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)

A retrospective review of the records of 1,507 patients with a diagnosis of cholecystitis was conducted for the five-year period, 1972 to 1977. Of this group of patients, a histopathologic diagnosis of acute cholecystitis was established in 154 patients (10.2%). Common duct calculi were detected in 17 of these 154 patients, an incidence of 11%. Preoperative evaluation by means of serum bilirubin and alkaline phosphatase levels and intravenous cholangiography was unsatisfactory for consistent demonstration of choledocholithiasis in the presence of acute cholecystitis. Intraoperative cholangiography was found to be the most reliable method for detection of common duct calculi and was successfully employed in 14 of 17 patients with choledocholithiasis. The remaining three patients had palpable stones.
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PMID:Choledocholithiasis associated with acute cholecystitis. 46 4

In a prospective series of 155 patients with acute cholecystitis preoperative liver function tests were determined with the aim of predicting the presence of common duct stones. Elevated serum bilirubin, aminotransferases and alkaline phosphatase levels were observed in 32, 34 and 22% of cases, respectively. The frequency of common duct stones was 17.4%. The sensitivity of bilirubin and aminotransferases with regard to ductal stones was higher (70-81%), but alkaline phosphatase showed the best predictive values (46%). The probability of common duct stones increased with higher degrees of elevation in the case of alkaline phosphatase, but not in the case of bilirubin or aminotransferases, A frequency of 31-67% of choledocholithiasis was found when one or all of the tests were positive. After random assignment the patients were operated on early or after delay. In the delayed surgery group more failures occurred in the conservative treatment of acute cholecystitis if the tests were elevated (36%) than if normal (15%, p less than 0.05). The frequencies of common duct stones were 11 and one in these groups (p less than 0.001). There was no increase in postoperative morbidity after early surgery (15%) compared with delayed surgery (22%, p greater than 0.1), when liver function was disturbed. Liver function tests thus allow patients with common duct stones to be selected for early surgery in acute cholecystitis.
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PMID:Abnormal liver function tests in acute cholecystitis; the predicting of common duct stones. 74 32

The value of serum liver function tests and abdominal ultrasound as screening tests of the need for endoscopic retrograde cholangiopancreatography (ERCP) was determined in patients with unexplained abdominal pain without associated jaundice. In 1989 and 1990 1005 ERCPs were undertaken, of which 138 (14%) were for this indication. The duct or ducts of interest were delineated by ERCP in 95% of patients. The lesions found were bile duct stones in 10 patients, chronic pancreatitis in five, pancreatic carcinoma in one, peptic ulcer or duodenitis in four. A satisfactory ultrasound examination had been performed in 94% of patients. For chronic pancreatitis, its sensitivity was 60% and specificity 95%. For choledocholithiasis, the ultrasonic detection of duct dilatation or stones had a sensitivity of 90% and specificity of 86%. Of the liver function tests, the alkaline phosphatase was more sensitive (67%) than the transaminases (44%) in indicating the presence of bile duct stones and had a high specificity (95%). None of the 10 patients with duct stones had normal ultrasound and normal alkaline phosphatase. Thus it was found that demonstration of a normal common bile duct by abdominal ultrasound and normal serum alkaline phosphatase together have 100% specificity in excluding bile duct stones. Using such knowledge over the two year period of this study would have spared 36 patients the need for ERCP.
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PMID:Value of ultrasound and liver function tests in determining the need for endoscopic retrograde cholangiopancreatography in unexplained abdominal pain. 145 84

A prospective study to evaluate the selective or routine use of intraoperative cholangiography on elective cholecystectomy was performed. 178 patients were studied, listing criteria to explore the biliary tract with the cholangiography aspects. The criteria showing choledocholithiasis were the alkaline phosphatase and/or bilirubin increase, dilated common bile duct, large cystic duct, small stones and pancreatitis or jaundice on the past history. The patients were divided in 4 groups: 1) no criteria: 61 (34.3%); 2) one criterion: 53 (30%); 3) two criteria: 22 (12.3%); 4) more than two criteria: 42 (23.4%). The false-positive was 1.6% to the first group, 3.8% to the group 2 and 0% to the other groups. We concluded that the intraoperative cholangiography must be achieved on patients that have at least one choledocholithiasis criterion.
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PMID:[Cholangiography: a routine procedure in elective cholecystectomy?]. 147 21

Jaundice is a disorder of bilirubin metabolism and has many causes. History and physical examination help establish the diagnosis in 70 to 80 percent of patients. Elevation of alkaline phosphatase and gamma-glutamyl transpeptidase suggests cholestasis, either intrahepatic (e.g., medication reactions) or extrahepatic (e.g., choledocholithiasis), whereas markedly elevated serum aminotransferases are indicative of hepatocellular damage from infection, toxins or ischemia. Ultrasound examination is a useful initial procedure when extrahepatic obstruction is suspected. Endoscopic retrograde cholangiopancreatography and computed tomography may be better used to diagnose obstruction at the level of the pancreas or distal common bile duct. The treatment is based on the etiology of jaundice and includes removal of offending medications or toxins, therapy for underlying liver disease or surgery for extrahepatic obstruction.
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PMID:Jaundice. 154 99

A prospective study to evaluate the selective or routine use of intraoperative cholangiography on elective cholecystectomy was performed. 178 patients were studied, listing criteria to explore the biliary tract with the cholangiographic aspects. The criteria showing choledocholithiasis were the alkaline phosphatase and/or bilirubin increase, dilated common bile duct, large cystic duct, small stones and pancreatitis or jaundice on the past history. The patients were divided in 4 groups: 1) No criteria: 61 (34.3%); 2) One criterion: 53 (30%); 3) Two criteria: 22 (12.3%); 4) More than two criteria: 42 (23.4%). The false-positive was 1.6% to the first group, 3.8% to the group 2 and 0% to the other groups. We concluded that the intraoperative cholangiography must be achieved on patients that have at least one choledocholithiasis criterion.
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PMID:[Cholangiography: a routine test in elective cholecystectomy?]. 156 58

