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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study has been conducted in 36 cholestatic patients to determine the diagnostic accuracy of ultrasonography in preliminary differentiation of obstructive from non-obstructive hepato-biliary disease. Due to the high rate of correct biliary duct caliber evaluation, ultrasonography has proved itself an excellent screening method in patients with cholestasis of uncertain origin. The choice of the subsequent more invasive diagnostic examinations (ERC, PTC, laparoscopy) depends on the ultrasonic findings.
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PMID:[Value of sonography in the diagnosis of obscure cholestasis]. 15 6

PTC is a good radiographic method in the diagnosis of cholestasis. Complications are rare, primarily due to the ultra-thin Chiba needle. For penetrating the liver we recommend to keep a distance of at least 4 cm between needle and spine (measured on the monitor). Our experience has shown routine liver tomography to be very helpful. Furthermore, delayed radiography can show extrahepatic bile ducts not seen on initial films.
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PMID:[Improved diagnosis in percutaneous transhepatic cholangiography (PTC) (author's transl)]. 48 23

Indications, success-rate and disadvantages of endoscopic retrograde (n = 928) and percutaneous transhepatic cholangiography (n approximately 360) at the Surgical and Medical University Clinics of Freiburg/German are discussed. Direct cholegraphy is the method of choice in cases of cholestasis of unknown origin. Endoscopic retrograde procedures usually preceed the percutaneous transhepatic approach. PTC either complementary or decisive when ERCP has failed. Therapeutic possibilities of both methods are not yet totally utilized.
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PMID:[Direct cholangiography: endoscopic-retrograde or percutaneous transhepatic? (author's transl)]. 48 24

Jaundice is a rewarding condition to investigate because an explanation is usually found. A preliminary diagnosis based on the clinical features and liver function tests is made. Specialized investigations are then undertaken. In cholestasis or if the diagnosis is in doubt an obstructing lesion must be excluded. Ultrasonography should be performed first followed by PTC if the ducts appear dilated, ERCP may be the most useful examination in patients whose ducts are normal and in those who have had previous biliary surgery. If either PTC or ERCP fails to demonstrate the biliary system the other should be attempted. Liver biopsy should be performed before submitting an undiagnosed jaundiced patient to surgery.
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PMID:The jaundiced patient. 48 31

The authors describe their experience in 23 cases of biliary tract drainage by the transhepatic-percutaneous approach in the course of obstructive jaundice of diversified origin. This can be done for essentially three reasons, namely to alleviate jaundice preoperatively, to provide permanent bile drainage in patients not amenable to surgery, and to relieve excess pressure in surgical anastomoses of the biliary passages. On the basis of biological considerations (relationship between severity and duration of cholestasis on the one hand and postoperative mortality and morbidity on the other), and in light of their own results, the authors argue in favor of this procedure, explaining that it is only mildly traumatic to the patient, easy to perform, attended by a low quota of complications, and above all effective as a drainage; also, it does not unduly prolong the preoperative period for patients scheduled for further and major surgery. Also in view of the current role of PTC in the diagnosis of obstructive jaundice, they submit that transhepatic-percutaneous drainage should be done right next to recognition of dilatation of the intrahepatic bile passages by CAT or echotomography.
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PMID:[Percutaneous transhepatic biliary drainage]. 69 20

Percutaneous transhepatic cholangiography with the Chiba University needle has been performed in 42 patients with cholestasis. The examination was successful in 100% of patients with dilated intrahepatic bile ducts and in 89% of those with normal-size ducts. Complications were minimal. The results of this study suggest that PTC with the Chiba needle is superior to the current conventional methods. The patients with intrahepatic cholestasis, which often simulates extrahepatic biliary obstruction, were spared an unnecessary laparotomy.
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PMID:Percutaneous transhepatic cholangiography utilizing the Chiba University needle. 95 43

In this study, the results of transhepatically aspirated bile culture, and cholangiography done in 220 cases with biliary tract diseases were presented. Aerobes and anaerobes were found in 76.4% and 64.7% of all samples respectively. Patients with partial common bile duct obstruction from stricture and choledocholithiasis had markedly higher positive cultures than that with simple gallbladder stones and complete common duct obstruction secondary to carcinomas of the pancreas or ampulla. Bile culture from patients with symptomatic cholangitis was much more often positive than those with asymptomatic cholangitis. It was also found that patients with positive bile cultures were more prone to after-PTC acute cholangitis. This study suggested that bile organisms are mainly from the gut, bile organisms and bile duct obstruction are two major causes of acute cholangitis, abrupt elevation of bile pressure during PTC procedure was also a causing factor of acute cholangitis. The authors advocate the comprehensive and prophylactic use of antibiotics both effective to aerobes and anaerobes in the treatment of biliary tract infection.
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PMID:[Comprehensive study of percutaneous transhepatic aspiration bile culture and cholangiography]. 208 96

Anomalies of the pancreatico-biliary tract present the most frequent cause of posthepatic cholestasis in the young child, whereas calculous disease or infections or compression by vascular abnormalities or neoplasms are less frequent. Generally, abdominal pain and jaundice begin acutely and increase following progressive biliary congestion. The preoperative diagnosis by ERCP or PTC or the intraoperative diagnosis of a relevant pancreaticobiliary anomaly stress the necessity of an operative management performing a bypass of the Sphincter Oddi and of the site of the anomaly. Local operative revision alone seems to be associated with a frequent relapse of cholestasis.
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PMID:[Posthepatic jaundice caused by abnormalities of the pancreaticobile duct system in early childhood]. 323 32

Aim of a rational diagnostic approach is keeping the risks and challenges of the patient at a minimum, shortening the time interval till the diagnosis is established and putting the charges to a low level. Anamnesia, clinical examination and laboratory results allow the experienced clinician in about 90% a correct diagnosis if an extrahepatic cholestasis is the case in question. On the other hand the result is only 75-80% if there is an intrahepatic cholestasis. Non dilated bile ducts do not exclude an extrahepatic cholestasis and additional diagnostic measures like ERCP or/and PTC are recommended in case the suspicion of a extra hepatic pattern exists. The diagnostic approach may be shorten at all if anamnesia and clinical statement are suspect of an extrahepatic cholestasis. Then after getting the laboratory results the ERCP or PTC may add.
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PMID:[Rational diagnosis of the cholestasis syndrome]. 409 52

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


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