AUTOIMMUNE CHOLESTATIC LESIONS OF BILIARY DUCTS

The review presents literature data and original findings of light and electron microscopy of pathomorphological changes in the bile ducts in primary sclerosing cholangitis (PSC), immunoglobulin G4 (IgG4)-associated autoimmune sclerosing cholangitis and overlap syndromes: PSC + chronic autoimmune hepatitis (AIH); PSC + primary biliary cirrhosis (PBC).

SP6.1.6 Rule of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy

Aims Incidence of gall stone disease is estimated at 10-15%of population. Intraoperative cholangiography (IOC) diagnose choledocholithiasis, delineates the anatomy of the biliary ducts, facilitate the dissection and reduces injuries. Our aim is to assess the feasibility and role of IOC and the incidence of choledocholithiasis in acute cholecystitis (ACC). Methods Retrospective analysis of prospectively collected data for patients admitted with ACC and undergoing same-hospital-stay laparoscopic cholecystectomy (LC). IOC was systematically attempted in all cases. Results 475cases included. Female to male ratio1.9:1. Conversion to open was done in 3 cases. Preoperative cholelithiasis was confirmed in 439cases versus 34cases with no stones. USS CBD abnormality (dilated or contain stone) found in 53 cases, out of which 8(15%) cases had CBD stones. Jaundice was found in 69cases, where 25(39%) cases had confirmed choledocholithiasis. IOC was successful in all cases except one. Abnormal IOC was found in 99(21%) cases. Of those; CBD stones were confirmed in 76 (77%) cases regardless the presence of cholelithisasis on USS. Empyema was found in 237 cases and it was associated with higher risk of abnormal IOC in 59(25%) cases where CBD stones were confirmed in 45(76%) cases. Cystic duct (CD) stones found in 80cases, of those 27(34%)cases had choledocholithiasis. Conclusions Females have double the risk of ACC. Preoperative jaundice and CD stones are stronger indicators than CBD diameter for presence of choledocholithiasis. The incidence of choledocholithiasis in ACC is (20-25%) regardless the presence of gall stones on USS. IOC is feasible and highly recommended in emergency LC.

First report of bacillary hemoglobinuria in buffaloes / Primeiro relato de hemoglobinúria bacilar em búfalos

We herein describe a typical episode of bacillary hemoglobinuria in buffalloes, triggered by liver fluke invasion proved by pathognomonic macro and micro lesions of fasciolosis in the biliary ducts and the nephrosis and hepatic focal necrosis characterizing the toxic-infectious process caused by Clostridium haemolyticum. This report is quite similar to another one described by AHOURAI et al. (1990) in cattle following liver fluke invasion and C. haemolyticum isolation and we both agree with the fact that foci of ischemic of toxic necrosis serve as a focus in which clostridial spores might vegetate and cause the disease by producing toxins. Vaccination with bacterin or toxoids is the most effective measure for preventing these histotoxic clostridial diseases since the endospores of the microorganism persist in the environment. Also, as the process is triggered by fluke liver migration, the prevention should cover the control of this trematode as well. Although the pathogenicity of bacillary hemoglobinuria is well known, there are only a few reports currently available, and to our knowledge this is the first case of the disease described in buffaloes.

Percutaneous transhepatic biliary puncture simulator: a cord network prototype

Background The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures. Methods An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model. Results After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session. Conclusions This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver. Trial registration Retrospectively registered

Cholelithiasis, choledocholithiasis and hepatolithiasis with secondary necrotizing hepatitis and cholangiohepatitis in a dairy cow

Biliary calculi are rare in cattle and occur usually in the gallbladder, without clinical signs. In humans, cholelithiasis is a common cause of hepatic abscess due calculi microbiota. Here is described a case of cholelithiasis, choledocholithiasis and hepatolithiasis in a 10-year-old female mixed breed dairy cow. The animal died during physical examination with signs as cachexia, icterus, and fever. At necropsy, a large number of green calculi were observed in the gallbladder, common duct lumen and in markedly distended biliary ducts. The liver was firm and decreased in volume with multiple abscess and multiple red foci measuring 0.5 cm in diameter in the hepatic parenchyma. Microscopically in the liver, marked ductal proliferation and abscedative cholangiohepatitis with abundant fibrosis and multiple foci of hepatocytes necrosis. In conclusion, choledocholithiasis and hepatolithiasis may occur in cattle and cause significant clinical signs and pathological alterations.

Experimental investigation of peculiarities for impact of a sorption action preparation silicon dioxide on infectious agents of cholangitis

