Obstructive jaundice in an old man.
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Humans↗
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Results for “Jaundice, Obstructive”
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[Hypercholesteremic xanthomatosis in intrahepatic obstructive jaundice after administration of salvarsan].
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Arsphenamine↗
Renal handling of salt and water in the early stage of obstructive jaundice in rabbits.
Renal handling of salt and water in the early stage of obstructive jaundice was studied in rabbits 10 days after the ligation of the common bile duct (BDL). Sham-operated (SO) animals served as controls. No sodium retention was found in BDL rabbits, despite reduced renal perfusion and elevated plasma aldosterone level. A redistribution of intrarenal blood flow was not found. The filtration fraction did not change. A saline load resulted in decreases in arterial hematocrit and total serum proteins, and increases in urine output, urinary sodium excretion and osmolal clearance. Blood pressure, glomerular filtration rate (GFR), RPF, the filtration fraction and the intrarenal flow distribution were not significantly affected by the saline load. No significant difference was found in the natriuretic response to the saline load between the BDL and SO groups. After 60 h of water deprivation, there was no significant difference in urine-to-plasma osmolality ratios or renal tissue fluid osmolality between the BDL and SO animals. The findings indicate that renal handling of salt and water was well maintained in the early phase of obstructive jaundice in rabbits. The data also suggest the critical role of the redistribution of intrarenal blood flow rather than of GFR or aldosterone in determining sodium retention in obstructive jaundice.
Aldosterone↗
Role of endotoxin and nitric oxide in the pathogenesis of renal failure in obstructive jaundice.
BACKGROUND: There is an increased incidence of postoperative renal failure in patients with obstructive jaundice. The purpose of this study was to investigate the role of endotoxaemia and nitric oxide in this association. METHODS: In bile duct-ligated, sham-operated and control rats, plasma total bilirubin levels, creatinine clearance and plasma endotoxin were determined. Endothelium-dependent vasodilatation to acetylcholine, and endothelium-independent vasodilatation to nitroglycerine and forskolin were evaluated in isolated perfused rat kidney. RESULTS: Twenty-one of 27 bile-duct ligated rats had endotoxaemia. Plasma bilirubin levels were higher and creatinine clearance was significantly reduced in the bile duct-ligated endotoxin-positive group compared with values in the other groups. Furthermore, in the isolated perfused rat kidney from rats with endotoxaemia, basal perfusion pressure and renal vascular relaxation to acetylcholine and nitroglycerine which is mediated by guanosine cyclic 3',5'-cyclic monophosphate (cGMP) were significantly reduced, but relaxation to forskolin mediated by adenosine cyclic 3',5'-cyclic monophosphate did not change. CONCLUSION: Endotoxaemia in obstructive jaundice may induce overproduction of nitric oxide that may lead to impairment of cGMP-associated vasodilatation and disrupt autoregulation of the renal vascular bed. This may contribute to renal failure in obstructive jaundice.
Acetylcholine↗
Complications in obstructive jaundice: role of endotoxins.
Surgical treatment of patients with obstructive jaundice is associated with a high postoperative morbidity and mortality. A correlation was suggested between endotoxins and the observed complications. The mechanism by which endotoxins affect the negative outcome in operated jaundiced patients was, however, not clear, nor was the mechanism of clinically used preventive treatments. Several experiments were therefore performed in rats with biliary obstruction, to investigate whether and how endotoxins are active. The role of endotoxins was studied in a model in which endotoxins were absent. In germfree rats (free of bacteria and thus of endotoxin) the effect of biliary obstruction was studied and compared with biliary obstruction in conventional rats. To substantiate further the role of endotoxin, anti-endotoxin treatments (oral lactulose or internal drainage) were tested in rats with obstructive jaundice undergoing a severe surgical trauma. It is shown that endotoxins are responsible for complications (suppression of cellular immunity, kidney function, mortality) and that these complications can be prevented with an anti-endotoxin treatment. These results may have implications for preoperative treatment of jaundiced patients.
Animals↗
Ultrasound in obstructive jaundice.
One hundred and twenty-five consecutive patients with obstructive jaundice were prospectively studied by ultrasonography to determine the level and cause of obstruction. These were diagnosed precisely in 80 (72%) and 52 patients (41.6%) respectively. The results were compared with cholangiography. The final diagnosis was established at surgery (97 cases) and fine needle aspiration cytology (28 cases). While US is an excellent screening modality in distinguishing obstructive and non-obstructive jaundice, cholangiography is still the gold standard for determining the precise anatomic level and cause of obstruction.
Adult↗
Etoposide kinetics in patients with obstructive jaundice.