Ninety-one patients with choledocholithiasis were admitted for endoscopic (51 cases) or surgical (40 cases) sphincterotomy of Oddi's muscle, and were followed up on a yearly basis thereafter for a period spanning 1 to 5 years. The study protocol included clinical examinations, ultrasonographic investigations and biochemical tests. The post-surgery mortality rate was 3.9% following endoscopic sphincterotomy versus 0% after surgery. Postoperative complications occurred in 3.9% of patients treated endoscopically (bleeding, angiocholitis) and in 5% of surgical patients (bronchopneumonia, suppuration of abdominal wall). Attempts to remove calculi via endoscopic Oddian sphincterotomy failed in 37% of cases. Long-range results were classified as excellent or good in 92% of patients treated endoscopically, and in 100% of cases treated surgically. Endoscopic division of Oddi's sphincter was unsuccessful in 4 patients (8%), who either had recurrent bile-duct stones (2 cases) or developed sphincteric stenosis. Among biochemical indices of biliary stasis, only alkaline phosphatase contents showed a greater increase following endoscopic sphincterotomy than after surgical treatment. Ultrasonographic studies of the bile duct evidenced a greater incidence of air entrapment in the bile ducts of patients subjected to surgical sphincterotomy.
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PMID:[Immediate and long-term results of endoscopic or surgical Oddi sphincterotomy in the treatment of lithiasis of the common bile duct]. 217 42

The efficacy of endoscopic sphincterotomy in the treatment of acute cholangitis caused by choledocholithiasis was evaluated in a consecutive series of 30 patients. Twenty-five patients (83%) were satisfactorily treated, leading to a normalization of serum alkaline phosphatase, bilirubin and temperature. The procedure was unsuccessful in 4 patients because of large stones. All 4 were submitted to surgery. None of the patients in whom sphincterotomy had been performed had short-term complications. Follow-up with a mean observation time of 22 months showed that 84% of the patients, remained completely symptom-free. Our results are in agreement with those reported in the literature. It is concluded that treatment with instrumental extraction through endoscopic sphincterotomy is simple and fast, and that it should be considered the treatment of choice in the majority of patients with acute cholangitis. For these patients, relief of the biliary obstruction and normalization of the increased intrabiliary pressure remain an essential prerequisite for a favourable outcome.
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PMID:Endoscopic sphincterotomy in acute cholangitis due to choledocholithiasis. 234 Nov 15

The most common diagnoses of transhepatic cholangiography (THC) among 58 surgical patients were pancreatic adenocarcinoma, choledocholithiasis and cholangiocarcinoma. THC was complicated in 17 of 58 patients or 18 of 68 attempts due to bacteremia or fever in four, subcapsular hematoma in two and Ring catheter shearing and apical pneumothorax in one each. THC related deaths occurred in four patients. In uncomplicated THC, the mean hematocrit value decreased from 35.9 +/- 5.8 (n = 39) to 34.1 +/- 4.8 (n = 39) (p less than 0.02). Of THC attempts, 8.8 per cent failed; before THC, ultrasonography (UTZ) in most of these showed no dilation of the bile ducts. THC showing dilated ducts had a significantly higher (p less than 0.01) bilirubin and alkaline phosphatase levels (14.8 +/- 8.7 milligrams per cent, n = 46 and 414 +/- 283.9 units, n = 46) compared with the THC showing no dilation (5.29 +/- 5.45 milligrams per cent, n = 13 and 235 +/- 294.1 units, n = 13). Of the 30 patients given ampicillin and gentamicin before THC, only three had bacteremia develop; two of six who were untreated and nine of 47 of those pretreated with other antibiotics had bacteremia develop. Of seven instances of stones of the common bile duct found at operation, computed tomography diagnosed zero of seven; UTZ, two of seven, and THC, seven of seven. No THC gave a misleading diagnosis. Eighteen palliative transhepatic drains were attempted with the THC (15 successfully). A significant (p less than 0.01) 50 per cent decrease in the bilirubin and alkaline phosphatase levels were obtained by catheter drainage but neither test returned to normal. THC is not a benign procedure and should be done only if bilirubin or alkaline phosphatase, or both, are elevated above 5 milligrams per cent and 200 units, respectively, and UTZ shows dilated biliary ducts. Pretreatment with antibiotics and operating room availability are important to limit THC morbidity.
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PMID:Patient selection and complications of transhepatic cholangiography. 244 23

The medical records of 277 consecutive patients who underwent cholecystectomy for benign gall stone disease, were reviewed to determine the incidence and cause of biliary tract obstruction. Obstructive jaundice (icteric obstructive biliopathy) was present in 38 cases. This was due to choledocholithiasis in 22. Mirizzi's Syndrome in two, biliobiliary fistula in eight and biliary stricture in five patients. Preoperative direct cholangiography (ERCP/PIC) was helpful. Anicteric patients were classified on the basis of a history of jaundice serum alkaline phosphatase, sonography and operative findings. Anicteric patients with evidence of biliary tract pathology (anicteric obstructive biliopathy) had a significant incidence of choledocholithiasis (33.3%). Biliary complications were uncommon in this group (4.3%). Peroperative cholangiography was carried out and was valuable in these patients but was normal in all 83 patients who had no evidence of biliary obstruction.
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PMID:Gall bladder and common bile duct stones--when is direct cholangiography indicated. 248 86


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