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PubMed2000

Obstructive jaundice impairs hepatic sinusoidal endothelial cell function and renders liver susceptible to hepatic ischemia/reperfusion.

BACKGROUND/AIMS: Obstructive jaundice is associated with increased surgical morbidity and mortality. While parenchymal injury has been defined in obstructive jaundice, the pathogenesis of hepatic sinusoidal endothelial cell injury in obstructive jaundice is unclear. The aims of this study were to investigate hepatic sinusoidal endothelial cell injury in obstructive jaundice by determining serum hyaluronic acid levels, purine nucleoside phosphorylase/alanine aminotransferase ratios, and hyaluronic acid elimination rate, and also to determine whether hepatic parenchymal cell injury in obstructive jaundice is induced more than in normal liver after hepatic ischemia/reperfusion. METHODS: Male Wistar rats underwent ligation and division of the common bile duct (obstructive jaundice group) or sham operation (Sham group). Serum hyaluronic acid levels and purine nucleoside phosphorylase/alanine aminotransferase ratios in both groups were examined at intervals up to 21 days after surgery. Hepatic blood flow, permeability, neutrophil accumulation, and hyaluronic acid elimination rates in both groups were measured 14 days after surgery. Changes in serum hyaluronic acid and alanine aminotransferase concentrations were determined after 15 min of hepatic ischemia followed by reperfusion. RESULTS: Serum hyaluronic acid levels remained elevated after bile duct ligation. Hepatic sinusoidal endothelial cell swelling was observed by electron microscopy, and hepatic permeability was increased 14 days after bile duct ligation in association with neutrophil accumulation. Hepatic blood flow in obstructive jaundice remained unchanged, but hyaluronic acid elimination capacity was less than that in the Sham group. After hepatic reperfusion, the disappearance rate of serum hyaluronic acid in obstructive jaundice was lower, and serum alanine aminotransferase levels were higher than those in the Sham group. CONCLUSIONS: Our findings suggest that obstructive jaundice impairs sinusoidal endothelial cells and that sinusoidal endothelial cell damage in association with sinusoidal deterioration during obstructive jaundice renders liver susceptible to ischemia/reperfusion relative to normal liver.

Animals↗
PubMed1981

Computed tomography in obstructive jaundice. Part I: The level of obstruction.

Computed tomographic (CT) scans of 67 cases of obstructive jaundice were analyzed to determine the value of CT in detecting the level of obstruction. The cases were divided into four groups by anatomical segments, according to the number of visualized hypodense ringlike structures produced by the dilated bile duct, as seen in axial sections made 1 cm apart. Gallbladder size, dilatation of intrahepatic biliary radicals and the pancreatic duct, visualization of tumor masses, and condition of the bile duct below the obstruction were other variables used to determine the level of obstruction. The overall accuracy of CT in determining the exact level has been 97%. The most reliable indicator is the number of rings, which has excellent correlation with the results of direct cholangiography. The diagnostic value of all other variables is limited to specific cases.

Cholecystography↗
PubMed1991

[Experimental study on cell damage of ischemic liver in obstructive jaundiced rats].

The hepatic cellular damage induced by liver ischemia was investigated in rats with obstructive jaundice. Hepatic tissue blood flow in obstructive jaundice was decreased in the relation to the duration of jaundice. The value of lipid peroxide and cathepsin D activity of the hepatic tissue increased in the obstructive jaundice. Therefore, it was suggested that cell membrane and lysosomal membrane injury were induced in obstructive jaundice. The value of lipid peroxide of hepatic tissue in obstructive jaundice was more increased after partial liver ischemia. The survival rate following hepatic ischemia in jaundiced rats was remarkably lower than that of normal rats, and also it related to the duration of jaundice. In addition, histological changes of the liver after partial ischemia are severe in obstructive jaundiced liver. These data suggest that more remarkable hepatic cellular damage than in normal liver may be induced by liver ischemia in obstructive jaundice.

Animals↗
PubMed1995

Aminoglycoside-associated nephrotoxicity in extrahepatic obstructive jaundice.

Experimental data demonstrate that biliary obstruction increases renal sensitivity to gentamicin. In the present study the incidence of and risk factors for aminoglycoside nephrotoxicity were prospectively studied in patients with extrahepatic obstructive jaundice. Two hundred and thirty-seven hospitalized adult patients were classified into three groups. Group I consisted of 84 patients with extrahepatic obstructive jaundice, who received aminoglycoside (gentamicin or tobramycin). Group II consisted of 81 patients with extrahepatic obstructive jaundice, who received either antibiotics other than aminoglycoside or no antimicrobial therapy. Group III consisted of 72 noncholestatic patients receiving aminoglycosides for different disorders. Nephrotoxicity developed in 27 patients (32%) in group I vs 9 patients (11%) in group II and 4 patients (5.6%) in group III (p < 0.00001). In group I, a comparison of patients with and without nephrotoxicity revealed significantly higher values in the former for mean serum bilirubin concentration, initial steady-state trough aminoglycoside concentration and estimated half-life. Stepwise multivariate analysis with nephrotoxicity status as the dependent variable determined that the most significant variable for predicting nephrotoxicity was serum total bilirubin level. In extrahepatic cholestasis a high serum bilirubin level is a distinct factor predisposing to aminoglycoside nephrotoxicity.

