Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.1.3.1 (alkaline phosphatase)
 47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Lipoprotein X (LP-X) is an abnormal lipoprotein that appears in the sera of patients with obstructive jaundice and is thus a marker for cholestasis. The presence of LP-X in serum does not allow discrimination between intra- and extra-hepatic cholestasis. In addition LP-X is present in the plasma of patients with familial plasma lecithin: cholesterol acyl transferase (LCAT) deficiency. It is a spherical particle that aggregates strongly. Phospholipids and unesterified cholesterol make up the bulk of LP-X, which is a low density lipoprotein. Protein, cholesterol esters, and triglycerides together make up 12 percent of the composition of LP-X. Lithocholic acid is the major bile acid in LP-X. Three species of LP-X have been isolated (LP-X1, LP-X2 and LP-X3). Because of its aggregating properties, LP-X complexes with enzymes, such as alkaline phosphatase. Electrophoretic and immunochemical methods are available for assay of LP-X. The fact that bile lipoprotein can be converted to LP-X by addition of albumin, and LP-X can be converted to bile lipoprotein by the addition of bile salts may suggest that the integrity of the LPX molecule depends on a certain critical bile salts to albumin ratio. Phospholipase in plasma is implicated in the catabolism of LP-X. The role of LP-X in cholestasis is apparently related to the removal of free cholesterol from the circulation as a consequence of its aggregating properties.
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PMID:Biochemistry and clinical relevance of lipoprotein X. 647 82

Distal common bile duct stenosis was observed in 16 (9%) of 170 alcoholic patients admitted to a Veterans Administration Medical Center in the last five years. The following clinical and biochemical features were significantly more common (P less than 0.05) among the 16 patients with common bile duct stenosis than in 154 without: jaundice, cholangitis, hyperbilirubinemia, alkaline phosphatasemia, pancreatic calcification, and malabsorption. Surgical decompression of biliary tree was necessitated in 13 of 16 cases due to obstructive jaundice in seven, cholangitis in four, portal fibrosis in one, and persistent abdominal pain in one. The mean (+/- SE) time interval between initial serum alkaline phosphatase elevation and surgical intervention was 308 +/- 108 days. Liver histology in eight cases was remarkable for portal fibrosis in seven and biliary cirrhosis in one. These data suggest that distal common bile duct stenosis is a progressive lesion which is quite prevalent in patients with advanced pancreatic disease of alcoholic etiology.
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PMID:Prevalence and natural history of distal common bile duct stenosis in alcoholic pancreatitis. 647 79

The Authors compare two groups of patients suffering from obstructive jaundice due to neoplasia of the head of the pancreas or the terminal bile duct who undergo bile drainage by means of cholecystostomy via the percutaneous transhepatic route, in order to reduce icterus, and subsequently undergo a duodenocephalopancreatectomy. The two groups are then compared with a third group in which duodenocephalopancreatectomy was performed without a preoperative reduction in the jaundice. The decrease in bilirubin and alkaline phosphatase, the drainage period, the nature and length of the post-operative course and the average total hospitalisation period are analysed. Whereas the recovery of hepatic function is comparable in the three groups, in the group undergoing percutaneous transhepatic bile drainage the post-operative course is decidedly better (lower morbidity and a shorter period of hospitalisation).
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PMID:Cholecystostomy and PTBD in the treatment of obstructive jaundice (a comparative study). 652 11

The influence of diabetes on mortality and morbidity following operations for obstructive jaundice has been assessed in 118 consecutive patients, all of whom received antibiotic cover, subcutaneous heparin and intravenous mannitol. 44 patients had diabetes mellitus (37%). There were 12 post operative deaths (10%). Factors which significantly contributed to mortality included; admission values for alkaline phosphatase, creatinine, haematocrit, bilirubin and age of patient over 70 years. Although mortality was not increased in diabetics, wound sepsis was significantly more common (20% and 4% respectively; p less than 0.02). The majority of infections were due to antibiotic sensitive Staphylococcus aureus. Diabetes did not influence survival after operation for malignant disease.
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PMID:Influence of diabetes on mortality and morbidity following operations for obstructive jaundice. 669 98

Hepatic dysfunction associated with parenteral nutrition (PN) is a well recognized occurrence. In order to define the temporal inter-relationships of direct bilirubin to other laboratory parameters, total and direct bilirubin, serum glutamic-pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT), and alkaline phosphatase were measured prior to beginning PN and then weekly throughout the duration of PN in 60 consecutive neonates. Cholestatic jaundice (ChJ), defined as a direct bilirubin greater than or equal to 2.0 mg/dl, developed in 11 (33%) of 33 infants receiving PN for at least 2 weeks. Direct bilirubin was the most sensitive and earliest indicator of ChJ. SGOT and SGPT values in the ChJ group were not statistically different from the non-ChJ group until 2 weeks after the onset of cholestasis. Although there was a progressive increase in alkaline phosphatase during the course of PN, the increase was not greater in the ChJ group. In summary, direct bilirubin is the only laboratory indicator of hepatic status that need be determined serially in parenterally alimented infants. Although SGPT and SGOT may be helpful in characterizing hepatic dysfunction once ChJ has occurred, alkaline phosphatase levels do not reliably assess PN-associated liver injury.
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PMID:Laboratory monitoring of parenteral nutrition-associated hepatic dysfunction in infants. 678 77

