THE PATHOGENESIS OF EARLY OBSTRUCTIVE JAUNDICE

1. After experimental ligation of the bile ducts in dogs, two distinct processes are clearly manifested: first, the accumulation of the normally circulating bilirubin in the blood with its characteristic indirect Van den Bergh reaction for a period of several hours, and second, the subsequent appearance of the bile bilirubin giving the direct Van den Bergh reaction. It is possible that the first process may be due to a temporary reflex inhibition of the function of the liver cells due to ligation of the duct and comparable to the same phenomenon which usually occurs in the kidney when the ureter is ligated. The second process begins before any rupture of the bile capillaries is visible. Liver sections made 6 to 7 hours after obstruction show these bile capillaries dilated and extending between the liver cells in small distended pouches the blind end of these lying in contact with the pericapillary spaces. It is possible that bile may diffuse from these thin walled pouches into the perivascular lymph spaces, this diffusion being favored by the mounting pressure inside the bile ducts. 2. In early obstructive jaundice bile first appears in the lymph, but exclusion of the thoracic duct from the circulation by drainage causes a delay of only a few hours in the appearance of bile bilirubin in the blood stream. We must therefore conclude that after biliary obstruction bile enters the circulation both by way of the blood capillarieś and the lymphatics, although the latter route is the more important.

Download Full-text

Eosinophilic Cholangitis and Cholangiopathy: A Sheep in Wolves Clothing

HPB Surgery ◽

10.1155/2010/906496 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 24

Author(s):

Catherine Nashed ◽

Sujit Vijay Sakpal ◽

Victoria Shusharina ◽

Ronald Scott Chamberlain

Keyword(s):

Surgical Treatment ◽

Obstructive Jaundice ◽

Biliary Obstruction ◽

Bile Ducts ◽

Scientific Literature ◽

Diagnostic Challenge ◽

Rare Form ◽

Younger Patients ◽

Eosinophilic Cholangitis ◽

Disease Free

Background. Eosinophilic cholangitis (EC) is a rare benign disorder of the biliary tract which can cause biliary obstruction. Similar to other disease processes involving the bile ducts, this disorder can pose a difficult diagnostic challenge as it can mimic cholangiocarcinoma. Methods. A systematic search of the scientific literature was carried out using PubMed to access all publications related to EC. Search keywords that were utilized included “eosinophilic cholangitis,” “etiology,” “treatment,” and “obstructive jaundice.” Results. Twenty-three cases of EC have been reported. Nineteen patients (82.6%) who presented with EC remain disease-free; 15 of these 19 patients (78.9%) with followup time remain disease-free at a mean of 9.7 months (range, 2–24 months). Conclusion. EC is a rare form of biliary obstruction which can masquerade as a malignancy. Unlike cholangiocarcinoma, EC occurs more commonly in younger patients and in men. Most patients will require surgical treatment.

Download Full-text

A NOTE ON THE EFFECT OF AN INTRAVENOUS INJECTION OF BILE SALT ON THE PLASMA PHOSPHATASES OF THE RABBIT

Canadian Journal of Research ◽

10.1139/cjr50e-010 ◽

1950 ◽

Vol 28e (2) ◽

pp. 51-55 ◽

Cited By ~ 1

Author(s):

W. F. Haight

Keyword(s):

Alkaline Phosphatase ◽

Acid Phosphatase ◽

Obstructive Jaundice ◽

Bile Salt ◽

Phosphatase Activity ◽

Biliary Tract ◽

Biliary Obstruction ◽

Bile Salts ◽

Blood Stream ◽

Plasma Alkaline Phosphatase

Since it has been established (a) that the alkaline phosphatase activity of the plasma is increased in obstructive jaundice, (b) that the white cells are rich in alkaline phosphatase, (c) that this alkaline phosphatase is liberated from the cells in the presence of bile salts, and (d) that bile salts accumulate in the blood when the biliary tract is obstructed, there remained the possibility that the increase in plasma alkaline phosphatase observed after obstruction to the biliary tract might be the result of the liberation of alkaline phosphatase from the white cells by the retained bile salt. However the injection of bile salt into the blood stream of rabbits caused an increase in the acid phosphatase activity of the plasma with no significant change in the concentration of alkaline phosphatase. Since there is no increase in the acid phosphatase of the plasma in obstructive jaundice, these experiments provide no evidence for the theory that the increase in plasma alkaline phosphatase that follows biliary obstruction is the result of the retention of bile salt.

