumed in the case of both enzyme systems during the neonatal period. On attainment of a degree of maturity compatible with the appropriate neonatal stage, the LP-X values become negative between the 7th and the 16th week of life. It is conceivable that the appearance of LP-X in the newborn infant can be ascribed to LP-X1, since the "physiological" LP-X concentrations in the neonatal period (values of up to 20 mg/100 ml) are distinctly lower than the values found in obstructive jaundice. LP-X determination can be rated as a useful supplementary investigation in the differential diagnosis of extrahepatic biliary atresia during the first weeks or months of life...

Alanine Transaminase↗

PubMed1997

Experimental model of obstructive jaundice in mongrel dog: study of subsequent pathological changes in liver.

BACKGROUND: Attempts at creating an experimental model of obstructive jaundice in large animals have been unsuccessful because of frequent fistulization of the ligated bile duct. OBJECTIVES: To produce a model of obstructive jaundice in mongrel dogs and to study subsequent serial pathological changes in the liver. METHODS: Four techniques were evaluated in four dogs to produce obstructive jaundice. After creation of a successful model, subsequent clinical and biochemical outcome and serial pathological changes in the liver were studied in another 14 dogs. RESULTS: Complete extrahepatic biliary dissection produced a model of persistent obstructive jaundice. Serial histological changes included inflammation and edema in the first 14 days followed by lymphocytic infiltration at 28 days. Fibrosis started by day 7 and resulted in architectural distortion by day 21. CONCLUSION: An acute, complete and irreversible model of obstructive jaundice can be produced by extrahepatic biliary tree excision and ligation. Serial pathological changes showed acute inflammation, followed by fibrosis and architectural distortion.

Animals↗

PubMed1990

Soluble interleukin-2 receptor and soluble CD8 in liver cirrhosis and obstructive jaundice.

Activated lymphocytes secrete soluble interleukin-2 receptor (sIL-2R); CD8-positive lymphocytes secrete soluble CD8 (sCD8). Liver dysfunction in cirrhosis and obstructive jaundice is known to result in depressed cellular immunity. To evaluate whether this is due to real inactivation of the immune system, we measured sIL-2R and sCD8 in the serum of 46 patients with liver cirrhosis, 25 patients with obstructive jaundice, 32 patients with alcoholic liver disease without evidence of cirrhosis, 23 healthy persons and 43 patients with unrelated disease. sIL-2R in patients with cirrhosis (mean +/- s.e.m. 1499 +/- 140 U/ml) and obstructive jaundice (1517 +/- 204) was significantly increased compared with healthy subjects (363 +/- 29) and patients with unrelated diseases (685 +/- 92); sCD8 was significantly increased in patients with cirrhosis (737 +/- 63) but not in patients with obstructive jaundice (419 +/- 32) compared with healthy subjects (322 +/- 23) and patients with unrelated diseases (375 +/- 22). No difference was found between patients with cirrhosis due to alcohol abuse (n = 15) and chronic hepatitis B (n = 6). The Child-Pugh score had no significant influence on the sIL-2R or sCD8 value. In obstructive jaundice, sIL-2R correlated with alkaline phosphatase as marker of cholestasis (r = 0.43). These data show that in spite of the apparent depressed cellular immune defense both in liver cirrhosis and obstructive jaundice there is a general activation of the immune system but the CD8+ cell compartment is only activated in liver cirrhosis. The great changes of sIL-2R and sCD8 in liver dysfunction are important for the interpretation of studies using these serum proteins as markers for immune activation.

Adult↗

PubMedDate not supplied

Factors affecting surgical mortality and morbidity in patients with obstructive jaundice.

