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PubMed1994

Inhibition of bacterial translocation in obstructive jaundice by muramyl tripeptide phosphatidylethanolamine in the rat.

Obstructive jaundice is frequently associated with septic complications and enteric bacteria have been isolated from both the infectious focus and bile in jaundiced patients. The present study aimed to evaluate bacterial translocation and the influence of a macrophage-stimulant (muramyl tripeptide phosphatidylethanolamine) on bacterial translocation in obstructive jaundice. Male Sprague-Dawley rats were subjected to sham operation (n = 10) or common bile-duct ligation and transection (n = 35). Two weeks later, jaundiced animals received either physiological saline (n = 15), muramyl tripeptide phosphatidylethanolamine liposomes (n = 10) or placebo (empty) liposomes (n = 10) orally, while sham-operated rats received physiological saline, 48 h prior to evaluation of enteric bacterial translocation. Blood, bile and caecal contents were collected and cultured aerobically and anaerobically, as were tissue samples from the liver, spleen and mesenteric lymph nodes. Positive mesenteric lymph node cultures in animals with jaundice + saline (7/15; 47%) and jaundice + placebo liposomes (4/10; 40%) significantly differed (p < 0.05) from sham-operated animals (1/10; 10%) and muramyl tripeptide phosphatidylethanolamine treated animals (0/10). Caecal counts (CFU/g) of Escherichia coli, Lactobacilli and aerobic and microaerobic bacteria did not differ statistically among the groups, although the number of E. coli tended to be higher in jaundiced animals. Thus, liposomal muramyl tripeptide phosphatidylethanolamine inhibits bacterial translocation, probably by activating mucosal macrophages and enhancing reticuloendothelial system function in rats with biliary obstruction.

Acetylmuramyl-Alanyl-Isoglutamine↗

PubMed1993

New model of reversible obstructive jaundice in rats.

OBJECTIVE: To develop a simple, reversible, reproducible model of obstructive jaundice in rats that could also be used for studies of infection associated with foreign bodies in the biliary tract. DESIGN: Open study. SETTING: University of Lund, Sweden. MATERIAL: 18 Male Sprague-Dawley rats. INTERVENTION: Laparotomy and the placing of a "minioccluder" (developed in this laboratory) around the common bile duct. This was left in place for five days. MAIN OUTCOME MEASURES: Results of standard liver function tests measured on days 0, 5, and 12; the degree of obstruction seen on cholangiography on day 12; and changes in body weight on days 5 and 12. RESULTS: Activities of hepatic enzymes and plasma bilirubin concentrations were significantly increased on day 5 compared with day 0 (p < 0.01 in each case), but had returned to the reference range by day 12. Cholangiography (n = 10) showed that even though the part of the common bile duct proximal to the minioccluder was dilated the distal part was of normal diameter and patent. By 5 days the animals had lost 5% of their mean body weight, but this increased by 8% during the 7 days after relief of the occlusion (day 12). CONCLUSION: We have developed a reversible, reproducible model of obstructive jaundice in rats, which can be used for the study of topics related to obstructive jaundice and in particular infection associated with foreign bodies in the biliary tract.

Animals↗

PubMed2001

Effectiveness of endoscopic biliary drainage for unresectable hepatocellular carcinoma associated with obstructive jaundice.

Endoscopic biliary drainage (EBD) for unresectable hepatocellular carcinoma (HCC) associated with obstructive jaundice remains controversial because of the short survival of these patients. To evaluate the effectiveness of this procedure, we retrospectively studied 18 patients who had unresectable HCC with obstructive jaundice and underwent EBD with polyethylene stents, over a 10-year period. Nine patients with tumor thrombus involving the first branches of the portal vein or portal trunk (Vp3) formed group A and the other 9 (Vp0-Vp2) formed group B. The serum albumin level and serum total bililubin level differed significantly between the two groups (P < 0.05 and P < 0.005. Student's t-test), but prothrombin time did not. The obstructive jaundice was mainly caused by direct tumor invasion in 6 patients from group A and 3 from group B, by blood clots and/or tumor fragments in 2 patients from group A and 3 from group B, by the tumor protruding into the common hepatic duct in 2 patients from group B. and by tumor compression of the common bile duct in 1 patient from each group. Drainage was successful in 4 patients (44%) from group A and in all 9 patients (100%) from group B. Among the 5 patients with unsuccessful drainage in group A, 4 had obstruction of both the left and right hepatic ducts and 3 had multiple tumors in both lobes. The mean survival time (mean +/- SD) after EBD was 47 +/- 44 days in group A and 181 +/- 70 days in group B. In group A. the average survival time was only 85 days in the 4 patients with successful drainage. However, an improvement in the quality of life after EBD was observed in one-third of the Vp3 patients and in all of the Vp0-Vp2 patients. In summary, satisfactory palliation is possible with successful EBD, but this is difficult in most patients with Vp3 portal thrombus, direct tumor invasion involving both hepatic ducts, and multiple tumors in both lobes. It is important to determine the site, extent, and nature of the obstruction, as well as liver function and the presence of portal thrombus, before performing EBD.

