Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hepatocellular carcinoma can be complicated by obstructive jaundice with tumor growing into the extrahepatic bile duct. This complication is an autopsy finding in most reported cases and, rarely, is recognized ante mortem. We report two patients with hepatocellular carcinoma who presented initially with obstructive jaundice. Clotted blood and tumor, which caused bile duct obstruction, was removed operatively and the biliary tract was drained in both patients. We conclude that blood clot and fleshy debris removed from the common bile duct at operation for obstructive jaundice suggests the possibility of hepatocellular carcinoma; the differential diagnosis of jaundice and fever in patients known to have hepatocellular carcinoma should include intrabiliary tumor causing obstruction and cholangitis; and the association of obstructive jaundice and hepatocellular carcinoma may occur more often than previously recognized.
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PMID:Obstructive jaundice caused by hepatocellular carcinoma. 609 Aug 14

In 73 cases of pancreas cancer, histological diagnosis was not obtained in 43 (59%). Relief of obstructive jaundice was not satisfactorilly achieved in 14 of 39 patients at risk (36%), while gastric outflow obstruction developed subsequent to surgery in eight of 31 patients at risk (26%). Fine needle aspiration cytology is advocated to improve the rate of positive peroperative tissue diagnosis. To relieve bile duct obstruction, cholecystojejunostomy is advocated only in patients with pancreas cancer who have a very short life expectancy, and only when the cystic duct is patent. Choledochojejunostomy and gastrojejunostomy "double bypass" is advocated for cancers which are macroscopically localized to the pancreatic area. The selective use of this double bypass will improve surgical palliation and minimize reoperations in cancer of the pancreas.
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PMID:The objectives of palliative surgery in pancreas cancer: a retrospective study of 73 cases. 616 Aug 44

Insertion of an endoprostheses for internal biliary drainage was attempted upon 150 patients with obstructive jaundice. It was successful in 123 patients, and 99 patients had permanent drainage with the endoprosthesis. The plasma bilirubin level became normal in 64 of the patients. The effect upon jaundice was equal to that in 43 patients who underwent operation with palliative surgical bypass. The median survival time was not different from that for the patients with surgical anastomoses. Twenty-eight patients died in the first month after insertion, mostly of advanced malignant disease. Fifteen of the patients in the group with surgical anastomoses died within the first month. The insertion of an endoprosthesis for bile duct obstruction is relatively easy and seems to have little risk. Most complications are caused by the transhepatic cholangiography procedure. The method may be used for temporary drainage before operation, in transient benign obstructions or as permanent drainage in unresectable lesions. In patients with dislodgement or insufficient function, additional endoprosthesis may be inserted. Thus, sufficient palliation of jaundice is achieved with a low frequency of cholangitis. Internal biliary drainage by insertion of an endoprosthesis is a valuable alternative to surgical bypass in patients with unresectable lesions.
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PMID:Nonsurgical internal biliary drainage by endoprosthesis. 617 Oct 41

Individual non-sulfated bile acids in the serum of 65 patients with hepatobiliary diseases were quantitated by mass fragmentography. Serum with deuterium labeled deoxycholic acid as an internal standard was hydrolyzed with strong alkali, extracted with ether after acidification under cooling, and quantitated by mass fragmentography as the hexafluoroisopropyl-trifluoracetyl derivatives. In obstructive jaundice, the ratio of cholic to chenodeoxycholic acid was significantly higher than others. Cholic or chenodeoxycholic acid levels were correlated with total bilirubin levels in obstructive jaundice and acute hepatitis. Lithocholic acid value was independent of the degree of liver injury. Total bile acid value was helpful in estimating the extent of liver cell injury and cholestasis, and these two pathological conditions can be distinguished to some extent by cholic to chenodeoxychoic acid ratio.
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PMID:Quantitative determination of non-sulfated bile acids in the serum of patients with hepatobiliary diseases by mass fragmentography. 630 3

In modern gastroenterology, ultrasonography, particularly the real-time modality, is one of the most important diagnostic procedures, and the value of ultrasound in the diagnosis of cholestasis, and obstructive jaundice in particular, is indisputable. Although sector-type real-time ultrasonography has certain merits, for a routine examination, the linear scan is much more practical. It should be the first imaging investigation in patients with jaundice, along with the routine hematologic and biochemical tests. In obstructive jaundice, these studies are followed by ERC or PTC, and a definitive diagnosis is possible in the large majority of patients. Such a diagnosis very rarely requires correction at surgery.
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PMID:How to investigate cholestasis: utility of ultrasound as the first imaging study. 635 26