The importance of clinical and laboratory parameters which have an effect on postoperative mortality and morbidity was evaluated in 124 patients operated on because of obstructive jaundice. The causes of obstructive jaundice were a malign disease in 38 patients (30.6%) and a benign disease in 86 patients (69.4%). Biliary enteric anastomosis in 66 patients (53%), external drainage in 46 patients (37%), and cholecystectomy in 12 patients (10%) were the surgical techniques of choice for correction of obstructive jaundice. There were significantly high mortality rates in patients with weight loss, more than 10 kg during preoperative the month (p < 0.05); jaundice longer than 21 days, (p < 0.001); and malignancy caused jaundice (p < 0.002). Haematocrite less than 30% (p < 0.05), albumin level below 3 g/dl (p < 0.01), blood urea nitrogen level above 30 mg/dl (p < 0.001), and bilirubine above 10 mg/dl (p < 0.01) were determined as risk factors in mortality. Direct relationships between the number of risk factors, complications, and mortality ratios were determined. One or more complications were determined in patients with more than six risk factors. High mortality rate was also determined in patients who had five and more risk factors. The following factors were evaluated: respiratory, circulatory, renal functions, and infection, and metabolic concomitant diseases, and comorbid scores for each patient were calculated. High rate complications in patients with eight and more comorbid scores and high mortality rates in patients with six and more were also determined. Finally, all these parameters were important in demonstrating postoperative mortality in obstructive jaundice patients. We suggest that surgery after treatment of correctable risk factors decreases postoperative morbidity and mortality.

Cholestasis↗

PubMed1995

Factors influencing the success rates of endoscopic nasobiliary drainage in treatment of obstructive jaundice.

BACKGROUND: Endoscopic nasobiliary drainage (ENBD) is a safe and effective modality which has been well documented for obstructive jaundice. However, factors predicting success rate of ENBD remain inconclusively. This study analyses those factors and discusses the outcome of patients with obstructive jaundice. METHODS: One hundred and sixteen patients (male 99, female 17; mean age 68.2 years) with obstructive jaundice received ENBD after endoscopic retrograde cholangiogram (ERC) by Olympus JF-lT20 endoscope and 7F Wilson-Cook nasobiliary catheter from Sep. 1990 to Oct. 1993. Bile output (QD), serum bilirubin (BIW), liver biochemistry (QW), bile culture (next day), blood culture (if BT > 38.5 degrees C) were checked until definite treatment or death. Adequate drainage was defined as a daily output of bile more than 200cc, a gradual drop in serum bilirubin and no signs of cholangitis. Factors such as causes of jaundice, obstruction level, serum bilirubin, albumin, juxtapapillary diverticulum (JPD), bacteremia, fever before ERCP and ascites were analyzed. RESULTS: The success rate was 86.2% (100/116) in ERC and 78% (78/100) in ENBD. Adequate biliary drainage was 82.1% (64/78), and serum bilirubin was reduced from 14.3 +/- 8.5 mg% to 7.5 +/- 5.6 mg% within one week. In patients with non-cancerous causes, higher success rate and adequate drainage rate were obtained compared with those with cancerous causes (94.3% vs. 69.2%, p < 0.01 and 88.6% vs. 50.8%, p < 0.01, respectively). In all patients, a higher success rate was achieved at the obstruction level at the common bile duct (CBD) compared with periampullary and hilar levels (90.7% vs 69.2%, p < 0.05 and 90.7% vs 28.6%, p < 0.001, respectively). In patients with cancer as a cause, higher success rate was achieved at CBD level than at hilar level (85% vs 28.6%, p < 0.05). Those patients with cancer and serum bilirubin above 15 mg/dl had a higher failure rate in ENBD. Success rate of ENBD was not related to the presence of JPD, bacteremia or fever before ERCP and serum albumin level. CONCLUSIONS: Factors decreasing the success rates of ENBD were underlying cancerous causes, obstruction level at hilum or periampullary region and serum bilirubin level more than 15 mg%.

Adult↗

PubMed2005

Effects of recombinant human growth hormone on intestinal translocation of bacteria and endotoxin in rats with obstructive jaundice.