The kinetics and urinary excretion of etoposide and etoposide glucuronide were determined in 11 patients with obstructive jaundice (bilirubin greater than 2.0 mg/dL) and in 23 patients with normal renal and hepatic function. Mean (+/- SE) measurements of clearance (24.5 +/- 2.06 v 26.5 +/- 2.05 mL/min/m2), half-life (5.7 +/- 0.5 v 6.4 +/- 0.5 hours), and volume of distribution (12.4 +/- 1.1 v 13.7 +/- 1.6 L/m2) were not significantly different in patients with jaundice when compared with controls. Similarly, etoposide kinetics in three patients determined during a period of hyperbilirubinemia were not different from measurements made in the same patients following resolution of their obstructive jaundice. In patients with jaundice, 46% of an administered etoposide dose was excreted in the urine as etoposide compared with 35% in controls (P = .15). Urinary excretion of etoposide glucuronide accounted for 29% of an administered etoposide dose in control patients and 15% in those with hepatic obstruction (P = .03). Biliary etoposide excretion measured in four patients with T-tubes was insignificant (less than 2.0% of an administered dose). The calculated renal clearance of etoposide was 11.5 mL/min/m2 in patients with jaundice and 10.4 mL/min/m2 in controls (P = .53). Respective metabolic clearance was 4.9 and 6.9 mL/min/m2 in these two study groups (P = .13). Although hepatic metabolism of etoposide may be slightly decreased in patients with obstructive jaundice, a modest increase in renal etoposide excretion appears to compensate for this change, so that total clearance is similar in the patients with jaundice when compared with controls. No etoposide dose reductions appear to be needed in treating patients with obstructive jaundice who have normal renal function.
Biliary Tract↗
Bacterial translocation and gut microflora in obstructive jaundice.
Bacterial translocation from the gut is implicated in the pathophysiology of complications associated with obstructive jaundice. Absence of intraluminal bile salts and their antiendotoxic effects may result in overgrowth of bacteria, promoting bacterial translocation. The large bowel is the largest source of gram negative bacteria but the small bowel is more permeable. This study investigated the effect of obstructive jaundice on bacterial translocation and on the indigenous luminal microflora at 3 sites in the gastrointestinal tract. Significant bacterial translocation was demonstrated following 7 d of bile duct ligation compared with control or sham operated groups. A qualitative disturbance of the caecal indigenous microflora was demonstrated in jaundiced rats. There was no 'site-to-site' variation in the indigenous microflora at the 3 intestinal sites studied. We conclude that experimental obstructive jaundice for 1 wk promotes bacterial translocation without significant quantitative disturbance of the intestinal microflora in the small intestinal or caecum.
Animals↗
Obstructive jaundice increases sensitivity to lipopolysaccharide via TLR4 upregulation: possible involvement in gut-derived hepatocyte growth factor-protection of hepatocytes.
BACKGROUND: Patients with obstructive jaundice are prone to sepsis after biliary tract surgery. The present study was designed to determine the effect of biliary obstruction on cytokine responses to lipopolysaccharide (LPS). METHODS: Wister rats were allocated into two groups; the BDL group underwent bile duct ligation, followed 2 weeks later by administration of LPS into the duodenum. The control group underwent sham operation, and similarly received enteral LPS. Specimens were collected serially, and applied for the assays. RESULTS: Serum aspartate aminotransferase and alanine aminotransferase levels were significantly increased in BDL rats. High tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-6 levels in peripheral blood were observed 2 h after LPS administration in BDL rats. In contrast, no increases in both cytokines were noted in peripheral and portal blood in control rats. Baseline HGF levels in portal and peripheral blood in BDL rats were significantly higher than in control rats. LPS significantly increased hepatocyte growth factor (HGF) levels in portal blood and decreased in peripheral blood in BDL rats, but not in control rats. Immunohistochemical analysis revealed that BDL increased expressions of Toll-like receptor (TLR)4, CD14 and CD68 both in the small intestine and liver. Both TLR4 and CD14 mRNAs were upregulated in the small intestine and liver after LPS administration in BDL rats. CONCLUSION: Obstructive jaundice and LPS stimulation induced TLR4 upregulation both in the liver and small intestine, which led to increased TNF-alpha and IL-6 production in liver and HGF production in the small intestine. The upregulation of TLR4 may lead to pathological and host defense reactions in obstructive jaundice complicated with Gram-negative bacterial infection.
Alanine Transaminase↗
Obstructive jaundice secondary to bile duct involvement with Hodgkin's disease: a case report.
CONTEXT: Obstructive jaundice due to lymphoma is very rare. It may be difficult to distinguish between this condition and a large number of causes of extrahepatic bile duct obstruction, even by endoscopic retrograde cholangiography. Its prognosis is poor. Combined chemotherapy and/or radiotherapy with bile duct drainage is a therapeutic option. CASE REPORT: We describe a case of obstructive jaundice as the initial presentation of Hodgkin's disease. After chemotherapy and endoscopic bile duct stenting, it was noted that the enlarged lymph nodes, jaundice and bile duct dilation disappeared.
