Effects of Alteration of Biliary Pressure on Bile Composition—A Method for Study: Primate Biliary Physiology V.

Strasberg, Steven M.; Dorn, Barry C.; Redinger, Richard N.; Small, Donald; Egdahl, Richard H.

doi:10.1016/s0016-5085(19)33533-4

Cited by 14 publications

(4 citation statements)

References 5 publications

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“…In an animal model, normal CBD hydrostatic pressure is 10 to 15 cm H 2 O (7.4–11 mm Hg), and nonsphincteric biliary obstruction increases pressure to 25 to 40 cm H 2 O (18–30 mm Hg). [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.…”

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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Section: Discussionmentioning

confidence: 99%

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

et al. 2016

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“…Although earlier studies noted MRCP sensitivities ranging from 81 to 90% specificities from 91 to 100% for choledocholithiasis, recent studies with "state of the art" techniques have found the sensitivities of 90 to 100% and the specificities of 92 to 100. 20…”

Section: Discussionmentioning

confidence: 99%

Analysis of the management of choledocholithiasis and it’s outcome with the role of preoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography

Valarmathi

Andappan

2019

Int Surg J

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Background: Choledocholithiasis implies stones in the common bile duct (CBD). Most of the common bile duct stones are those that have passed into the bile duct from the gall bladder. About 20 to 25% of patients above the age of 60 with symptomatic gall stones are likely to have stones in the CBD. To analyse the role of ERCP and MRCP in the management of choledocholithiasis.Methods: About 60 patients who are attending the General Surgery OPD of Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India from the October 2017-March 2018 were included in the study with confirmed common bile duct stones with or without gall stones were chosen. patients were categorized into group A- who has undergone a successful ERCP followed by laparoscopic cholecystectomy and group B- who underwent open cholecystectomy with CBD exploration.Results: Ultrasonography was done in 57 patients, of which 41 patients showed CBD stones (71.93%), 12 patients showed dilated CBD in the presence of cholelithiasis (21.05%) and in the remaining 4 patients (7.01%) this investigation showed only cholelithiasis. Since clinical condition warranted, authors proceeded with further hepatobiliary imaging, which revealed choledocholithiasis.Conclusions: Magnetic resonance cholangio pancreatography can also be used for follow up of the patients with choledocholithiasis after therapy, to look for the presence of retained stones, since it can detect stones even in the size as small as 2 mm. Selective use of intraoperative choledochoscopy in suspected cases helps in reducing the incidence of retained stones.

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“…The situation however is returned to normal by a compensatory increase in secretory effort which represents an increase in work demand upon the hepatic cell. Studies investigating the effect of sustained elevation of biliary pressure upon bile flow secretion and composition in the rhesus monkey revealed that bile flow and output of bile salts, cholesterol, and phospholipids fall progressively at biliary pressure greater than 12 cm saline (26).…”

Section: Effect Of Cppv On Splanchnic Circulationmentioning

confidence: 99%

Side effects of positive pressure ventilation on hepatic function and splanchnic circulation

Geiger

Georgieff

Lutz

1986

International Journal of Clinical Monitoring and Computing

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Positive pressure ventilation is associated with a reduction and redistribution of cardiac output. Splanchnic blood flow is decreased. Blood supply of the liver is reduced exceeding the fall in cardiac output. As a result oxygen transport to the mesenteric bed and liver is curtailed. There is a concomitant impairment of hepatic venous outflow. These hemodynamic changes may cause functional, structural and metabolic disturbances in organs whose blood supply arises from splanchnic circulation.

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Effects of Alteration of Biliary Pressure on Bile Composition—A Method for Study: Primate Biliary Physiology V.

Cited by 14 publications

References 5 publications

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

Clinicopathological features of choledocholithiasis patients with high aminotransferase levels without cholangitis

Analysis of the management of choledocholithiasis and it’s outcome with the role of preoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography

Side effects of positive pressure ventilation on hepatic function and splanchnic circulation

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