BACKGROUND: Extrahepatic biliary obstruction promotes intestinal translocation of bacteria and endotoxin and this process is an important cause of morbidity and mortality in patients with jaundice. This study was undertaken to investigate the effect and mechanism of recombinant human growth hormone(rhGH) and to alleviate intestinal translocation of bacteria and endotoxin in murine obstructive jaundice. METHODS: A group of 42 Wistar rats were divided into 3 groups:sham operation(SO), bile duct ligation (BDL), and BDL and rhGH treatment(rhGH). By the end of the experiment, on day 7, the animals were killed, and their liver function and serum endotoxin were measured, bacterial cultures of the liver, kidney and mesenchymal lymph were made. Terminal ileum mucosa was observed under an electron microscope. RESULTS: Liver function was improved more significantly in the rhGH group than in the BDL group. The value of endotoxin in the rhGH group was 0.38+/-0.03 EU/ml, significantly lower than that in the BDL group(0.65+/-0.04 EU/ml, P < 0.01), and similar to that in the SO group (0.30+/-0.02 EU/ml, P > 0.05). The rate of bacteria translocation in the liver, kidney and mesenteric lymph was much higher in the BDL group than in other two groups. The rate of bacteria translocation in mesenteric lymph was 64.29%, significantly higher than that in the SO group and the rhGH group (P < 0.05). There was no significant difference in bacteria translocation rate between the SO group and the rhGH group (P > 0.05). Under an electron microscope, ileum mucosa epithelial cells in the BDL group were necrotic, and organelle were markedly metamorphic. In the rhGH group, ultrastructural changes were less evident or similar to those in the SO group. CONCLUSION: rhGH has significant protective effects on intestinal mucosa barrier in obstructive jaundice, and reduces intestinal translocation of bacteria and endotoxin.

Animals↗

PubMed1998

An autopsy case of granulocytic sarcoma of the porta hepatis causing obstructive jaundice.

We describe an extremely rare case of granulocytic sarcoma of the porta hepatis causing obstructive jaundice. The patient was an 84-year-old man admitted because of obstructive jaundice. Ultrasonography (US) and computed tomography (CT) scanning of the abdomen disclosed a mass about 2.5 cm in diameter near the neck of the gallbladder, and thickening of the gallbladder wall. Based on these findings, gallbladder carcinoma was suspected. After endoscopic retrograde biliary drainage (ERBD) was performed, the jaundice resolved. However, blast cells were detected in the peripheral blood 51 days after admission, and laboratory studies disclosed acute myelocytic leukemia (AML: French-American-British [FAB] type M0). We treated him conservatively, with antibiotics and ERBD but he died of disseminated intravascular coagulation. Autopsy showed that the suspected gallbladder carcinoma was actually a granulocytic sarcoma arising in association with AML and causing obstructive jaundice. The largest tumor involved the porta hepatis. It should be kept in mind that granuloctyic sarcoma is a possible cause of obstructive jaundice, even in patients with no evidence of AML.

Aged↗

PubMedDate not supplied

Dilatation of the cystic duct in patients with obstructive jaundice.

BACKGROUND: It is well known that obstructive jaundice causes biliary dilatation, but sonographic (US) findings of the cystic duct in patients with obstructive jaundice are rarely reported. METHODS: We reviewed US findings in 25 such patients. RESULTS: US findings of dilated cystic duct could be divided roughly into two patterns: tortuous and tubular. The former pattern was a tortuously dilated cystic duct arising from the gallbladder neck, running predominantly deeply, turning anteromedially, and then joining the posterior face of the common hepatic duct. The latter pattern was a straight dilated cystic duct running parallel with the common hepatic duct, giving the appearance of a septated bile duct. CONCLUSION: A better understanding of the US findings of dilated cystic duct translates into improved biliary US diagnosis.

Adult↗

PubMedDate not supplied

Obstructive jaundice promotes bacterial translocation in humans.