Cholangiopancreatography, Endoscopic Retrograde↗
Interleukin 2 production and its relationship with T lymphocyte subsets in patients with obstructive jaundice.
Sepsis remains a major risk in the high mortality and morbidity after surgery for obstructive jaundice. The reasons for the increased susceptibility to infection are unknown. This study examined interleukin 2 (IL-2) production and the lymphocyte response to PHA mitogen in 31 patients with obstructive jaundice. Among them, 18 patients were simultaneously investigated by enumeration of T lymphocyte subsets in peripheral blood with APAAP technique. The results showed that the patients had significantly decreased IL-2 production and lymphocyte response to PHA mitogen. The percentage of Leu 3a (helper/inducer T cell) in the patients was significantly lower than that in normal controls. Leu 3a/Leu 2a (suppressor/cytotoxic T cell) ratio was significantly lower in these patients. The reduction of IL-2 production correlated significantly with the suppression of lymphocyte proliferation but not with the percentage of Leu 3a cells. From these results, it may be suggested that the reduction of IL-2 production in the patients with obstructive jaundice is an important reason for the suppression of T lymphocyte proliferative response, not merely a reflection of the decrease of helper T cells.
Adult↗
Investigation of obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) or CT scan of the abdomen.
Investigation of the cause of obstructive jaundice usually involves a myriad of blood tests and x rays. The recent development refinement and availability of new techniques--ultrasonography, computed tomographic scans (CT), and endoscopic retrograde cholangiopancreatography (ERCP), have significantly improved the diagnostic accuracy of establishing the cause of obstructive jaundice. What is not clear is whether all investigations should be carried out on all patients presenting with jaundice. Recently the authors have had experience with 14 patients who presented with obstructed jaundice. This report compares the accuracy rate between CT scans and ERCP.
Aged↗
Magnetic resonance cholangiography for evaluation of obstructive jaundice.
OBJECTIVES: Magnetic resonance (MR) cholangiography is a newly developed adjunctive tool for noninvasive evaluation of patients with obstructive jaundice. We discuss whether MR cholangiography can provide useful information about the biliary tract, compared with other diagnostic modalities. METHODS: MR cholangiographies of 20 patients with obstructive jaundice were reviewed to evaluate the site of obstruction, the cause of obstruction, and the degree of stricture. RESULTS: The precise location of an obstructing lesion and complete display of the dilated biliary tree just proximal to the obstruction were provided in all 20 patients by MR cholangiography the same as in direct cholangiography. MR cholangiography could completely distinguish common duct stones from malignancies, whereas accurate differentiation among the malignancies was impossible. In six patients, MR cholangiography was not able to help in differentiating between high-grade stenosis and complete occlusion. CONCLUSION: Although precise cholangiographic estimation of the morphology and extent of the malignant disease by MR cholangiography was inferior to direct cholangiography, MR cholangiography is easily performed for a short duration and is a noninvasive diagnostic modality for assessing the outline of the anatomy of the dilated biliary tree. Therefore, we recommend promptly performing MR cholangiography if obstructive jaundice is suspected on clinical grounds.
Aged↗
[Experimental study on the effects of endotoxemia as a retardation-factor influencing on the decrease of serum bilirubin after the relief of obstructive jaundice].
UNLABELLED: I examined the effects of endotoxemia influencing on obstructive jaundice and the decrease of serum bilirubin after the relief of it. Experimental obstructive jaundice and its alleviation by external biliary drainage was made in Donryu-rats. Serum bilirubin was higher (p < 0.01) in the group treated by continuous infusion of low-dose endotoxin (LPS E. coli 0111:B4, 6 micrograms/hr/100gBW) during 72 hours biliary obstruction (10.48 +/- 1.54mg/dl) than in the control group (6.76 +/- 0.71mg/dl). After the relief of biliary obstruction, 4 kinds of experimental conditions were set up as follows: CONTROL; infusion of sterile saline, ET; continuous infusion of low-dose endotoxin, ET + UDCA; continuous infusion of endotoxin and ursodeoxycholic acid (UDCA, 10mg/hr/100gBW) through another intravenous tube simultaneously, ET + MP; continuous infusion of endotoxin after one-shot injection of methylprednisolone (MP, 3mg/100gBW). Serum bilirubin 7.5 hours after the relief of biliary obstruction was as follows: CONTROL: 0.48 +/- 0.18mg/dl, ET: 3.41 +/- 1.13mg/dl, ET + UDCA: 2.80 +/- 1.28mg/dl, ET + MP: 1.18 +/- 0.50mg/dl. ET-group showed retardation of the decrease of serum bilirubin (p < 0.01). MP showed improvement of the impaired decreasing rate of serum bilirubin by endotoxemia (p < 0.01). Bile-output from the external biliary drainage after the relief of biliary obstruction was decreased significantly in the ET-group. ET + UDCA-group showed remarkable increase of the bile-output, but no increase of excretion of bilirubin in the bile compared with ET-group. While ET + MP-group showed improvement of the bile-output and increase of excretion of bilirubin in the bile compared with ET-group.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Biliary drainage for obstructive jaundice enhances hepatic energy status in humans: a 31-phosphorus magnetic resonance spectroscopy study.
