Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:3.1.3.1 (alkaline phosphatase)
47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report presents eight patients with dilatation of the biliary tree, six of whom had no clinical or laboratory evidence of biliary tract disease except for elevated levels of serum alkaline phosphatase. In two patients, dilatation was caused by obstruction of only one hepatic duct; in three, it was caused by a pancreatic tumor; and in three, it was associated with gallstones which exercised a ball-valve effect, producing intermittent obstruction. The elevation of the alkaline phosphatase level in six of these patients suggests that it is a more sensitive indicator of biliary tract obstruction than the serum bilirubin level is. The recognition of biliary dilatation in one or both lobes of the liver should lead to a careful examination, with ultrasound or another modality, of the porta hepatis, common bile duct, and pancreas.
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PMID:Ultrasound demonstration of anicteric dilatation of the biliary tree. 735 19

The patient with gallstones has an unknown risk of also having choledocholithiasis. To establish this risk preoperatively, several tests were studied in 167 patients, 37 of whom had common duct stones at exploration. With no previous or current jaundice, as well as normal alkaline phosphatase levels and a duct size of less than 12 mm, there was less than a 5% risk of choledocholithiasis; elevated bilirubin and/or alkaline phosphatase levels indicated intermediate risks (33% to 66%); and a duct size of 12 mm or greater, with any combination of other factors, indicated a 90% to 100% risk of choledocholithiasis. The surgeon should be aware of these probabilities in evaluating conditions of patients with cholelithiasis.
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PMID:Preoperative evaluation of the risk of common bile duct stones. 741 58

In order to assess the validity of a biochemical prediction of gallstones early in the course of acute pancreatitis by simple biochemical values (SGOT greater than or equal to 60 U/l, bilirubin greater than or equal to 1.6 mg/dl, alkaline phosphatase greater than or equal to 100 U/l) 297 patients with alcoholic, idiopathic and biliary pancreatitis were reinvestigated in a retrospective manner. The present study shows that a valid prediction by these values is not possible since 1) only about 40% of attacks of acute gallstone pancreatitis were associated with elevated SGOT, bilirubin and alkaline phosphatase concentrations and 2) there was a considerable overlap with the other etiological groups especially with idiopathic pancreatitis.
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PMID:[The problem of diagnosis of biliary calculi in acute pancreatitis by means of laboratory methods]. 743 50

We reviewed the medical records of 17 patients with sickle hemoglobinopathy-associated cholelithiasis who were candidates for laparoscopic cholecystectomy (LC) between 1991 and 1994. Eight patients with suspected choledocholithiasis (CDL) were identified, all of whom had preoperative endoscopic retrograde cholangiopancreatography (ERCP), which revealed CDL in 3 patients (18%), all of whom had endoscopic ductal clearance. Choledocholithiasis was suspected because of hyperbilirubinemia or serum liver enzyme abnormalities. Incremental hyperbilirubinemia exceeding "baseline" values by > 5 mg/dL was the best predictor of CDL. Subsequent LC was successful with discharge within 2 days of LC in all but one patient, who was converted to open cholecystectomy. This small series suggests that in sickle hemoglobinopathy patients with cholelithiasis (1) CDL is relatively common among patients with an increase above baseline hyperbilirubinemia, (2) bile duct dilatation, alkaline phosphatase, and serum aminotransferase levels are poor predictors of CDL, and (3) sequential endoscopic/laparoscopic management of cholelithiasis and suspected CDL is successful.
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PMID:Sequential endoscopic/laparoscopic management of sickle hemoglobinopathy-associated cholelithiasis and suspected choledocholithiasis. 748 84

Early and appropriate treatment of acute pancreatitis (AP) depends on early causal diagnosis. Published studies have shown favourable results following sphincterotomy performed within the 72 hours of onset of severe gallstone-associated AP. Among the various bio-clinical indices, the lipase/amylase (L/A) ratio, computed within 72 hours after onset, has been shown to discriminate between alcoholic and non alcoholic AP. Our study evaluates the data of biochemical disorders in 51 patients presenting with an episode of AP; these patients were divided into 3 groups: A: alcoholic AP, n = 15; B: biliary AP, n = 25; and C: post-ERCP AP, n = 11. These 3 groups were similar with respect to clinical severity of AP and CT scan. The time delays between onset of the symptoms and the biochemical assay were 1.9 +/- 0.3, 1.9 +/- 0.2 and 0.6 +/- 0.3 d (P < 0.01). AST, ALT, bilirubin, GGT and alkaline phosphatase were significantly (P < 0.05) greater in group B. Blamey's score was 0.5 +/- 0.2, 2.8 +/- 0.2 and 2.5 +/- 0.4 in groups A, B and C respectively. Serum amylase, serum lipase and L/A ratio were identical in groups A and B. The decrease in serum amylase after 48 hours was more important only in group B (56 +/- 8, 80 +/- 4, 47 +/- 3% respectively in groups A, B and C). L/A ratio was significantly greater in group C when compared with group A and B (1.7 +/- 0.4, 1.5 +/- 0.2 and 2.2 +/- 0.3 in groups A, B and C respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Is the identification of acute biliary and alcoholic pancreatitis by early pancreatic enzyme assay possible?]. 751 3