A 58-year-old man manifested obstructive jaundice secondary to adenocarcinoma of the common hepatic duct. The markedly icteric patient underwent multiple diagnostic and therapeutic procedures, including percutaneous needle biopsy of the liver, curettage, catheterization and washing of the hepatic ducts, and percutaneous transhepatic cholangiography. Three months later the patient died of a bleeding gastric ulcer. Autopsy confirmed the presence of adenocarcinoma of the common hepatic duct. Microscopic examination of the lungs disclosed numerous bile emboli in the smaller arteries, arterioles, and in a few alveolar capillaries. Histochemical reaction of the emboli was positive for bilirubin. Organizing fibrin was seen around occasional bile emboli, but most were without microscopic reaction. Review of the literature disclosed nine cases of pulmonary bile embolism, six of which had a history of marked cholestasis and trauma to the liver, like the present patient. Bile reaches the systemic circulation through a biliary-venous fistula that, in our case, was probably iatrogenic.
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PMID:Pulmonary bile emboli. Sequelae of iatrogenic trauma. 638 59

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

Viral hepatitis characterized by prolonged cholestasis has not been associated with a specific serologic marker. We report the cases of six patients presenting with a clinical syndrome typical of cholestatic hepatitis who were subsequently found to have acute hepatitis A. Usual features include pruritus, fever, diarrhea, and weight loss with serum bilirubin levels greater than 10 mg/dL, and a clinical course lasting at least 12 weeks. All patients recovered completely without sequelae. Knowledge of this unusual manifestation of hepatitis A may help avoid potentially invasive procedures involved in the evaluation of suspected obstructive jaundice and facilitate appropriate immunoprophylactic measures.
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PMID:Prolonged intrahepatic cholestasis secondary to acute hepatitis A. 648 95

A series of 46 patients with obstructive disease of the bile ducts complicated by acute renal failure (ARF) is presented. The patients exhibited obstructive jaundice with prevalence of conjugated bilirubine. In 80% of the cases biliary obstruction was associated with cholangitis. Disturbances of the liver function (from mild cholestasis to biliary cirrhosis) were also present. The renal damage was due to biliary disorders and was either present on admission (33 cases) or developed postoperatively (13 cases). Most of the patients presented nonoliguric ARF as well as poor perfusion resulting from decreased circulating blood volume (dehydration and electrolyte loss). Among the criteria used to determine the type of ARF, the urinary/plasma creatinine ratio less than 10 and urinary/plasma osmolarity ratio less than 1.1 were the most valuable. Management of ARF by dialysis alone was not satisfactory. Attention is called to the surgical treatment of the biliary disorder as being essential to prognosis. Patients not treated by radical surgery died in proportion of 87 to 100%. From the rest of 18 patients in whom the operation provided an adequate biliary drainage, in 15 the renal function was restored and 12 survived. Better prognosis in these patients was dependent not only on the ability to cure the cholestasis and infection, but on the early surgical treatment. The ultimate prognosis depends on the improvement of the liver function.
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PMID:Acute renal failure in obstructive diseases of the extrahepatic biliary ducts. 649 68

Obstructive jaundice in patients with chronic pancreatitis still constitutes a surgical problem deserving the attention of many specialized centers throughout the world. Out of a series of 149 patients operated upon for chronic pancreatitis, 45 (30.2%) with common duct stricture secondary to pancreatic disease have been studied in this series. Eleven patients (24.4%) had transient jaundice, eleven (24.4%) persistent cholestasis and six patients (13.3%) presented cholestasis with cholangitis. Seventeen patients (37.7%) were considered to have asymptomatic biliary tract stenosis. In 37 patients, pancreatic and biliary tract surgery were performed at the same time. There were two postoperative deaths (4.4%) and the late mortality was 9.3%. Choledochojejunostomy was preferred in the treatment of biliary stricture associated with pancreatitis. Cholecystojejunostomy provides inadequate biliary decompression and should not be used in the treatment of these patients. When a pancreatojejunostomy needs to be performed in association with biliary tract decompression, a double intestinal loop technique should be used because it is associated with less morbidity and mortality.
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PMID:Surgical treatment of biliary complications from calcifying chronic pancreatitis. 650 Aug 80


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