BACKGROUND: Biliary obstruction impairs liver function although the pathophysiological mechanism is incompletely understood. AIMS: The aim of this study was to examine serial changes in liver metabolism in patients with obstructive jaundice using image guided in vivo 31-phosphorus magnetic resonance spectroscopy ((31)P MRS). This technique allows repeated and non-invasive assay of organ energy metabolism and phospholipid biochemistry. PATIENTS: We studied 10 patients presenting with obstructive jaundice secondary to extrahepatic localised malignancy. There were eight men and two women, median age 72 years (range 54-94), six with cholangiocarcinoma (all Bismuth type 1) and four with carcinoma of the head of the pancreas. Ten healthy volunteers (median age 24 years (range 21-26)) were studied for comparison. METHODS: Hepatic metabolism in jaundiced patients was measured by (31)P MRS at presentation and again after a one week period of biliary drainage. Conventional liver function tests were also recorded. RESULTS: Compared with controls, liver spectra from jaundiced patients contained an excess of phosphomonoester (PME) metabolites (PME/total phosphate median 10.3% (interquartile range 8.7-11.5) in controls, 15.4% (13.1-17.7) in jaundiced cases; p<0.01). Biliary decompression was achieved in all patients (five with internal stents and five by external drainage catheters), and plasma biochemistry improved predictably (bilirubin 176 micromol/l (158-351) at presentation, 110 micromol/l (42-241) after drainage for one week; p<0.01). Enhancement of hepatic energy status, measured by the ratio of adenosine triphosphate (ATP) to inorganic phosphate (Pi), was observed in all cases after relief of biliary obstruction (ATP/Pi 1.4 (1.17-1.69) at presentation, 1.97 (1.4-2.48) after drainage; p<0.01) and was independent of the route of bile drainage. Hepatic phosphodiester (PDE) content was decreased after relief of obstruction (PDE/total phosphate 25.2% (20.5-27.4) at presentation, 19.8% (16.6-24.5) after drainage; p<0.01). This change was probably due to a reduction in the contribution from bile contents to this resonance as a strong PDE signal was also detectable in spectra obtained from separate bile specimens. CONCLUSIONS: Obstructive jaundice produces alterations in liver phosphoester biochemistry, most likely reflecting disturbances in phospholipid metabolism. Relief of biliary obstruction is associated with a measurable increase in hepatic energy status. Bile may contribute to the phosphodiester signal of the 31-phosphorus liver spectrum and changes in these resonances must therefore be interpreted with caution and in relation to the clinical situation. Monitoring of liver metabolism by (31)P MRS may allow clinicians to refine the selection and timing of therapeutic options in jaundiced patients.
Adult↗
[Percutaneous transhepatic inserted self-expanding metal endoprosthesis in the palliative treatment of malignant obstructive jaundice].
Prospective studies comparing biliary-enteric bypass with implantation of endoprostheses in palliation of malignant obstructive jaundice showed no significant difference. A new self-expandable metal endoprosthesis was introduced to ameliorate the results in terms of early complication and occlusion rate. Between December 1988 and April 1991 we treated 35 patients (32 with malignant obstructive jaundice) by 50 self-expandable endoprostheses. The implantation was successful in 96% of patients. The early complication rate was 37% and the 30-day mortality 14%. In 89% of the patients relief of jaundice after 3 months was found. Recurrent jaundice and cholangitis occurred in 39%, whereas reoperation was necessary in 25%. 16 of 26 patients (61%) with malignant obstructive jaundice where alive after an average of 7.5 months. We found no advantage of the self-expandable endoprostheses compared with conventional plastic stents. Implantation of a self-expandable metal endoprosthesis may be an alternative to surgical bypass in selected cases. It would be interesting to evaluate the endoscopic route of insertion and to compare the results with palliative surgery in randomized studies.
Aged↗
[The negative thymol test in obstructive jaundice].
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Jaundice↗
Pancreatic heterotopia causing post-cholecystectomy symptoms and obstructive jaundice.
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Bile Ducts↗