Aged↗

PubMedDate not supplied

Aetiological spectrum of obstructive jaundice and diagnostic ability of ultrasonography: a clinician's perspective.

BACKGROUND: A vast array of invasive and non invasive diagnostic tests are available to diagnose and establish the etiology of surgical obstructive jaundice (SOJ). Invasive tests may cause cholangitis and imaging techniques like computed tomography(CT) scan and MRI are expensive. The aim of the present study was to test ultrasonography as the primary investigation in patients with SOJ and to elucidate the aetiological spectrum of obstructive jaundice as seen at a tertiary referral center. METHODS: 429 patients diagnosed as having obstructive jaundice on the basis of either CT, endoscopic retrograde cholangiopancreatography(ERCP), fine needle aspiration cytology(FNAC) or surgery underwent real time sonography over a 10 year period from May 1988 to Dec 1997. The diagnostic accuracy of ultrasonography for SOJ was established. RESULTS: Sonography correctly established the presence of obstructive jaundice in 380 of 429 patients. Of 429 patients (mean age 62.5 +/- 34.2 yrs, 229 males and 194 females) the sensitivity of ultrasound to correctly diagnose and establish the site of etiology of obstruction was 94% with a specificity of 96%. Malignant SOJ was much more common than benign causes (75.3% Vs. 24.7%). Carcinoma (Ca) of the gallbladder (28.7%) was the commonest aetiology followed by Ca pancreas (26.5%), choledocholithiasis (12.4%), cholangio Ca (10.8%) benign stricture (10.8%) and ampullary Ca (9.8%). A total of 167 subjects (44%) had high block while 213 (56%) had low block. Block at the porta hepatis was due to gallbladder Ca in 91% of patients. Ca pancreas was the cause of lower end block in 76% of patients. CONCLUSION: SOJ, as seen in this large series of patients was most often due to malignant cause and gallbladder Ca was the commonest cause in North Indian patients. The clinician should utilize the ability of the ultrasound to diagnose the presence of obstructive jaundice and its location.

Adult↗

PubMed1980

Presence of gallstones is a poor indicator of the cause of obstructive jaundice.

In a series of 56 patients with obstructive jaundice, the presence or absence of calculi in the gallbladder has been correlated with the cause of the obstruction. Seven of 23 patients with obstruction caused by stone had no calculi in the gallbladder. Twelve of 33 patients with obstruction due to tumor also had gallstones. It was concluded that the presence of calculi in the gallbladder is a poor indicator of the cause of obstructive jaundice.

Cholelithiasis↗

PubMed1988

Impaired fibrinolysis in obstructive jaundice--evidence from clinical and experimental studies.

Microvascular thrombosis is considered an important pathogenetic factor in renal failure associated with obstructive jaundice but the mechanisms leading to fibrin deposition are still unknown. The plasma levels of plasminogen activator inhibitor (PAI) in 29 patients with obstructive jaundice were found significantly increased as compared to 20 nonjaundiced patients. Fibrin autography of plasma supplemented with tissue plasminogen activator (t-PA) revealed that in icteric samples most of the added activator migrated with an apparent Mr of 100 kDa, corresponding to t-PA-PAI complex, whereas in control samples virtually all t-PA migrated as free enzyme. PAI activity detected in icteric samples is similar to the endothelial type PAI since it is neutralized by a monoclonal antibody against PAI-1. Venous stasis in jaundiced patients was neither associated with an increase in blood fibrinolytic activity nor with a decrease in PAI activity. Immunologic assay showed that t-PA release was impaired in 3 out of 4 patients. In controls, venous occlusion induced an increase in both fibrinolytic activity and t-PA antigen and a reduction in PAI activity. Bile duct recanalization in jaundiced patients subjected to surgery was accompanied by a decrease in plasma PAI activity which paralleled the decrease in serum bilirubin levels. In nonjaundiced patients, surgical treatment did not cause significant changes in either parameter. Rabbits made icteric by bile duct ligation showed an early and progressive increase in plasma PAI activity indicating that obstructive jaundice itself causes the elevation of circulating PAI. it is concluded that obstructive jaundice is associated with a severe impairment of fibrinolysis which might contribute to microvascular thrombosis and renal failure.

