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PubMed1987

Bedside ultrasonography. A low-cost definitive diagnostic procedure in obstructive jaundice.

We evaluated real-time ultrasonography carried out by gastroenterologists for its diagnostic accuracy in 89 patients with obstructive jaundice. The positive predictive values for the site and nature of the obstruction were 94.3 and 89.9%, respectively. The advanced stage of disease in our patients and the clinical background of the investigators may have contributed to the high diagnostic accuracy of ultrasonography in this study. Nevertheless, we recommend that gastroenterologists themselves perform bedside ultrasonography for a definitive diagnosis in patients with obstructive jaundice. The high degree of precision achieved by ultrasound in our setting makes more expensive investigations unnecessary as routine procedures.

Cholestasis, Extrahepatic↗

PubMed2005

Three-dimensional helical computed tomography cholangiography with minimum intensity projection in gallbladder carcinoma patients with obstructive jaundice: comparison with magnetic resonance cholangiography and percutaneous transhepatic cholangiography.

OBJECTIVE: Computed tomography (CT) is traditionally used for evaluation and staging of gallbladder carcinoma (GC). However, in the subgroup of patients with obstructive jaundice, magnetic resonance cholangiography (MRC) is generally required to assess the level of biliary obstruction. The present study was undertaken to evaluate the diagnostic potential of three-dimensional helical CT cholangiography (3-D CTC) with minimum intensity projection (minIP), to determine the presence and level of biliary obstruction. MATERIALS AND METHODS: Twenty-five consecutive patients with proven GC, presenting with clinical and biochemical features of obstructive jaundice, over a 1-year period were included in the study. Dual phase helical CT data was obtained in the arterial and venous phases, respectively, after intravenous contrast injection using a pressure injector. Axial CT data (both arterial and venous phase) was studied for staging and resectability of tumor. Three-dimensional helical CT cholangiography using minIP obtained from the venous phase data set, was used to assess the level of biliary obstruction and isolation of hepatic segmental ducts. Three-dimensional helical CT cholangiography findings were compared with MRC and percutaneous transhepatic cholangiography (PTC) (gold standard). None of the patients were operated on as they were all considered inoperable on axial CT images due to extensive local disease or distant metastasis. RESULTS: In all patients, 3-D CTC demonstrated dilated intrahepatic ducts up to tertiary branch level. The 3-D CTC correctly diagnosed the level of biliary obstruction and demonstrated isolated segmental ducts in all patients and correlated well in all cases with MRC and PTC findings in this regard. However, the 3-D CTC did not add any additional information over the axial source images. CONCLUSION: Three-dimensional helical CT cholangiography with minIP can correctly determine the level of biliary obstruction in patients with GC and may be a strong competitor with MRC, because it gives equivalent information with regard to the level of ductal obstruction even while being a part of an overall comprehensive CT staging study. Even though 3-D CTC did not provide additional information on top of the source images, the referring physicians found them very useful for conceptualization of the 3-D biliary anatomy.

Adult↗

PubMed1997

Assessment of energy status and fructose metabolism of liver in obstructive jaundice by 31P magnetic resonance spectroscopy.

The effect of cholestasis on hepatic energy status and fructose metabolism in jaundiced rats and patients was investigated using 31P magnetic resonance spectroscopy. Rats with obstructive jaundice (OJ group) were studied 7 days after bile duct ligation. Drainage rats were studied at 3 days (DR3 group) and 7 days (DR7 group) after the relief of 1 week obstruction of the common bile duct. In the bile duct ligated rat, the beta-adenosine triphosphate (ATP)/Pi (inorganic phosphate) ratio was significantly lower than in sham-operated controls. This ratio recovered rapidly in the DR3 and DR7 groups. The maximum increase in the phosphomonoester peak (PMEmax) after an intravenous bolus of fructose was significantly reduced in both the OJ and DR3 groups, and was accompanied by a decrease in hepatic fructokinase activity. The PMEmax and the fructokinase activity recovered in the DR7 group. In a clinical study, the beta-ATP/Pi ratio in six healthy volunteers was comparable to that of 15 patients with obstructive jaundice, regardless of their biliary drainage status. The PMEmax in all patients (serum bilirubin > or = 5 mg/dL), irrespective of biliary drainage, was significantly lower than in volunteers. Furthermore, the PMEmax in four of the eight patients with biliary drainage (serum bilirubin < 5 mg/dL) was lower than in volunteers. It is concluded that while energy status in jaundiced patients is well maintained, fructose phosphorylation is inhibited and recovery is delayed after the relief of obstruction compared with serum bilirubin. For the non-invasive evaluation of damaged liver function in jaundice, 31P magnetic resonance spectroscopy is a useful technique.

