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Results for “Jaundice, Obstructive”

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PubMed1983

Suspected obstructive jaundice: a decision analysis of diagnostic strategies.

Clinical decision analysis and a computer model were used to evaluate ten diagnostic strategies for the diagnosis of extrahepatic obstructive jaundice. The sensitivity, specificity, complications, and costs of currently used individual tests were used to determine the overall sensitivity, specificity, complications, and costs of each strategy at different disease prevalences. In patients with a low probability of extrahepatic obstructive jaundice (less than or equal to 20%), the optimal strategy begins with ultrasonography, followed by a cholangiogram when dilated ducts are present. When dilated ducts are not present, patients may be observed clinically and endoscopic retrograde cholangiopancreatography is done if the jaundice does not resolve. In patients with a higher probability of extrahepatic obstructive jaundice, a cholangiogram is needed for an accurate diagnosis. In patients with a low probability of extrahepatic obstructive jaundice, the optimal strategy has an overall sensitivity of 92% and a specificity of 99%. About 40% of patients need a cholangiogram at an average cost of $1000 per patient. In patients with a higher probability of extrahepatic obstructive jaundice, the optimal strategy has an overall sensitivity of 97%, specificity of 98%, and cost of $1000 to $1200 per patient.

Biopsy↗

PubMed1987

Altered peripheral amino acid uptake in obstructive jaundice.

To characterize amino acid metabolism in obstructive jaundice, the amino acid uptake in tissues of bile duct-ligated (BDL) rats was determined. Fischer 344 rats underwent either bile duct ligation or sham laparotomy and were pair fed for 72 hr. Amino acid uptake was determined in peripheral skeletal muscle (quadriceps femoris, soleus, and rectus abdominis), liver, blood, and other tissues by accumulation of alpha-[14C]-aminoisobutyric acid following intracardiac injection. Although total hepatic amino acid uptake was unaltered in the BDL animals compared with the sham-operated controls, amino acid uptake in peripheral skeletal muscle was significantly decreased in all muscle groups studied in the BDL rats. The relative concentration (percentage dose per gram normalized to the animal mass) for quadriceps femoris was 0.16 +/- 0.02 for BDL and 0.32 +/- 0.04 for sham-operated rats, P less than 0.005. Muscle protein was lower in BDL animals when compared with sham-operated rats (P less than 0.05). Total trunk blood amino acid levels were not significantly different in the two groups; however, there was a decreased serum level of branched-chain amino acids in the BDL group, P less than 0.05. No differences in plasma glucose or serum insulin were found in the two groups; lactate levels were lower in the BDL group, and plasma triglyceride levels were three times higher in the BDL animals. These data suggest that obstructive jaundice in the rat is associated with organ-specific metabolic abnormalities consistent with impaired peripheral amino acid uptake.

Amino Acids↗

PubMedDate not supplied

Preoperative bile salt administration versus bile refeeding in obstructive jaundice.

BACKGROUND: Endotoxaemia due to intraluminal bile salt depletion may be a cause of renal failure in patients with obstructive jaundice. Administration of bile salts to these patients has been reported to decrease portal and systemic endotoxaemia during surgery and improve renal function. However, such changes have not been shown with bile refeeding. We compared the effect of preoperative bile salt administration with preoperative bile refeeding on renal function in patients with obstructive jaundice. METHODS: Sixteen patients with obstructive jaundice underwent percutaneous transhepatic biliary drainage--eight received oral bile salts (500 mg of sodium deoxycholate 8-hourly for 48 hours preoperatively) and the other 8 were refed the total bile output for the entire period of biliary drainage (median 13 days). Blood endotoxin levels and renal function were assessed before, during and after the operation. RESULTS: The number of patients with intraoperative portal and postoperative systemic endotoxaemia decreased after both forms of therapy. Renal function also improved in both the groups--all 4 patients with renal failure recovered. There was a significant increase in creatinine clearance postoperatively after bile salt therapy (from 65 ml/minute preoperatively to 87 ml/minute postoperatively). CONCLUSION: Refeeding of bile obtained by percutaneous catheter drainage is an effective, cost-free substitute for oral bile salts in patients with obstructive jaundice.

Adult↗

PubMed1985

Reversible suppression of the vascular contractile response in rats with obstructive jaundice.

