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

Extrahepatic bile flow obstruction is followed by a several-fold increase in alkaline phosphatase activity in the liver. This activity passes into the blood. The increase in the activity of the enzyme in the liver can be prevented by inhibitors of RNA and protein synthesis. Inducible alkaline phosphatase was purified from rat liver and 1,000-fold purification was achieved. The incorporation of labbelled precursors (14C amino acids and 14C glucosamine) into the liver alkaline phosphatase was evaluated. No significant difference were found between specific alkaline phosphatase activities and specific radioactivities in the control rats and rats with 7.30 h after bile duct obstruction. The incorporation of 14C-amino acids into the total liver proteins was 20% lower in rats with cholestasis than in the control group. The results are evidence that the liver is the source of elevated alkaline phosphatase activity in serum in cholestasis, and that the production of alkaline phosphatase in the liver is prevented by inhibitors of RNA a protein synthesis. However, the enzyme might be synthesized before the 14C-labelled precursors were applied.
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PMID:Experimental study on the mechanism of hyperphosphatasaemia in bile flow obstruction. 61 64

Both serum particulate alkaline phosphatase and serum lipoprotein-X have been proposed as diagnostic markers for obstructive liver diseases. In this study their diagnostic efficiencies have been compared with other biochemical indicators of liver function and the relative incidence of these two markers has been determined in 241 patients with well defined liver disease. Although these markers appeared together most frequently in obstructive liver disease they were both present in some patients with liver disorders where obstruction was unlikely. One marker was present, independently of the other in 35% of the patients studied, mainly those without apparent cholestasis. The reasons for this are discussed in terms of the likely origins of the two markers and the probability that serum particulate alkaline phosphatase exists in two forms, as part of a multienzyme plasma membrane complex and as soluble liver enzyme associated with lipoprotein-X.
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PMID:The incidence and likely origins of serum particulate alkaline phosphatase and lipoprotein-X in liver disease. 69 40

Marked biochemical cholestasis mimicking extrahepatic obstruction may occur in alcoholic liver disease. Twenty-three consecutive hyperbilirubinemic alcoholics who underwent liver biopsy were studied. Comparison of the clinical, laboratory, and histological features was made between patients with no or rare intraductal polymorphonuclear leukocytes, group A (19 cases), and those with polymorphonuclear leukocytes in multiple bile ducts ("microscopic cholangitis"), group B (4 cases). Extrahepatic biliary obstruction was excluded in group B by cholangiography. Group B had significantly higher serum SGOT, bilirubin, alkaline phosphatase, and cholesterol than group A. All group B patients had periductal acute inflammation and severe panlobular cholestasis. However, there was no significant histological difference comparing group A patients with alkaline phosphatase greater than 300 mIU per ml and group B patients, except for the presence of intraductal polymorphonuclear inflammation. Therefore, we conclude that microscopic cholangitis is a feature of severe cholestasis which may accompany alcoholic liver injury.
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PMID:Significance of microscopic cholangitis in alcoholic liver disease. 71 Aug 56

Twenty patients with longstanding alcoholism and biopsy-proven alcoholic liver disease presented with marked elevation of serum alkaline phosphatase (in excess of four times the upper limit of normal). None had a past or present history to suggest pancreatitis or biliary tract disease, nor had any of these patients recently taken medication which could be implicated in cholestatic jaundice. Thirteen (65%) of this group either had radiologic or post mortem confirmation of nonobstructed biliary systems. The histologic findings in this group of patients were compared with those of a group of patients with alcoholic liver disease and normal or only mild elevation of serum alkaline phosphatase. Significantly more hepatocellular necrosis (P less than 0.05), alcoholic hyaline (P less than 0.02), and cholestasis (P less than 0.002) were noted in the severely hyperphosphatasemic group. Minimal degrees of steatosis were found in both groups. These data indicate that intrahepatic cholestasis occurs in patients with alcoholic liver disease, and this may often be secondary to alcoholic hepatitis. Overemphasis has previously been given to alcoholic fatty liver as a cause of this syndrome.
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PMID:Alcoholic liver disease presenting with marked elevation of serum alkaline phosphatase. A combined clinical and pathological study. 73 13