Aged↗
PubMed2001

Preoperative biliary drainage before resection in obstructive jaundice.

BACKGROUND: Surgery for patients with malignant obstructive jaundice carries high morbidity and mortality rates. Preoperative biliary drainage (PBD) has been used in an attempt to improve the outcome in these patients. AIM: To review the evidence in the literature on whether PBD improves postoperative morbidity and mortality in obstructive jaundice patients. MEHOD: Using Medline a literature search was performed for papers published in English from January 1980 to October 2000, using the text words 'obstructive jaundice', 'preoperative', 'drainage' and 'stent'. All retrieved papers which reported experimental or clinical observations relevant to the study aim were carefully analysed and the findings are summarised in this review. RESULTS AND CONCLUSION: There is no evidence in the literature to support the view that routine PBD improves postoperative morbidity and mortality in patients with obstructive jaundice undergoing resection. PBD has its own complications that cancel out its benefits. However, PBD could be beneficial in patients presenting with sepsis, coagulation abnormalities or malnutrition.

Adult↗
PubMed2005

Validity of ultrasonography in diagnosing obstructive jaundice.

OBJECTIVE: To evaluate the validity of ultrasonography in patients who have obstructive jaundice. DESIGN: A descriptive retrospective study. SETTING: Surgical Department, Tikur Anbessa Teaching Hospital, Addis-Ababa, Ethiopia. SUBJECTS: A total of 49 patients; 15 male and 34 female underwent operation for obstructive jaundice. RESULTS: The cause of obstructive jaundice identified by ultrasonography with reasonable sensitivity of 90% and specificity of 79% for choledocholithiasis and sensitivity of 50% and specificity of 90% for pancreatic head tumours. The degree of common bile duct enlargement was significantly higher when the cause for obstruction was malignant, originating from the head of pancreas or distal end of the common bile duct. CONCLUSION: Ultrasonography should be the first and best initial imaging procedure in patients who have obstructive jaundice and shows reasonable sensitivity and specificity to identify causes of obstruction in obstructive jaundice. These findings may act also as a base for which further studies on validity of ultrasonography in the diagnosis of obstructive jaundice could be carried out.

Adult↗
PubMed1989

Less is better. The diagnostic workup of the patient with obstructive jaundice.

The typical patient with suspected obstructive jaundice is often subjected to an extensive preoperative workup on the premise of providing surgeons with information that will aid them at exploration. A 15-year review of 83 patients with obstructive jaundice from the common periampullary carcinomas was carried out and indicated that obtaining such information was unnecessary, unsafe, costly, and time-consuming. It is recommended that the patient with a medical history and liver function test results suggestive of obstructive jaundice should undergo an abdominal ultrasound study. If this discloses distal bile duct obstruction, no further tests are necessary in most patients and the operation should be carried out promptly.

Adult↗
PubMed1985

[Clinical study on glucose intolerance and insulin response in obstructive jaundice].

Insulin responses to oral glucose loads were studied in patients with obstructive jaundice and compared with those of other liver diseases (fatty liver, chronic hepatitis and liver cirrhosis), pancreatic diseases, and definite diabetes mellitus. Compared with their corresponding glucose intolerance, high insulin responses were characteristic in fatty liver, chronic hepatitis and liver cirrhosis, and insulin responses and insulinogenic index decreased in chronic hepatitis and liver cirrhosis as glucose intolerance progressed. In obstructive jaundice with the pancreatic ducts stenotic or obstructed, insulin responses were suppressed in comparison with their corresponding glucose intolerance, and also insulinogenic index were below 0.5 in most of the cases. However, in obstructive jaundice with the pancreatic ducts intact, high insulin responses were observed in almost half of the cases with insulinogenic index above 0.5, and insulin response and insulinogenic index decreased as glucose intolerance progressed. While most cases of fatty liver, chronic hepatitis and liver cirrhosis with insulinogenic index above 0.5 were distributed in non-diabetes zone in sigma BS-sigma IRI plane (Kosaka's), those with insulinogenic index below 0.5 were distributed in intermediate zone. Most cases with obstructive jaundice with pancreatic ducts stenotic or obstructed, had insulinogenic index below 0.5 and were distributed in diabetes zone. However, half of cases with obstructive jaundice with pancreatic ducts intact, had insulinogenic index above 0.5 and their distribution in non-diabetes zone, while the other half had insulinogenic index below 0.5 and their distribution in diabetes zone. Therefore, it may be concluded that insulin responses increase at the early stage of obstructive jaundice mainly under influence of liver dysfunction itself, but that insulin response is suppressed at later stage of obstructive jaundice as pancreatic islets are affected.

Blood Glucose↗