Adult↗

PubMedDate not supplied

Repeated obstructive jaundice and acute pancreatitis caused by metastatic liver tumor: an unusual case.

A case of repeated obstructive jaundice and acute pancreatitis caused by mucus plug produced by metastatic liver tumor is reported. A 74-year-old woman, who had a past history of curative resection of mucinous rectal cancer, showed repeated obstructive jaundice and acute pancreatitis during the follow-up period. Neither computed tomographic scan nor abdominal ultrasound could detect the recurrent lesion, however, cholangioscopy detected mucin and tumor projection into the left hepatic duct. Since the biopsy specimen of the tumor revealed adenocarcinoma, left hepatectomy was performed. The tumor was mucinous adenocarcinoma having the same histology as the primary rectal cancer, with partly mucosal replacement and formation of intraluminal mucus plaque. This case indicates that repeated obstructive jaundice and acute pancreatitis should be considered one of the manifestations of liver metastasis of mucinous cancer.

Acute Disease↗

PubMed1993

Primary chemotherapy for obstructive jaundice caused by intermediate-grade non-Hodgkin lymphoma.

BACKGROUND: Advanced non-Hodgkin lymphoma (NHL) usually is treated with doxorubicin-based combination chemotherapy. Because doxorubicin is excreted by the biliary route, many authorities recommend alternative initial interventions in patients with NHL causing obstructive jaundice. METHODS: The authors retrospectively reviewed the records of patients at Rochester General Hospital with NHL between 1983 and 1989 with obstructive jaundice at initial diagnosis. RESULTS: Five patients with obstructive jaundice due to intermediate-grade NHL were treated with combination chemotherapy without prior surgical or endoscopic biliary decompression, or radiation therapy. Three received higher doses of doxorubicin than called for in standard dose modification tables. Jaundice was relieved rapidly in all five patients without unexpected toxic effects, and all five patients entered remission (three had partial remission and two complete remission). CONCLUSIONS: Because biliary obstruction resolves rapidly after administration of chemotherapy for this disease, it is possible that standard dose reductions for doxorubicin and vincristine that are appropriate for patients with hepatocellular disease may be excessive for patients with obstructive jaundice resulting from lymphoma. The results of this study indicate that combination chemotherapy is appropriate initial therapy for patients with newly diagnosed NHL with obstructive jaundice.

Adult↗

PubMed2002

Obstructive jaundice results in increased liver expression of uncoupling protein 2 and intact skeletal muscle glucose metabolism in the rat.

BACKGROUND: A majority of patients with pancreatic cancer have obstructive jaundice and diabetes with skeletal muscle insulin resistance. Surgery for these patients is associated with significant morbidity. Uncoupling protein 2 (UCP2) has been proposed to regulate energy expenditure and promote liver vulnerability. The effects of obstructive jaundice on muscle glucose metabolism and expression of UCP2 in liver and muscle are unknown. METHODS: Rats were operated with bile duct ligation (BDL). After 7 days, UCP2 mRNA levels were determined in liver and muscle. Simultaneously, insulin-stimulated glucose transport and glycogen synthesis in skeletal muscle were analyzed in vitro. RESULTS: The jaundiced rats lost more weight than pair-fed controls. UCP2 mRNA levels were increased 5-fold in liver but not in muscle in jaundiced rats compared to pair-fed controls. The jaundiced rats were hypoglycemic and hypoinsulinemic but demonstrated intact or enhanced insulin action on skeletal muscle glucose transport and glycogen synthesis in vitro. Muscle glycogen content was increased in the jaundiced rats. CONCLUSIONS: Experimental obstructive jaundice in the rat is associated with increased liver expression of UCP2, rapid weight loss, and intact insulin action on skeletal muscle glucose metabolism. Obstructive jaundice, by upregulated liver UCP2, may contribute to the cachexia and high surgical morbidity observed in these patients, but not to skeletal muscle insulin resistance in pancreatic cancer patients.

Animals↗

PubMed2004

The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice.