Download Full-text

Obstructive Jaundice Following Transarterial Chemoembolization for Hepatocellular Carcinoma with Bile Duct Invasion

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0041-1730850 ◽

2021 ◽

Vol 5 (02) ◽

pp. 127-130

Author(s):

Kazuki Matsushita ◽

Ken Kageyama ◽

Natsuhiko Kameda ◽

Yurina Koizumi ◽

Akira Yamamoto

Keyword(s):

Hepatocellular Carcinoma ◽

Bile Duct ◽

Obstructive Jaundice ◽

Transarterial Chemoembolization ◽

Tumor Invasion ◽

Endoscopic Sphincterotomy ◽

Biliary Obstruction ◽

Intraductal Tumor ◽

Bile Duct Invasion ◽

The Common

AbstractHepatocellular carcinoma (HCC) with bile duct invasion is considered rare. A case in which a fragment of intraductal tumor dropped into the common bile duct after transarterial chemoembolization (TACE) and caused abdominal pain, and obstructive jaundice secondary to biliary obstruction is presented. This case was successfully managed by emergent endoscopic sphincterotomy. Physicians should recognize one of the complications due to TACE for HCC with intraductal tumor invasion.

Download Full-text

ULTRASONOGRAPHY IN OBSTRUCTIVE JAUNDICE

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.04.2245 ◽

2012 ◽

Vol 19 (04) ◽

pp. 436-441

Author(s):

ASMA AFZAL KIANI ◽

RANA HASSAN JAVAID ◽

ABDUL GHAFFAR ◽

Shamrez Khan

Keyword(s):

Obstructive Jaundice ◽

Sensitivity And Specificity ◽

Gold Standard ◽

Biliary Obstruction ◽

Pancreatic Head ◽

Histological Diagnosis ◽

Imaging Procedure ◽

Preoperative Ultrasonography ◽

Initial Imaging

Objective: To evaluate the validity of ultrasonography in patients who have obstructive jaundice. Design: Descriptive study.Place and duration of study: The study was carried out from September 2006 to May 2008 in department of Radiology Combined MilitaryHospital Quetta. Patients and Methods: A total of 30 patients; 14 male and 16 female underwent operation for obstructive jaundice. All of themhad preoperative ultrasonography. The site and nature of biliary obstruction were noted and the accuracy was determined with per-operativefindings / histological diagnosis as gold standard. Results: The cause of obstructive jaundice identified by ultrasonography with reasonablesensitivity of 90% and specificity of 90% for choledocholithiasis and sensitivity of 55.5% and specificity of 95.2% for pancreatic head tumours.Conclusions: Ultrasonography should be the first and best initial imaging procedure in patients who have obstructive jaundice and showsreasonable sensitivity and specificity to identify causes of obstruction in obstructive jaundice.

Download Full-text

Biliary Atresia

Pediatrics in Review ◽

10.1542/pir.11.2.57 ◽

1989 ◽

Vol 11 (2) ◽

pp. 57-62

Author(s):

Elizabeth A. Wanek ◽

Frederick M. Karrer ◽

Carlos T. Brandt ◽

John R. Lilly

Keyword(s):

Biliary Atresia ◽

Biliary Obstruction ◽

Bile Flow ◽

Bile Ducts ◽

Current Treatment ◽

Histopathologic Examination ◽

The Past ◽

The World ◽

Hepatic Portoenterostomy ◽

Extrahepatic Bile Ducts

Biliary atresia is a pathologic entity in which there is obliteration of some portion of the extrahepatic bile ducts. In the past, occlusion of the proximal ducts (at the liver hilus) was referred to as "noncorrectable" (Fig 1). If only the distal duct is occluded (and the proximal duct is patent), the lesion was referred to as "correctable." The distinction is academic because current treatment and prognosis are identical. The disease is panductular, ie, both extrahepatic and intrahepatic ducts are involved. Early in the disease, however, occlusion is complete only in the extrahepatic system. Without intervention, intrahepatic biliary obstruction and, subsequently, cirrhosis supervene. In the past, except for a few cases of the correctable variant, surgical procedures were unsuccessful until Morio Kasai performed a hepatic portoenterostomy, which was first reported in English in 1968. Bile flow was effectively reestablished in both correctable and noncorrectable forms of biliary atresia. The operation was only successful when done before the patient was 4 months of age. Subsequent confirmation of Kasai's results were reported throughout the world. ETIOLOGY/PATHOLOGY Biliary atresia was originally thought to be a congenital malformation. Careful histopathologic examination of excised surgical specimens indicate that this is not the case; instead, the disease is a dynamic, progressive panductular sclerotic process that may continue in the intrahepatic ducts even after surgical relief of biliary obstruction.