Adenosine Triphosphate↗

PubMed1988

Obstructive jaundice from benign, nonparasitic hepatic cysts: identification of risk factors and percutaneous aspiration for diagnosis and treatment.

Obstructive jaundice due to benign, nonparasitic hepatic cysts is rare, with only 11 previously reported cases. We report a case in which relief of jaundice was obtained by percutaneous cyst aspiration. For the elderly, infirm, or high-risk patient, percutaneous aspiration is recommended to relieve obstructive jaundice. Immense size and porta hepatis proximity are major risk factors for developing jaundice from simple hepatic cysts. Abdominal pain of recent onset and rising alkaline phosphatase are warning signs that this complication is developing. In these situations, treatment prior to developing jaundice is recommended.

Adult↗

PubMed2006

One-step palliative treatment method for obstructive jaundice caused by unresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent.

AIM: To describe a simple one-step method involving percutaneous transhepatic insertion of an expandable metal stent (EMS) used in the treatment of obstructive jaundice caused by unresectable malignancies. METHODS: Fourteen patients diagnosed with obstructive jaundice due to unresectable malignancies were included in the study. The malignancies in these patients were a result of very advanced carcinoma or old age. Percutaneous transhepatic cholangiography was performed under ultrasonographic guidance. After a catheter with an inner metallic guide was advanced into the duodenum, an EMS was placed in the common bile duct, between a point 1 cm beyond the papilla of Vater and the entrance to the hepatic hilum. In cases where it was difficult to span the distance using just a single EMS, an additional stent was positioned. A drainage catheter was left in place to act as a hemostat. The catheter was removed after resolution of cholestasis and stent patency was confirmed 2 or 3 d post-procedure. RESULTS: One-step insertion of the EMS was achieved in all patients with a procedure mean time of 24.4 min. Out of the patients who required 2 EMS, 4 needed a procedure time exceeding 30 min. The mean time for removal of the catheter post-procedure was 2.3 d. All patients died of malignancy with a mean follow-up time of 7.8 mo. No stent-related complication or stent obstruction was encountered. CONCLUSIONS: One-step percutaneous transhepatic insertion of EMS is a simple procedure for resolving biliary obstruction and can effectively improve the patient's quality of life.

Aged↗

PubMed2006

Nonparasitic solitary giant hepatic cyst causing obstructive jaundice was successfully treated with monoethanolamine oleate.

A 77-year-old man hospitalized for epigastric pain showed jaundice of the skin and conjunctivae. Laboratory tests revealed elevated hepatobiliary enzymes and inflammatory markers, and imaging studies demonstrated a 12 cm hepatic cyst compressing the common bile duct. The diagnosis was a giant hepatic cyst causing obstructive jaundice. Cyst drainage and sclerotherapy with 5% monoethanolamine oleate was performed twice, resulting in almost complete disappearance of the cyst. Obstructive jaundice due to a hepatic cyst, as seen in this case, is relatively rare and this report includes a review of other similar cases in Japan.

Aged↗

PubMed1999

Multidisciplinary approach to palliation of obstructive jaundice caused by a central hepatocellular carcinoma.

BACKGROUND/AIMS: Obstructive jaundice due to intraductal tumour growth is a rare symptom in association with hepatocellular carcinoma (HCC). METHODS: We report a 65-year-old white male who was admitted to our department with a 2-week history of progressive jaundice. At laparotomy, the liver showed advanced cirrhosis due to long-standing biliary obstruction. Cholangiography confirmed total obstruction of the main bifurcation of the hepatic duct by intraductal tumour growth. Combination treatment with surgical segment III drainage, transcatheter arterial embolization and radioembolization with yttrium-90 resin particles and endoscopic stenting was performed. This form of treatment has never been reported before. RESULTS: With these combined procedures, relief of jaundice and a survival time of 32 months could be achieved. CONCLUSION: The combination of palliative methods may relieve jaundice, ensure a good quality of life and possibly prolong survival in patients with mechanical tumour obstruction of the biliary tree by HCC.

Aged↗

PubMedDate not supplied

[Endoscopic treatment of obstructive jaundice at a second level national health system hospital].