BACKGROUND/AIMS: Significant bacterial translocation was demonstrated following experimental biliary obstruction, however very little is known about the importance and the prevalence of gut-origin sepsis in obstructive jaundice patients. Therefore, the aim of this study was to investigate the concept of gut-origin sepsis in obstructive jaundiced patients and its clinical importance. METHODOLOGY: Twenty-one patients requiring laparotomy for obstructive jaundice (group I) and thirty patients operated on electively mainly for chronic cholecystitis (group II) were studied. Peritoneal swab, mesenteric lymph node, portal venous blood, liver wedge biopsy and bile were sampled for culture immediately after opening the peritoneum. Additionally, peripheral blood samples were taken pre- and post-operatively from all patients. Post-operatively, patients were monitored for infectious complications. RESULTS: The mean serum bilirubin concentration, gamma glutamyl transferase and alkaline phosphatase levels in jaundiced patients before therapeutic intervention were significantly higher than in control patients. Five patients demonstrated bacterial translocation in group I (24%), whereas only one did so in group II (3.5%, p < 0.05). Septic complications were detected in three patients, but only in two with bacterial translocation in group I. There was one patient with bacterial translocation who had septic complication in group II. CONCLUSIONS: The present study demonstrated that obstructive jaundice significantly promotes bacterial translocation in humans, however, its clinical importance has yet to be defined.

Adolescent↗

PubMed2003

[Impact of spiral CT cholangiography on suspected obstructive jaundice].

OBJECTIVE: To study spiral CT cholangiography (SCTC) before treatment in patients with obstructive jaundice due to unknown cause. METHODS: Between October 1998 and November 2000, a total of 59 patients with obstructive jaundice of unknown cause were examined by two-phase enhanced spiral CT (eSCT). Twenty-nine of these cases were excluded because they had had T-Bil of > 34 micromol/L so that their biliary duct system could not have been visualized. The remaining 30 patients were 17 male and 13 female with an age range of 31 - 76 years (mean 56.6). Pathologically, the lesion was proven to be carcinoma of pancreatic head (n = 9), Vater's ampulla carcinoma (n = 4), extrahepatic or hilar cholangiocarcinoma (n = 13), hepatocellular carcinoma (n = 1), chronic pancreatitis (n = 1) and cholelithiasis (n = 2). SCTC was performed through intravenous injection of 20 ml 50% Cholografin within 20 min before eSCT. SCTC was undertaken with parameters of a slice thickness of 2 - 3 mm, a table feed of 3 - 5 mm, a gantry time of 0.75 sec, a reconstruction interval of 1 - 2 mm, a pitch of 1.1 - 1.2, a voltage of 120 kV, a current of 220 - 240 mA, a matrix of 512 x 512 and a scan range from the level above hepatic hilum to the third segment of duodenum within 60 - 105 min following the injection. Both reconstructed SCTC source images and later eSCT scans were considered as axial CT (ACT). Multiplanar reconstruction (MPR) was obtained immediately on the operator console. 3D imaging adopted in our study was volume rendering technology (VRT) that was processed on the Siemens 3D Virtuoso workstation within 30 min. Opacification of biliary tree (OBT) analyzed by Grades 1 to 5 and image quality (IQ) assessed by 4 scales as excellent, good, fair and poor were investigated in ACT, MPR and VRT, respectively. The correlation between total OBT, which was the highest among the 3 image methods in the same case, and T-Bil, D-Bil, ALT, severity of the biliary obstruction (SBO) as well as level of the obstruction was analyzed. RESULTS: In OBT, no statistically significant difference was found in the five grades by the three imaging techniques (P > 0.05), the distribution of percentages being 0, 0, 13.3%, 30.0% and 56.7% in ACT, 0, 6.7%, 20.0%, 30.0% and 43.3% in MPR and 0, 0, 13.3%, 40.0% and 46.7% in VRT. The evident correlation between total OBT and D-Bil (r(s) = -0.719), ALT (r(s) = -0.544) and SBO (r(s) = 0.650) was showed. In IQ, only a statistical significance existed between ACT and MPR (P = 0.034), having the scales "excellent to poor" in percentages of 93.3%, 6.7%, 0 and 0 for ACT, 66.7%, 30.0%, 3.3% and 0 for MPR and 70.0%, 23.3%, 6.7% and 0 for VRT, respectively. CONCLUSION: According to our study, spiral CT cholangiography is very useful for the evaluation of selected patients with suspected obstructive jaundice before treatment.