Both patients and experimental animals with obstructive jaundice manifest vascular instability, with animals showing a blunted vascular response to norepinephrine (NE). We sought an intrinsic abnormality of vascular smooth muscle by studying the contractile response of isolated, helically cut aortic strips and intact portal veins to cumulative doses of NE in rats with bile duct ligation (BDL) at different times compared with sham-operated (SO) rats as controls. At 3 days after surgery, the mean cumulative maximal contractile response (Rmax) of the aortic strip of BDL rats (94.3 +/- 9.0 mg/mg tissue) was significantly lower than that of SO controls (145.3 +/- 11.5 mg/mg tissue) (P less than 0.005), associated with a tendency toward decreased sensitivity (half-maximal dose [ED50]) (18.2 +/- 6.75 nmol/L vs. 6.7 +/- 0.6 nmol/L). By 6 days, there was no difference between the two groups. Similarly, by 3 days the mean Rmax for portal vein contraction in BDL rats (694 +/- 72 mg) was significantly lower than that for SO rats (1000 +/- 143 mg). In contrast, mean ED50 of the portal veins of BDL rats (327 +/- 65 nmol/L) was significantly less than that of SO rats (881 +/- 216 nmol/L), indicating greater sensitivity. At 1 and 6 days after surgery there was no significant difference between the two groups. These alterations in the vascular contractile response coincided with the maximum increases in serum bilirubin and liver enzyme levels. In conclusion, this study indicates that the circulatory abnormalities associated with obstructive jaundice are associated, at least in part, with suppression of the vascular contractile response caused by some abnormality of the vascular musculature.

Alanine Transaminase↗

PubMed1998

Obstructive jaundice alters Kupffer cell function independent of bacterial translocation.

BACKGROUND: There is a high incidence of perioperative morbidity and mortality in patients with obstructive jaundice. The absence of bile in the gastrointestinal tract promotes bacterial overgrowth and the increased translocation of bacteria and endotoxin to the liver which has been postulated to inhibit Kupffer cell function in these patients. But, biliary tract obstruction can directly damage liver cells and thus alter their function. Thus, we hypothesized that obstructive jaundice alone alters Kupffer cell function independent of the effects of bacterial translocation. This study was designed to evaluate the contribution of bacterial translocation to the altered Kupffer cell function observed in patients with obstructive jaundice. METHODS: Sprague-Dawley rats were randomized to three groups of six animals each. Group 1 underwent common bile duct ligation with intestinal bile salt replacement (sodium taurocholate 100 mg/kg/day) via gastrostomy and an implantable osmotic pump (CBDL + bile salts), Group 2 underwent common bile duct ligation with normal saline replacement (CBDL + saline), and Group 3 underwent a sham operation (sham control). After 7 days, tissue and blood were collected for bacterial translocation and biochemical analyses. Examination of cultured Kupffer cell function included measuring the phagocytosis of heat-killed Candida albicans and endotoxin (LPS)-induced TNFalpha and nitric oxide production. RESULTS: While bacterial translocation and cecal bacterial counts were significantly increased in the CBDL + saline group, these parameters were both reduced to control levels following intestinal bile salt replacement (CBDL + bile salts). Altered Kupffer cell function, as measured by the increased phagocytosis of C. albicans and LPS-induced NO production, and decreased LPS-induced TNFalpha production were observed in all animals with obstructive jaundice regardless of bile salt replacement. CONCLUSION: Kupffer cell function appears to be differentially affected by obstructive jaundice and these altered functions can occur independent of bacterial translocation.

Animals↗

PubMed1996

The effects of intravenously infused catecholamines on hepatic blood flow in conscious dogs with experimental obstructive jaundice.

This study was conducted to examine how the effects of dopamine and dobutamine on hepatic blood flow were influenced by obstructive jaundice in a conscious canine model. Prior to biliary obstruction, portal venous blood flow (PVF) increased in response to the infusion of either dopamine or dobutamine: dopamine infused at 8 micrograms/kg per min produced an increase of 19 +/- 0% in PVF, while dobutamine infused at 16 micrograms/kg per min produced an increase of 30 +/- 2%. Although hepatic arterial blood flow (HAF) decreased dose-dependently in response to the infusion of dopamine, no significant change was observed in HAF in response to any dose of dobutamine. Obstructive jaundice attenuated or completely abolished the PVF-increasing effect of dopamine, whereas it did not significantly alter the effect of dobutamine on hepatic blood flow. In dogs with obstructive jaundice, dopamine at 16 micrograms/kg per min produced a decrease of 17 +/- 3% in PVF. These findings suggest that dobutamine is more effective than dopamine for increasing hepatic blood flow in patients with obstructive jaundice.

Animals↗

PubMed2004

[Obstructive jaundice after surgery of the biliary tract, a benign stricture or not?].

Obstructive jaundice occurred in 3 patients, 2 women, aged 44 and 60 years, and one man aged 62 years: 17 years after choledochojejunostomy following a complicated cholecystectomy, 8 years after hepatojejunostomy following choledochal cyst removal, and 1 year after laparoscopic cholecystectomy. Percutaneous or endoscopic stent placement was performed in all patients to relieve biliary obstruction. However, stent dysfunction repeatedly resulted in re-stenting of the obstruction. Imaging techniques, as well as endoscopic brush pathology could not distinguish between a benign or malignant stenosis. Explorative laparotomy showed a new growth in all 3 patients, of which 2 were malignant. When obstructive jaundice occurs after surgery of the biliary tract for benign disease, the most likely cause is a benign stenosis. Percutaneous or endoscopic stenting is the treatment of choice. In case of unexpected and/or repeated stent failure, when a diagnosis cannot be made due to inconclusive imaging or pathology of the stenosis exploratory surgery should be considered, as malignant stenosis may be present.

Adult↗

PubMed1953