Objective. Determination of impact of combination, consisted of 3% solution of silicon dioxide and antibacterial preparations, on bacterial cultures of S. aureus, P. aeruginosa, E. coli. Materials and methods. Clean cultures of bacteria, kept in Collection of Microorganisms in Department of Microbiology and Immunology of Training–Scientific Centre «Іnstitute of Biology and Medicine» of Taras Shevchenko National University: S. aureus (Rosenbach, 1884), P. aeruginosa (Schröter, 1872; Migula, 1900), E. coli (Migula, 1895; Castellani і Chalmers, 1919) were applied. Action of antibacterial preparations cefoperazon, cefoperazon–sulbactam, ampicillin–sulbactam, amicacin, as well as enterosorbent 3% solution of silicon dioxide, was investigated. In the investigation the impact of antibacterial preparations and silicon dioxide together with antibacterial preparations on test–cultures of bacteria was studied, using broth and agarised medium of Muller–Hinton. Results. The data, obtained in the investigation, trust efficacy of combined application of 3% solution of silicon dioxide, owing sorption capacity, with antibacterial preparations in reduction or elimination of subsequent growth of bacterial test–cultures of S. aureus, P. aeruginosa, E. coli. Combination of 3% solution of silicon dioxide with ampicillin–sulbactam in dilutions 64 and 32 mg/l promotes reduction of the E. coli growth on surface of agarised medium in comparison with the investigation variant without application of 3% solution of silicon dioxide. While polyresistence of P. aeruginosa revealed, 3%solution of silicon dioxide together with cefoperazon–sulbactam in concentrations 8 and 16 mg/l and ceftazidime in concentrations 8, 16, 32, 64 mg/l guarantees bactericidal effect for this microorganism. Growth of P. aeruginosa while application of 3% solution of silicon dioxide in combination with ampicillin–sulbactam in dilutions 8, 16, 32, 64 mg/l was arrested. Application of 3% solution of silicon dioxide in combination with amicacin–sulbactam 16 mg/l inhibits the S. aureus growth, what is observed, when combination of 3% solution of silicon dioxide with amicacin in dilutions 8, 16 mg/l and cefoperazon–sulbactam in dilutions 8, 16 mg/l are exploited. Growth of the microorganism do not evolve in variants of the investigation without 3% solution of silicon dioxide, as well as with him, if amikacin is applied in concentrations 64 and 32 mg/l. Conclusion. The biliary ducts drainage in obturative jaundice of tumoral genesis and subsequent presence of drainage (internal or external) constitute the main risk factors for their colonization by multiresistant microorganisms. At the same time, the biliary ducts drainage in combination with antibioticotherapy is estimated as an urgent method for control of the infection primary focus in an acute cholangitis. Establishing of procedure for application of 3% solution of silicon dioxide in combination with certain groups of antibacterial preparations for microorganisms revealed constitute important measure for bacteriobilia prophylaxis. The further investigations conduction with wider spectrum of antibacterial preparations and 3% solution of silicon dioxide for control of clinically significant species of microorganisms is necessary and perspective.

Autoimmune liver damage in patients with primary Sjogren's syndrome associated with anticentromeric antibodies

Objective: to determine the frequency, spectrum and severity of liver affection in anti-centromere antibodies (ACA) positive patients with primary Sjogren's syndrome (pSS).Patients and methods. 119 ACA-positive patients with pSS were included in the study, 37 (31%) of them had signs of liver damage, 3 of these patients were excluded from the study (2 had cholelithiasis, 1 had viral hepatitis B). Signs of autoimmune liver damage were found in 34 (28.6%) patients, most of them were seropositive for antimitochondrial antibodies (AMA). The diagnosis of primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) was established according to the recommendations of the American Association for the Study of Liver Diseases, the Russian Gastroenterological Association and the Russian Society for the Study of the Liver. In 5 (14.7%) patients the cause of cholestasis remained unspecified.Results and discussion. AMA were found in 73.5% of patients, elevated serum IgM levels – in 57.6%. Clinically liver damage in most cases was characterized by an asymptomatic, slowly progressive course without a dramatic increase of symptoms over time. Liver cirrhosis was found in 14.7% of patients. According to clinical, laboratory and morphological manifestations, PBC was diagnosed in 21 patients, 4 of them also had a cross syndrome with AIH. AMA-negative PBC was found in 3 patients and isolated AIH – in 1. In most cases, histological stage I of PBC was detected. During follow-up, median of 7 years (range from 2 to 15 years), in 7 patients with stage I PBC and in 7 AMA-positive patients without functional liver disorders no clinical, laboratory or instrumental progression of liver damage was noted. In this regard, it was suggested that these patients have epitheliitis of the biliary ducts as manifestation of glandular affection in pSS, and not true PBC.Conclusion. Autoimmune liver lesions are detected in 28.6% of ACA-positive patients with pSS, most (41.2%) of them develop epitheliitis of the biliary ducts as pSS manifestation or a combination of pSS with PBC (with the same frequency), less often PBC / AIH cross syndrome is diagnosed. PBC / pSS-related epitheliitis of the biliary ducts in ACA-positive patients is characterized by a slowly progressive asymptomatic course in most cases and rarely leads to the development of liver cirrhosis.

Choledochal cyst with secondary cholangitis, choledochitis, duodenal papillitis, and pancreatitis in a young domestic shorthair cat

Choledochal cysts, congenital segmental dilations of the common bile duct, have been reported in few cats, and histologic characterization is lacking. A 20-mo-old spayed female domestic shorthair cat was presented because of vomiting and weight loss. There was progressive elevation of liver enzyme activity (ALT > ALP, GGT) and hyperbilirubinemia. Diagnostic imaging identified focal cystic dilation of the common bile duct, dilation and tortuosity of adjacent hepatic ducts, and a prominent duodenal papilla. A choledochal cyst was suspected, and the animal was euthanized. On postmortem examination, there was a 2-cm, firm, thickened, cystic dilation of the common bile duct, patent with adjacent ducts. Histologically, the cyst wall was expanded by fibroblasts, collagen, and lymphoplasmacytic inflammation. Adjacent bile ducts were markedly dilated and tortuous, with lymphoplasmacytic inflammation and papillary mucosal hyperplasia that extended to the major duodenal papilla. There was chronic neutrophilic cholangitis, suggesting bacterial infection and/or disturbed bile drainage, extrahepatic obstruction, and lymphoplasmacytic pancreatitis with ductular metaplasia. Prominent lymphoid follicles within biliary ducts and duodenum suggested chronic antigenic stimulation. Choledochal cysts can be associated with chronic neutrophilic cholangitis, extrahepatic obstruction, choledochitis, duodenal papillitis, and pancreatitis, and should be a differential for increased hepatic enzymes and hyperbilirubinemia in young cats.