The aim of this study was to investigate whether quantification of Lipoprotein X (LP-X) through its cholesterol moiety is advantageous in the differential diagnosis of obstructive jaundice. In the case of mechanic cholestasis, LP-X cholesterol never exceeds 22% of the total serum cholesterol. Lipoprotein-X cholesterol exceeded 70 mg/dl in the plasma of 85% of all cases of acute hepatitis. The combination of lipoprotein with the activities of alkaline phosphatase and GPT allows the recognition of almost 80% of cases acute hepatitis and thereby excludes all other causes of obstructive jaundice. In addition, 84% of all patients investigated can be correctly classified using a combination of LP-X with classical parameters for cholestasis. The concentration of LP-X cholesterol alone apparently is as powerful as the usually used clinical chemical parameters. A combination of lipoprotein and the classical parameters allows a better differentiation of cholestatic liver disease with regard to the underlying cause as it is possible with each group of parameters alone.
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PMID:[The significance of LP-X cholesterol in the differential diagnosis of cholestasis (author's transl)]. 707 29

Fibrosis of chronic pancreatitis can cause obstructive jaundice by compressing the intrapancreatic portion of the common bile duct. The frequency and clinical manifestations of common bile duct stricture from symptomatic chronic pancreatitis have been evaluated in 26 patients undergoing lateral pancreaticojejunostomy for intractable pain between 1974 and 1980. Four patients (15%) had a stricture with partial obstruction of the common duct in addition to pancreatic duct obstruction. Three of the four strictures were identified prior to operation by ERCP. The fourth developed biliary obstruction six months after pancreaticojejunostomy. Slight elevation of alkaline phosphatase was common and occurred in 12 of 22 patients with chronic pancreatitis without biliary obstruction. Alkaline phosphatase was elevated greater than four times normal in three of the four patients with a biliary stricture. Elevation of total and direct serum bilirubin occurred only in patients with stricture of the distal common duct. A waxing and waning picture of jaundice was seen in these four patients. When a fixed smooth stricture of the common duct is demonstrated in a patient with symptomatic chronic pancreatitis, drainage of the biliary tree should be combined with pancreatic duct drainage in order to prevent cholangitis, biliary cirrhosis, diagnostic confusion with pancreatic carcinoma, and persistence of pain.
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PMID:common duct obstruction in patients with intractable pain of chronic pancreatitis. 711 5

Common bile duct stricture secondary to chronic pancreatitis is difficult to detect clinically. Surgical bypass is necessary if complications from biliary obstruction develop. In 21 patients operated on between 1968 and 1979, the earliest typical biochemical finding was a persistently elevated serum alkaline phosphatase level. The SGOT level was minimally elevated in seven patients, but did not correlate with changes in the stricture. An increased bilirubin level was noted either during an acute exacerbation of pancreatitis or late in the course of the stricture development, when obstruction was almost complete. Operative cholangiograms taken in 12 of these patients and transhepatic cholangiograms taken in nine demonstrated a stricture of the intrapancreatic bile duct more than 2 cm long. Operations were performed for treatment of obstructive jaundice (11), ascending cholangitis (three), suspected pancreatic cancer (three), and progressive biliary cirrhosis (two). Sphincteroplasty, initially attempted in four patients, uniformly failed to relieve the obstruction due to the length of strictured duct. Satisfactory drainage was obtained for up to ten years with choledochoduodenostomy (12), choledochojejunostomy (three), and cholecystojejunostomy (six).
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PMID:Common duct stricture from chronic pancreatitis. 737 60

Serum and pancreatic juice carcinoembryonic antigen (CEA) concentrations were studied in a group of 144 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with a variety of benign and malignant pancreatic and biliary diseases. Serum CEA was found to be a poor diagnostic and discriminating marker for pancreatic disorders and was raised in obstructive jaundice from various causes correlating with serum alkaline phosphatase. A pancreatic juice CEA concentration of greater than 106 mcg/l was associated with pancreatic disease but did not distinguish benign from malignant lesions. Criteria derived from pancreatic juice volumes and bicarbonate responses provided additional diagnostic differentiation of normal from pancreatic disease but not cancer from pancreatitis. Pancreatic juice CEA may have a limited application where imaging techniques have failed or are not available and additional study of pancreatic juice biochemistry is required before adequate diagnostic criteria can be established.
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PMID:Serum and pancreatic juice carcinoembryonic antigen in pancreatic and biliary disease. 742 29

A two-step procedure for percutaneous transhepatic drainage (PTD) of the biliary tract was attempted on 101 patients with obstructive jaundice, 29 with benign and 71 with malignant lesions, and was successful in 100. With this procedure, marked clinical improvement, with reduction in levels of serum bilirubin, SGOT, SGPT and alkaline phosphatase, was achieved after 1-2 weeks as a preoperative step or for continuous drainage in inoperable cases. In one patient 8 dys after PTD, however, a complicating large intrahepatic hematoma proved fatal. Emergency operation was necessary in three of the four patients who developed bile peritonitis due to dislocation of the catheter and in one with intra-abdominal bleeding. Our results suggest that this procedure is very useful in the diagnosis and management of certain obstructive diseases of the biliary tract.
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PMID:Percutaneous transhepatic drainage: experience in 100 cases. 745 29


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