OBJECTIVE: To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001. METHODS: Forty nine consecutive patients included 19 men and 30 women, suspected of obstructive jaundice. Patients underwent ultrasound (n = 49), CT (n = 11), ERCP (n = 25) and biliary surgery (n = 17). Final diagnosis was established by surgical exploration, endoscopic sphincterectomy, cytology and clinical follow up. RESULTS: Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive (88%) and specific (96.8%) in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture. CONCLUSION: Our prospective study confirms that MRCP, a noninvasive and well tolerated imaging technique is of value in the diagnosis of obstructive jaundice.

Adolescent↗

PubMed1997

New technique for inducing reversible obstructive jaundice in the rat.

We present a new animal model of reversible obstructive jaundice, in which two polyethylene tubes were inserted into the common bile duct, one towards the liver and the other towards the duodenum. The ends of the tubes were tunneled subcutaneously and tied shut to establish obstructive jaundice. Biliary drainage was achieved without a second laparotomy by connecting the tubes with a 1-cm segment of a 24-gauge needle. Serum concentrations of total bilirubin (TB), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), alkaline phosphatase (ALP), and albumin (Alb.) were measured before and after obstruction and decompression. TB, GOT, GPT and ALP increased and Alb. decreased 7 days after the onset of biliary obstruction. All values normalized 14 days after biliary drainage at the latest. Our model is reproducible and allows for evaluation of biliary decompression. Unlike previous models, it can be used for long-term investigation of chronic obstructive jaundice.

Alanine Transaminase↗

PubMed1988

Effects of sera from patients with obstructive jaundice on the generation of oxygen intermediates by normal polymorphonuclear leukocytes.

Recently it has been suggested that oxygen intermediates play an important role in the pathogenesis of tissue damage. The effect of sera from patients with obstructive jaundice on the generation of oxygen intermediates by normal polymorphonuclear leukocytes (PMNs) was investigated. Sera from patients with obstructive jaundice increased superoxide anion (O2-), hydrogen peroxide (H2O2) and hydroxol radical (OH.) generation compared with sera from healthy individuals or patients with biliary tract stones and/or tumors of the biliary tract or pancreas (without obstructive jaundice). In particular, the hydroxyl radical, which is one of the most potent oxidants capable of causing tissue damage, was produced in large quantities. Sera from patients with obstructive jaundice have a strong capacity to induce production of oxygen intermediates from PMNs, and oxygen intermediates may play a role in the pathogenesis of hepatic and other organ injury in obstructive jaundice.

Cholestasis↗

PubMed1988

Mucinous hamartoma of the biliary dust system causing obstructive jaundice.

A unique case of obstructive jaundice due to a previously undescribed mucus-secreting hamartoma compressing the common bile duct is reported. The obstructing lesion was part of a diffuse hamartoma that originated within the walls of the intrahepatic bile ducts. Gross and microscopic findings are presented.

Bile Duct Neoplasms↗

PubMed1990

The benefits of percutaneous cholecystostomy for decompression of selected cases of obstructive jaundice.

Eleven selected patients with obstructive jaundice underwent percutaneous cholecystostomy (PC) for decompression. Ten of these patients had the constellation of distal common duct obstruction, nondilated or minimally dilated intrahepatic ducts, and a distended gallbladder; one patient with a bleeding dyscrasia had moderately dilated intrahepatic bile ducts. All procedures were successful and effective, and 10 of 11 cholecystostomies were performed within 5-15 minutes. No specific complications occurred. The success, ease, and safety of the procedure indicate primary use of PC for biliary decompression when the intrahepatic bile ducts are minimally dilated or nondilated, because standard transhepatic biliary drainage may be difficult in these cases. Because cannulation of the cystic duct and hence internalization through the tumor may be difficult, PC may be most valuable preoperatively, or before standard percutaneous biliary drainage, or as an alternative to endoscopic drainage. This is a rapid and safe method with which to achieve biliary decompression, especially with minimally dilated or nondilated intrahepatic bile ducts.

Adult↗

PubMedDate not supplied

The effect of platelet activating factor antagonist BN 52021 on bacterial translocation and ICAM-I expression in experimental obstructive jaundice.