Adult↗

PubMed1979

Resectability and functional reserve of the liver with obstructive jaundice in dogs.

Fifty-five dogs were used to evaluate the resectability of the liver with obstructive jaundice. Cholecystectomy and ligation of the distal common bile duct were used to produce obstructive jaundice. It was found that 40 per cent of the liver with obstructive jaundice was resectable with biliary decompression 2 weeks after ligation. At 1 week after induction of obstructive jaundice, 70 per cent hepatectomy with biliary decompression may be tolerated with careful postoperative management. From serum chemical studies it was found that if the serum albumin level was below 2.0 g/dl, 60 per cent of the dogs died after 40 per cent hepatectomy and all died after 70 per cent hepatectomy. From the standpoint of hepatic functional reserve 40 per cent hepatectomy is successful if the maximal removal rate of indocyanine green is above 0.14 mg/kg/min. Hepatic functional reserve is reliable for predicting the risk of hepatectomy, and it correlates well with the rate of hepatic regeneration after hepatectomy.

Animals↗

PubMed1996

Percutaneous transhepatic biliary drainage for the treatment of obstructive jaundice caused by metastases from nonbiliary and nonpancreatic cancers.

The usefulness of percutaneous transhepatic biliary drainage (PTBD) in the treatment of obstructive jaundice caused by metastases from nonbiliary and nonpancreatic cancers was evaluated. Eighteen patients underwent PTBD during a 3-year period. The primary cancers were located in the stomach (nine cases), colon (four), lung (three), uterus (one), and breast (one). The causes of obstructive jaundice and bile duct strictures were investigated using both abdominal computed tomography and abdominal ultrasonography. The causes of obstructive jaundice, the usefulness of PTBD in terms of the relief of symptoms and laboratory data, survival after PTBD, and the relationship between patient characteristics and survival were evaluated. Obstructive jaundice was most often attributable to metastases to the lymph nodes (17 of 18 cases). One case was attributed to metastasis to the liver. PTBD decreased the jaundice and relieved the symptoms caused by biliary tract obstruction. Median survival after PTBD was 59 days. Patients whose performance status was 2 or less survived longer than those with a performance status of 3 or more (P=0.018). Furthermore, patients aged less than 60 years tended to survive longer than those aged 60 or over (P=0.057). Our results suggest that PTBD is useful for relief of symptoms caused by obstructive jaundice in patients with nonbiliary and nonpancreatic cancers.

Adult↗

PubMed1989

[Effect of li dan ling in decreasing jaundice and improving liver function in patients with obstructive jaundice].

A total of 89 cases with extrahepatic jaundice were studied clinically. All patients were divided into two groups at random: control group and Li Dan Ling treatment group. It was found that: (1) liver functions in the patients with obstructive jaundice were injured severely; bilirubin, R15ICG, m-GOT, and gamma-GT were increased significantly; (2) in patients with incomplete biliary obstruction or after the relief of obstruction, liver functions could be improved gradually. They were improved more quickly in patients of the Li Dan Ling treatment group; (3) for the patients suffering from complete biliary tract obstruction, until the obstruction was relieved liver function could not be improved. After the herbal medicine, all the indicators would be further worsened before the relief of the obstruction, and the value of "b" would be positive. The increase in m-GOT and gamma-GT was higher than in the control group, indicating the liver functions were further injured. Therefore, the herbal cholegogue was not suitable for the patients before the obstruction was relieved. The further investigations showed that excretion of bilirubin from the bile could be accelerated by Li Dan Ling, and after herbal administration, the cholesterol level in bile was lowered significantly; the liver blood flow in normal and jaundiced rats would be increased 30 to 90 min. after administering the herbs.

