Common Bile Duct Pressure in Patients With Common Bile Duct Stones With or Without Acute Suppurative Cholangitis

Csendes, Attila; Sepulveda, Alfredo; Burdiles, Patricio; Braghetto, Italo; Bastias, J; H, Schutte; Díaz, Juan Carlos; Yarmuch, Julio; Maluenda, Fernando

doi:10.1001/archsurg.1988.01400300039005

Cited by 56 publications

(44 citation statements)

References 16 publications

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“…the maximal secretory biliary pressure [16]. Furthermore, in humans, the maximal secretory biliary pres-DISCUSSION sure is 40 cm H 2 O and during contraction of the gallbladder, intrabiliary pressure can even rise to 80 cm This study clearly showed that biliary pressure and H 2 O, which is much higher than the pressures used in a period of bile duct obstruction are determinants of the present study [17].…”

Section: Introductionsupporting

confidence: 50%

Bacterial Translocation from the Biliary Tract to Blood and Lymph in Rats with Obstructive Jaundice

Karsten

Gulik

Spanjaard

et al. 1998

Journal of Surgical Research

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Section: Introductionsupporting

confidence: 50%

Bacterial Translocation from the Biliary Tract to Blood and Lymph in Rats with Obstructive Jaundice

Karsten

Gulik

Spanjaard

et al. 1998

Journal of Surgical Research

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“…[16,17] In humans, CBD pressure is increased in biliary obstruction along with an increase in the frequency of retrograde propagation of the phasic wave, which contributes to a rapid increase in biliary hydrostatic pressure. [18,19] These changes also lead to increased hepatocellular permeability, aminotransferase production, and hepatocyte toxicity caused by bile acid, which in turn results in increased aminotransferase levels. [20,21] When the bile duct is occluded, hepatocytes undergo inflammatory damage.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

et al. 2016

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Common bile duct (CBD) stones are generally associated with greater elevations of alkaline phosphatase and gamma-glutamyl transpeptidase levels than aspartate aminotransferase and alanine aminotransferase levels. However, some patients with CBD stones show markedly increased aminotransferase levels, sometimes leading to the misdiagnosis of liver disease. Therefore, the aim of this study was to investigate the clinicopathologic features of patients with CBD stones and high aminotransferase levels.This prospective cohort study included 882 patients diagnosed with CBD stones using endoscopic retrograde cholangiopancreatography (ERCP). Among these patients, 38 (4.3%) exhibited aminotransferase levels above 400 IU/L without cholangitis (gallstone hepatitis [GSH] group), and 116 (13.2%) exhibited normal aminotransferase levels (control group). We compared groups in terms of clinical features, laboratory test results, radiologic images, and ERCP findings such as CBD diameter, CBD stone diameter and number, and periampullary diverticulum. Liver biopsy was performed for patients in the GSH group.GSH patients were younger and more likely to have gallbladder stones than control patients, implying a higher incidence of gallbladder stone migration. Also, GSH patients experienced more severe, short-lasting abdominal pain. ERCP showed narrower CBDs in GSH patients than in control patients. Histological analysis of liver tissue from GSH patients showed no abnormalities except for mild inflammation.Compared with control patients, GSH patients were younger and showed more severe, short-lasting abdominal pain, which could be due to a sudden increase of CBD pressure resulting from the migration of gallstones through narrower CBDs. These clinical features could be helpful not only for the differential diagnosis of liver disease but also for investigating the underlying mechanisms of liver damage in obstructive jaundice. Moreover, we propose a new definition of “gallstone hepatitis” based on the specific clinicopathologic characteristics observed in our patients.

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“…When colonized, bile stasis favors multiplication of bacteria, and increased biliary pressure facilitates invasion into the systemic circulation. Csendes et al [8] evaluated patients with and without cholangitis at time of cholecystectomy. Biliary pressures were measured in the different groups.…”

Section: Mechanism Of Disease In Cholangitismentioning

confidence: 99%

“…At biliary pressures of 20 cm H 2 0 (normal 8-12 cm H 2 0), clinical signs and symptoms of cholangitis occur as bacteria spread from the bile ducts into the lymphatic structures. At higher pressures (> 25 cm H 2 0), bacteria enter the bloodstream, resulting in increased rates of bacteremia, morbidity, and mortality [8,9].…”

Section: Mechanism Of Disease In Cholangitismentioning

confidence: 99%

Contemporary management of biliary tract infections

George

Baillie

2005

Curr Infect Dis Rep

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Biliary tract infections are a worldwide problem, with a large financial burden on health care. Biliary infections can result from multiple causes, but the most common culprit is cholelithiasis. In the past decade, our knowledge of the mechanism of disease, microbiology of infections, and management options has grown enormously. Although at times perplexing, it is important to understand this information to allow for efficient, quality, and cost-effective health care.

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Common Bile Duct Pressure in Patients With Common Bile Duct Stones With or Without Acute Suppurative Cholangitis

Cited by 56 publications

References 16 publications

Bacterial Translocation from the Biliary Tract to Blood and Lymph in Rats with Obstructive Jaundice

Bacterial Translocation from the Biliary Tract to Blood and Lymph in Rats with Obstructive Jaundice

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

Contemporary management of biliary tract infections

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