Management of Liver Failure in a Patient Following Jejunoileal Bypass

Baker, Alfred L.; Monroe, Paul; Glagov, Seymour; Sitrin, Michael D.

doi:10.1016/s0016-5085(19)30522-0

Cited by 7 publications

(2 citation statements)

References 22 publications

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“…Steatonecrosis and lymphokinin activation of collagen synthesis [16,17] coupled with protein and vitamin deficiency may have led to some of the fibrosis seen in the portal area. Also bacterial toxins may play a major role in the liver injury associated with bypass patients [18,19]. All of the above probably contributed to her death.…”

Section: Discussionmentioning

confidence: 99%

Micro-nutrient deficiency in a case of jejunoileal bypass.

Hove¹,

Baker²

1982

Journal of the American College of Nutrition

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This report describes various clinical and micro-nutrient abnormalities that existed in a 47-year-old woman who underwent a jejunoileal bypass operation. She exhibited extensive electrolyte, mineral, amino acid, and vitamin deficiencies. Amino acid absorption tests indicated an inability to absorb essential amino acids, especially the branched-chain and aromatic varieties. Vitamin absorption tests indicated an inability to notably absorb folic acid, niacin, vitamins B6, A, and E; the fat-soluble beta-carotene (provitamin A) was not absorbed from the diet. A liver biopsy revealed that 80% of the tissue was filled with fatty cysts. The ensuing liver disease compounded with biochemical abnormalities due to the bypass, contributed to the patient's death.

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Section: Discussionmentioning

confidence: 99%

Micro-nutrient deficiency in a case of jejunoileal bypass.

Hove¹,

Baker²

1982

Journal of the American College of Nutrition

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“…The most significant and severe of these, hepatic dys function or failure, has occurred in 20-30% of patients [83,[85][86][87]. Severe loss of minerals and vitamins is commonplace [82,83,86,87]. Colonie pseudo-obstruction, possibly due to the overgrowth of anaerobic bacteria [85,88], and urinary tract stones [89] are also common sources of morbidity.…”

Section: Smentioning

confidence: 99%

Obesity

Dietz

1989

Journal of the American College of Nutrition

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Over the past 20 years, obesity has represented a significant focus of research conducted in Clinical Research Centers (CRCs) in the United States. This review will focus on the progress in our understanding of the disease that CRC-based research has produced; therefore, the reference list is not exhaustive and consists primarily of CRC-based research. Obesity is defined as an excess of body fat as measured by triceps skinfold thickness. The time of onset of obesity is an important factor; for example, early onset is associated with an increase in the number of fat cells. Weight loss reduces the size but not the number of fat cells. Type II diabetes mellitus is a common complication in obese adults; this condition has been related to fat cell size and, in women, to predominantly upper-body fat distribution. Pregnant obese women and their babies are at risk for a number of problems. Abnormalities commonly found in obese persons include increased plasma lipid levels, hyperinsulinism, increased cholesterol synthesis, high frequency of gallstones, and hypertension. Under a variety of experimental conditions, the only difference in the response of obese and normal weight subjects to food was that the obese subjects appeared to consume more, but other data suggest that the obese may have greater energy needs. Carbohydrate intake has been studied extensively. Metabolic rate increases with over-feeding, especially in response to carbohydrate. Basal metabolic rates are higher in obese adults and rise in response to overfeeding; they decrease after weight reduction. This decrease can be counteracted with sucrose, perhaps because sucrose maintains triiodothyronine levels.(ABSTRACT TRUNCATED AT 250 WORDS)

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Aminopyrine breath test

et al. 1983

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To determine whether the aminopyrine breath test reflects the presence of increased pericentral fibrosis, steatonecrosis, and cirrhosis following jejunoileal bypass, 21 patients were evaluated with liver biopsies, liver chemistry tests, 45-min bromosulfothalein retention tests, and aminopyrine breath tests prior to bypass and at 3, 6, and 12 months thereafter. Following bypass, 15 biopsies demonstrated increased pericentral fibrosis, steatonecrosis, or cirrhosis, and 35 biopsies revealed increased fatty infiltration alone. Although the aminopyrine breath test results were significantly lower in patients with increased pericentral fibrosis, steatonecrosis, and cirrhosis at 6 and 12 months following bypass (P less than 0.05), this test had a positive predictability of only 0.67. An abnormal AST had a positive predictability of 0.87. Other liver function tests were less reliable in identifying patients with potentially progressive lesions following bypass. Thus, the AST is more useful than the aminopyrine breath test in reflecting increased pericentral fibrosis, steatonecrosis, and cirrhosis following jejunoileal bypass. The nonspecific effects of obesity and increased fatty infiltration of the liver following jejunoileal bypass may account for the low predictability of the aminopyrine breath test.

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Management of Liver Failure in a Patient Following Jejunoileal Bypass

Cited by 7 publications

References 22 publications

Micro-nutrient deficiency in a case of jejunoileal bypass.

Micro-nutrient deficiency in a case of jejunoileal bypass.

Obesity

Aminopyrine breath test

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