BACKGROUND AND AIMS: The difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) in our patients in the reference hospitals within a few days of diagnosis of obstructive jaundice led us to perform this technique in our center. We expected to perform a small number of ERCP annually. We analyzed the success rate of initial biliary drainage and the complications of this procedure. PATIENTS AND METHODS: We performed a retrospective study. From 1997-1999 we carried out 240 ERCP. In 128 patients, 140 ERCP were performed for obstructive jaundice (58,3%). The final diagnosis was choledocholithiasis in 69 patients (54%), tumors in 35 (27%), dilatation of the biliary tract without obstruction at cholangiography in 21 (17%) and benign stenosis of the biliary tract in 3 (2%). RESULTS: The mean procedure time for ERCP was 5.26 ( 2.8) days. Cholangiography was successfully performed in 117 patients (91.4%). Effective therapeutic endoscopy was performed in 111 patients (86.7%). Jaundice was resolved in 62 patients (90%) with choledocholithiasis, 55 (80%) by stone removal and in 7 (10%) by prosthesis. Resolution was also achieved in 25 (71.5%) tumors, mainly by prosthesis, and in 100% of patients with benign stenosis. In all patients with dilatation of the biliary tract without obstruction, biliary sphincterotomy was performed. Complications were found in 15 patients (11.7%) and two (1.56%) died. CONCLUSIONS: The majority of patients with obstructive jaundice can be satisfactorily treated in a center with our characteristics. However, in tumors, the figures for drainage were slightly lower than those reported in the medical literature.

Adult↗

PubMed1984

[Morphogenesis of intralobular liver fibrosis in obstructive jaundice patients].

The results of ultrastructural study of the intralobular liver fibrosis in 38 patients with obstructive jaundice of various duration are presented. It is established that the appearance of fibroblast-like sinusoid cells plays a leading role in the development of intralobular liver fibrosis. The morphologic characteristics of poorly differentiated and differentiated cells of this type and their involvement in collagen fiber synthesis within liver lobules are given. It is shown that in obstructive jaundice a significant disturbance of the sinusoidal wall takes place due to the formation of collagen fibers, basal membrane that results in the worsening of the exchange between the blood and hepatocytes.

Cholelithiasis↗

PubMed2006

Obstructive jaundice caused by biliary stone formation around the stent after liver transplantation.

We report an unusual case of obstructive jaundice caused by a biliary stone, which developed in the stump of a Roux-en-Y hepaticojejunostomy after undergoing LT. The patient was a 13-yr-old male. At 74 days after birth, a hepaticojejunostomy (Kasai's procedure) was performed for the treatment of biliary atresia. He underwent a reduced size deceased donor LT in the left subphrenic space twice at the age of one and three years in Australia. Eleven years after his second LT, he developed liver dysfunction and jaundice with a low grade fever. Computed tomography showed a marked jejunal loop enlargement by a rugby ball-shaped stone and the bile duct in the graft was thus dilated. A surgical exploration revealed the jejunal loop to be bent sharply while its stump side was dilated by stagnated bile including a biliary stone. The stone included a stent that had been previously used for the hepaticojejunostomy. This case suggests that a retained stent used for hepaticojejunostomy had thus caused biliary stone formation because of a combination of various conditions in the jejunal loop.

Anastomosis, Surgical↗

PubMed1979

Renal function and other factors in obstructive jaundice.

Renal function and other factors that possibly affect the outcome of operation were measured in 24 patients with obstructive jaundice and in 15 non-jaundiced controls. The preoperative features that were associated with a poor postoperative recovery from obstructive jaundice were a raised serum fibrinogen/fibrin degradation product concentration, infection, hypoalbuminaemia and a low glomerular filtration rate. Preoperative serum fibrinogen/fibrin degradation product concentrations were raised in 4 of the 6 jaundiced patients who died after surgery but in none of the controls, in whom there was no mortality. In the jaundiced patients there was a greater incidence of postoperative renal impairment than in the controls. All patients were given mannitol during operation. Further mannitol was required after surgery in 13 of the 24 jaundiced patients in order to maintain urine flow rate despite adequate intravenous fluids being given. In contrast, only 1 of the 15 control patients required post operative mannitol. It is emphasized that repeated doses of mannitol can lead to a profound natriuresis and adequate intravenous saline should be given.

Cholestasis↗

PubMed1995

Renal dysfunction in obstructive jaundice.