In order to determine the predictive value of noninvasive investigations for choledocholithiasis, we conducted a prospective preoperative study on 82 patients with symptomatic gallstones who received laparoscopic cholecystectomy. Ultrasonography (US), liver function tests and endoscopic retrograde cholangiography (ERC) were routinely performed in all cases prior to operation. The results showed a strong correlation between noninvasive procedures (liver function tests and US) and the presence of choledocholithiasis as shown by ERC. Using ERC as a reference, the sensitivity and selectivity of ductal dilatation at US and the elevation of alkaline phosphatase (ALP), gamma-glutamyltransferase and total bilirubin in the serum were studied for the detection of common bile duct (CBD) stones. The values of the combination of these tests were also calculated. From receiver operator characteristics curves, the best cut-off point for US in conjunction with ALP was chosen. ERC should be restricted to patients with possible CBD stones, suspected after a combination of the noninvasive US and ALP tests. This study emphasized the necessity and timing of performing ERC as a preoperative modality in the detection of choledocholithiasis in patients who are to undergo laparoscopic cholecystectomy.
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PMID:Preoperative assessment of choledocholithiasis in laparoscopic cholecystectomy. 761 54

There is a great body of evidence linking a high fat diet with the formation of gallstones. However, the effect of fat per se on obstructive liver damage (not involving gallstone formation) has not been assessed. The aim of this work was to study the effect of a high fat diet on liver damage induced by bile duct ligation in rats. Male 21-day-old Wistar rats were divided into two groups: group 1 received standard Purina chow diet 5001 containing 4.5% fat, group 2 received Purina chow diet 5001 enriched with 33% pork fat. Animals were allowed food and water ad libitum for 5 weeks. Obstructive jaundice was induced by double ligation and division of the common bile duct. The animals were sacrificed 1 week after biliary obstruction. Control animals were sham operated. Serum bilirubins and alkaline phosphatase, gamma-glutamyl transpeptidase and glutamic pyruvic transminase enzyme activities increased by biliary obstruction. Glycogen content decreased in the bile duct-ligated rats. These effects were more important in the group fed a 33% fat diet. Our results show that a high animal fat diet increases liver damage in experimental biliary obstruction in rats. Owing to our experimental design (bile duct ligation), the effect of a high fat diet cannot be attributed to an increase in the formation of gallstones but a direct effect must be considered. The mechanism by which fat augmented liver damage can be associated with an increase of total bile content and its toxicity.
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PMID:High fat diet and liver damage induced by biliary obstruction in the rat. 778 57

Acalculous cholecystitis, a recognized manifestation of acquired immune deficiency syndrome (AIDS), causes abdominal pain which can be relieved by cholecystectomy. The indications for cholecystectomy have remained undefined, however, because the cholecystitis is usually accompanied by generalized cholangitis and it is difficult to distinguish the relative clinical importance of the two problems. Since 1985, we have performed cholecystectomy on 8 patients with AIDS who had clinical manifestations of acute cholecystitis associated with a thickening of the gallbladder wall by 5 mm to 12 mm. Two of the 8 had gallstones and 4 had associated cholangitis. All had been treated with antibiotics for 20 to 180 days before surgery, but physical deterioration had progressed in every case. At the moment of surgical intervention, 4 patients had multiple organ failure. One patient died 3 days postoperatively, but the rest recovered rapidly with resolution of the abdominal pain and sepsis. Two patients died 20 days after surgery due to complications of AIDS. The remaining 5 died due to AIDS at 6, 9, 10, 12, and 14 months after surgery. Two of this group developed progressive cholangitis with raised serum alkaline phosphatase. Our experience indicates that cholecystectomy should be considered for the treatment of severe and persistent symptoms of hepatobiliary manifestations of AIDS notwithstanding the presence of cholangitis.
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PMID:Cholecystectomy for cholecystitis in patients with acquired immune deficiency syndrome. 808 61

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993; 131 (18%) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and altered liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 hours later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2%) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with altered liver function tests only alkaline phosphatase was significantly predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8%; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3%: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.
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PMID:[Treatment of lithiasis of the common bile duct by endoscopic sphincterotomy and laparoscopic cholecystectomy]. 816 Nov 53

We report the case of an 80-year-old woman with a previous history of HBP, hysterectomy due to cancer of the uterus and cholelithiasis, who was admitted in our hospital because of diffuse abdominal pain, marked jaundice, choluria and acholia during one week, together with anorexia and loss of weight. Blood chemistry results disclosed a total bilirubin of 11 mg/dl, a direct bilirubin of 8 mg/dl, GGTP 826 U/I, alkaline phosphatase 287 U/I, AST 285 U/I, ALT 837 U/I and LDH 242 U/I. The CA 19-9 marker was higher than 500 U/ml. The abdominal ultrasound examination did not show any space-occupying lesions; the extra and intrahepatic bile ducts were very dilated and the gall bladder showed multiple stones within its contents. The endoscopic retrograde cholangiopancreatography (ERCP) showed a homogeneous filiform defect at the middle third of the common bile duct of approximately 1 cm in length and with a marked dilatation of the bile ducts. A percutaneous drainage of the bile tree was performed, but the patient died.
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PMID:[Cancer of the middle third of the choledochus: an infrequent diagnosis]. 821 88


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