Expression of intracellular adhesion molecule-1 (ICAM-1) in an obstructive jaundice model and the potential protective role of platelet activating factor antagonist over small intestine and liver together with its effects on bacterial translocation are examined in this study. Forty-eight male Wistar albino rats were assigned into four equal groups of 12. In groups I and II, animals were sham operated. In groups III and IV, common bile duct ligation and division were performed. In group I and group III, 0.5 ml/day normal saline was applied intraperitoneally daily from day 2 to 6 of the study; in group II and group IV, 1 mg/kg/day BN 52021 was applied intraperitoneally daily from day 2 to 6 of the study. All animals were sacrificed on postoperative day 7. ICAM-1 expression (CD54 positivity) was analyzed in the liver and ileum tissue by immunohistochemical method. Samples from blood, liver mesenteric lymph nodes, and spleen were cultured under aerobic conditions. It is revealed that ICAM-1 expression was statistically higher in group III, with highest bacterial translocation and liver and spleen injury when compared to other groups. Serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyltranspeptidase (GGT), bilirubin, tumor necrosis factor alpha (TNFalpha), and interleukin 1beta(IL-1beta) values were at the highest level in group III, and there was a statistical decrease in group IV compared to group III. The administration of BN52021 in experimental obstructive jaundice is a useful way to reduce liver and intestinal mucosal villi damage by inhibiting bacterial translocation and systemic inflammatory response.

Animals↗

PubMed2005

Risk of postoperative infection in patients with bactibilia undergoing surgery for obstructive jaundice.

BACKGROUND: This study was performed to investigate the relationship between bactibilia and postoperative infection in patients undergoing surgery for obstructive jaundice. METHODS: With IRB approval, we prospectively examined 76 patients undergoing surgery for obstructive jaundice. It was the routine practice of the surgeons performing the operations to culture the common bile duct bile (CBDB). Rates of postoperative infection were analyzed with regard to the effect of positive bile cultures and biliary instrumentation preoperatively. RESULTS: Seventy-one patients had CBDB cultures, 16 of whom had bactibilia. Bactibilia was present in 15 of 47 (33%) who had preoperative ERCP versus one of 24 (4%) of those without preoperative ERCP (p = 0.0075). Postoperative infection, including pneumonia, bloodstream, central venous catheter, surgical site, intraabdominal, and urinary tract infection, occurred in six of 16 (38%) of those with bactibilia versus four of 55 (7%) of those without bactibilia (p = 0.0071). CONCLUSIONS: Preoperative ERCP was associated with an approximately eightfold increase in the likelihood of having culture-positive bile at the time of surgery for obstructive jaundice. Additionally, culture-positive bile at the time of surgery was associated with a greater than fivefold incidence of postoperative infection.

Adult↗

PubMed2002

Annular pancreas with obstructive jaundice: beware of underlying neoplasm.

INTRODUCTION: Annular pancreas is a rare congenital abnormality, and in adult patients it presents with clinical features that differ from those seen in newborns. Features in the adult patient include peptic ulceration, duodenal obstruction, acute pancreatitis, and obstructive jaundice. Treatment strategies for annular pancreas with obstructive jaundice remain controversial. AIM: To present three cases involving adult patients with annular pancreas and obstructive jaundice, due to carcinoma of the ampulla of Vater in two patients and chronic pancreatitis in the third. METHODOLOGY AND RESULTS: Pancreaticoduodenectomy was performed on all patients, and the postoperative courses were uneventful. CONCLUSION: Our experience suggests that for adult patients with annular pancreas presenting with obstructive jaundice, it is necessary to consider the possibility of associated or coexisting periampullary malignancy.

Adult↗

PubMed1991

[Effect of da cheng qi decoction co. on endotoxemia in obstructive jaundice].

The role of da cheng qi decoction co. (DCQDC) in preventing endotoxemia in obstructive jaundice has been investigated. A prospective study was performed on 43 consecutive patients with obstructive jaundice undergoing surgery. 24 patients were given oral DCQDC before operation and were compared with 19 jaundiced control patients and 17 non-jaundiced control patients. The incidence of endotoxemia was reduced in perioperative portal (P less than 0.05) and postoperative systemic (P less than 0.01) blood samples in the DCQDC treated group, and a significant fall of the postoperative 24h creatinine clearance (P less than 0.01) and the plasma fibronectin level (P less than 0.01) occurred in jaundiced controls compared with the DCQDC treated group. DCQDC may reduce endotoxin absorption by a reduction or alteration of gut flora thereby reducing the endotoxin pool available for absorption as well as by a direct effect on endotoxin. Result of this study indicated that DCQDC had a beneficial effect on endotoxemia or outcome in obstructive jaundice.

Cholestasis, Extrahepatic↗