The association between renal dysfunction and obstructive jaundice is well established. Despite a substantial number of clinical reviews and prospective studies, the exact incidence and extent of the problem has not been determined accurately. Various pathogenic mechanisms and therapeutic strategies have been proposed but renal dysfunction remains a persistent problem in hepatobiliary practice. The intention of this review is to determine the current extent of the problem, outline the proposed pathophysiological mechanisms and assess the current therapeutic options.

Acute Kidney Injury↗

PubMedDate not supplied

Laparoscopic cholecystjejunostomy as palliation for obstructive jaundice in inoperable carcinoma of pancreas.

Malignant obstructive jaundice can be palliated by either surgical bypass, which has the advantage of long-term patency, or by stent placement, which has the advantage of initial lower morbidity and mortality. We describe a technique, laparoscopic cholecystjejunostomy, which has the advantage of both. We predict that laparoscopic surgery, which has already had a major impact on biliary stone surgery, will also have a major impact on interventional endoscopic retrograde cholangiopancreatography.

Cholecystostomy↗

PubMed1999

Gastric cancer presenting with obstructive jaundice.

Gastric cancer is rarely associated with obstructive jaundice, which is associated with poor survival. We describe five patients with gastric cancer who presented with jaundice. Two patients had primary gastric cancer and three had recurrent disease. The patients were treated by operation, chemotherapy, and percutaneous transhepatic biliary drainage (PTBD) according to the stage of the cancers. Although these treatments often fail to prolong survival, chemotherapy and PTBD can improve patient's quality of life.

Journal Article↗

PubMed1992

A clinical study of obstructive jaundice among Singapore infants.

Fifty infants with obstructive jaundice were reviewed. Other than jaundice, hepatomegaly and splenomegaly were the other common presentations. The mean age of referral was 9.4 weeks. This was unsatisfactory as the prognosis depends on the age of corrective surgery. Majority of the non surgical cholestasis were due to idiopathic hepatitis. These patients did well as all of them were asymptomic and had no evidence of liver disease at 2 years of age.

Biliary Atresia↗

PubMed1987

Bile salts, endotoxin and renal function in obstructive jaundice.

Surgical treatment for the relief of obstructive jaundice is still complicated by postoperative acute renal failure in almost 10 per cent of patients. Renal failure in the patient with jaundice is associated with the presence of bacterial endotoxin in the peripheral blood, and enteric endotoxin absorption is facilitated by the absence of bile salts from the intestine. Oral replacement of bile salts should prevent endotoxemia and renal failure. Forty-six patients with jaundice were studied. Twelve patients received sodium deoxycholate preoperatively, 12 received chenodeoxycholic acid and 22 acted as controls. Endotoxemia was measured by the limulus test and renal function assessed by 24 hour creatinine clearance. No patient given deoxycholate preoperatively had systemic endotoxemia or postoperative impairment of renal function. Endotoxemia was reduced in the chenodeoxycholic acid group, but not significantly, and renal function was not protected. Sodium deoxycholate is undergoing further evaluation in a multicenter randomized prospective study.

Acute Kidney Injury↗

PubMed1976

[Blood coagulation and blood electrolytes in obstructive jaundice].

An examination of 76 patients with obstructive jaundice of cholelithic and tumor origin indicated an association of manifest hypocoagulation properties of blood with the absolute kalium deficiency in blood. In 54 patients postoperatively following restoration of bile passage in the bowel a progressive decrease in kalium concentration and an increase of sodium in erythrocytes were associated with a simultaneous enhancement of coagulation properties, and vice versa an increased kalium and decreased sodium content in erythrocytes was associated with a hypocaugulation tendency. It is evident that activation or suppression of hemocoagulation is dependent on the state of multiple factors of blood coagulation system in altered electrolytic medium and on eletrolytic reconstruction of erythrocytes.

Blood Coagulation↗

PubMedDate not supplied

External radiotherapy for decompression of cholangiocellular carcinoma with obstructive jaundice: report of a case.

Percutaneous transhepatic catheter drainage (PTCD) is generally performed for the treatment of obstructive jaundice. However, in some cases it is difficult to perform insertion because of lack of dilatation of the intrahepatic bile duct. We report a patient who had been suffering from jaundice as a result of recurrent cholangiocarcinoma near the hilum and whose symptoms were relieved by external radiotherapy. We consider radiotherapy for cholangiocarcinoma effective palliative treatment for decompression of obstructive jaundice.

Bile Duct Neoplasms↗