Download Full-text

SURGICAL EXPLORATION IN OBSTRUCTIVE JAUNDICE OF INFANCY

PEDIATRICS ◽

10.1542/peds.26.1.27 ◽

1960 ◽

Vol 26 (1) ◽

pp. 27-35

Author(s):

Thomas V. Santulli ◽

Ruth C. Harris ◽

Keith Reemtsma

Keyword(s):

Differential Diagnosis ◽

Obstructive Jaundice ◽

Bile Ducts ◽

Frozen Section ◽

Surgical Trauma ◽

Bile Pigment ◽

Biliary Cirrhosis ◽

Intestinal Anastomoses ◽

Surgical Exploration ◽

Frozen Section Examination

From a review of 71 cases and an evaluation of frozen-section examinations of liver biopsies, the authors propose the following method of management of infants with prolonged obstructive jaundice. All patients are carefully selected on the basis of history, clinical findings and appropriate laboratory investigation. Laboratory studies found to aid in the differential diagnosis are: serial determinations of bilirubin (conjugated and unconjugated) in the serum, zinc sulfate turbidity test, cholesterol and cholesterol esters in serum, estimation of bile pigment in urine and stool, studies of the maternal and infant blood factors and erythrocyte fragility. Determinations that have not been useful in the differential diagnosis are: cholesterol esterase, alkaline phosphatase and cephalin fiocculation.19 The activity of transaminases in the serum may prove helpful and are currently under study. The measurement of the prothrombin time should be included in the preoperative studies. If the diagnosis is impossible by the age of 7 weeks, then surgical exploration is carried out. This consists of exposing the liver, taking a biopsy for frozen-section examination and performing a cholangiogram, if possible. With increasing experience, confidence has been acquired in interpretation of the frozen-section of the liver biopsy at this age. The authors are convinced of its value in helping the surgeon establish the diagnosis before proceeding with further exploration of the bile ducts. By this method of management, surgical exploration need not be delayed beyond 7 weeks of age. Thus a patient with congenital atresia of the bile ducts, who may be fortunate enough to have a correctable lesion, will not be deprived of the only possible chance of cure. At this age it is unlikely that biliary cirrhosis will have progressed to a severe degree. Admittedly, it would be preferable to explore such a case earlier, but more experience is needed in diagnosis by frozen-section examination at an earlier age. It does not appear that any patient with hepatitis or other non-surgical condition has been harmed either by the anesthesia or surgical trauma attendant on this limited procedure. One of the greatest advantages of the frozen-section examination has been the information provided to the surgeon at a crucial time during the exploration. With this information the surgeon should be able to avoid unnecessary exploration of the bile ducts and possible injury to patent ducts, as well as unnecessary biliary-intestinal anastomoses which have been performed in the past because of mistaken diagnoses.

Download Full-text

Malignant Biliary Obstruction of the Hilum and Proximal Bile Ducts

ERCP ◽

10.1016/b978-1-4557-2367-6.00037-8 ◽

2013 ◽

pp. 356-364.e2

Author(s):

Savreet Sarkaria ◽

Michel Kahaleh

Keyword(s):

Biliary Obstruction ◽

Bile Ducts ◽

Malignant Biliary Obstruction

Download Full-text

Percutaneous Transhepatic Biliary Drainage in Malignant Obstructive Jaundice

Tumori Journal ◽

10.1177/030089168306900213 ◽

1983 ◽

Vol 69 (2) ◽

pp. 161-165 ◽

Cited By ~ 4

Author(s):

Aldo Severini ◽

Guido Cozzi ◽

Massimo Bellomi ◽

Maria Chiara Castoldi ◽

Roberto Doci

Keyword(s):

Prognostic Factors ◽

Surgical Treatment ◽

Liver Function ◽

Obstructive Jaundice ◽

Biliary Drainage ◽

Biliary Obstruction ◽

Percutaneous Transhepatic Biliary Drainage ◽

Malignant Obstructive Jaundice ◽

High Operative Risk ◽

Transhepatic Biliary Drainage

Results obtained in 70 patients with neoplastic (primary or metastatic) biliary obstruction and submitted to percutaneous transhepatic biliary drainage indicate the effectiveness of the technique in relieving jaundice, improving general conditions and restoring liver function. In 25.4% of cases, the drainage allowed the patients to undergo surgical treatment of the neoplasm. In 74.6%, the drainage was left in place as definitive palliation. The complication rate was very low and similar to that described in the literature. At this time it is difficult to identify prognostic factors and foresee the results of percutaneous transhepatic biliary drainage, but the procedure is always indicated in patients at high operative risk or inoperable.

Download Full-text