Adult↗

PubMed2005

Roles of protein kinase C and fructose in hepatic injury caused by obstructive jaundice.

The regulating mechanism in hepatic injury caused by obstructive jaundice (OJ) was examined in this study. Rat hepatocytes were harvested by in situ collagenase perfusion and subjected to primary culture. The heptocytes were pre-treated with various concentrations of protein kinase C (PKC) agonist PMA and its inhibitor chelerythrine and cultured for 20 min. After the treatment, 50 micromol/L glycochenodeoxycholate (GCDC) was added and the cells were cultured for an additional 24 h. Cells were then detected by flow cytometry (FCM) and TUNEL. After hepatocytes were treated with different concentrations of fructose and 100 microM GCDC, the cells were examined by FCM and TUNEL. Experimental obstructive jaundice (BDL) was induced by double ligation of the bile duct. After BDL, the rats were fed with or without fructos and sacrificed 3, 7, 14 and 21 days after the ligation. The apoptotic status was observed in liver of all rats with TUNEL and PKC protein in liver of OJ was studied by immunohistochemical method. Our results showed that PMA increased GCDC-induced apoptosis and chelerythrine decreased GCDC-induced apoptosis in a concentration-dependent manner. After the treatment with fructose of different concentrations, 100 microM GCDC decreased the apoptotic rate and the apoptotic rate decreased with the increase of fructose concentration. The apoptotic rate of liver was related to the time of OJ. Without the treatment of fructose, PKC and apoptosis index (AI) were highest 14 days after the bile duct ligation. With the treatment of fructose, apoptosis index (AI) and PKC were decreased from the 14th day after the bile duct ligation. It is concluded that PKC is involved in the regulation of apoptosis in the liver cells with OJ and plays important roles in the development and progression of liver injury caused by OJ. Fructose can protect hepatocytes in the bile salt-induced apoptosis by regulating PKC.

Alkaloids↗

PubMed1999

Depressed cytotoxic activity of hepatic nonparenchymal cells in rats with obstructive jaundice.

BACKGROUND: The nonparenchymal cells (NPC) of the liver have strong cytotoxic activity. Our hypothesis is that their activity may be imparted by obstructive jaundice and show recovery after biliary drainage. METHODS: In Donryu rats, we performed either a sham operation (group C; n = 5), production of irreversible obstructive jaundice (group J; n = 5), or production of reversible obstructive jaundice for 7 days, with biliary drainage then provided for 3 days (group Ds; n = 5) or for 14 days (group Dl; n = 5). Natural killer (NK)-cell activities shown against YAC-1 lymphoma cells of hepatic NPC and peripheral blood mononuclear cells were assessed. We then measured the growth of experimental liver metastases 13 days after inoculation of a tumor cell line (AH130) into the portal vein of rats that had undergone similar biliary manipulations (group mC, group mJ, group mDs, and group mDl; n = 5 in each group). RESULTS: The highest number of NK activities by NPC in group J (11.5%) and group Ds (37.7%) were significantly lower than those in group C (68.8%) and group Dl (90.5%; effector/target ratios, 40:1; P < .01). NK activity of peripheral blood mononuclear cells was similar among groups. Metastatic liver tumors in group mJ (10.2% +/- 2.6%) and group mDs (5.4% +/- 1.5%) were significantly larger than in group mC (0.4% +/- 0.1%) and group mDl (0.5% +/- 0.3%; P < .02). CONCLUSIONS: Obstructive jaundice depressed the NK activity of hepatic NPC and enhanced the growth of liver metastases. To counter this depression, adequate biliary drainage was required. These results suggest that preoperative biliary drainage to relieve obstructive jaundice might help to prevent liver metastases after surgery for biliary tract or pancreatic tumors.

Animals↗