An original method of statistical treatment of biological data is proposed. It permits satisfactory biochemical classification of 322 patients divided up into 3 groups : intrahepatic cholestasis (235 patients), extrahepatic obstruction (44 patients) and carcinoma of the liver (43 patients). On the basis of 32 tests, it was possible to define discriminating areas permitting satisfactory diagnosis in 95 per cent of published cases. The reduction in the number of tests necessary for diagnosis was considered. The selection technic used was original to the extent that it dose not require, like most methods used today, the determination of better individual discriminators, but the establishment of a better discriminating subunit, obtained from the initial subunit composed of a group of variables. From the 32 parameters contained in the standard liver function tests, a search for a better discriminating subunit consisting of the best four tests, permitted the authors to select a group of 10 tests : bilirubin, alkaline phosphatase, 5-nucleotidase, Thymolturbidity, Cetavlon test, serum albumin, total LDH, TGP (ALAT), OCT, GLDH, of which the discriminating value remains very satisfactory.
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PMID:[Statistical evaluation of biochemical data by the method of discrimination analysis. Selection of the discriminant biochemical variables. Attempted biochemical discrimination of intrahepatic cholestasis, extrahepatic obstruction and liver cancer]. 77 46

Transient hepatic secretory obstruction manifested primarily by chemical evidence of cholestasis with a conjugated bilirubin above 2.0 mg/100 ml occurred in eight of 19 neonates and infants receiving total parenteral nutrition. The incidence of cholestasis was greater in the premature than full-term infant. Prospective determinations of conjugated bilirubin and 5' nucleotidase are essential to detecting cholestasis before jaundice becomes obvious. These tests are more sensitive than serum alkaline phosphatase which normally rises after birth and during periods of accelerated osteoblastic activity. Preliminary data indicate that the 5' nucleotidase is the most sensitive indicator of secretory obstruction and may become elevated in patients with a normal direct bilirubin. The etiology of hepatic cholestasis during total parenteral nutrition is unknown but is presumed to be caused by interference with hepatocellular enzymes controlling bile secretion; immaturity of these enzyme systems increases the risk of secretory obstruction.
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PMID:Hepatic secretory obstruction with total parenteral nutrition in the infant. 80 74

Reports on correlations between the activity of so-called "marker enzymes of cholestasis" in serum and the ultrastructural changes of the liver are rare. Therefore studies of ultrastructural changes were carried out in 40 patients with intrahepatic cholestasis. In the patients' serum activity of alkaline phosphatase, bile duct alkaline phosphatase, leucine-aminopeptidase (LAP), and 5'-nucleotidase (5'-Nu) as well as the concentration of bilirubin were determined. The results showed a significant correlation between the morphometry of the bile canaliculi and the serum activity of LAP and 5'-Nu. In patients with elevated LAP, an enlargement of the bile canaliculi could be proved. An increased serum activity of 5'-Nu correlated with a higher incidence of bile canaliculi in the ultrastructural picture. The results suggest an investigation of the ultrastructure of bile canaliculi and the determination of marker enzymes of cholestasis in the serum may both contribute to the assessment of cholestatic liver disease.
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PMID:[Ultrastructural-morphometric analysis of liver biopsies in patients with intrahepatic cholestasis. I. Correlations between morphometry of bile canaliculi and so-called "marker enzymes of cholestasis" (author's transl)]. 80 5

Using routine liver function tests, cholestasis of pregnancy was diagnosed in 86 pregnant women with pruritus. Serum aminotransferase levels were elevated in all cases, ASAT in 99%, and ALAT in 100%. In these patients serum concentrations of cholic, chenodeoxycholic, and deoxycholic acid were determined using a gas chromatographic method and were compared with those in a group of 40 uncomplicated pregnancies. Of these bile acids, cholic acid levels were most frequently elevated, ie, in 92% of the patients. The frequency of elevation of serum levels of alkaline phosphatase, and total and conjugated bilirubin was lower. Thus, it appears that in addition to serum aminotransferase levels the serum cholic acid concentration is a sensitive indicator of cholestasis of pregnancy. The cholestasis series was divided into 3 subgroups of increasing severity of cholestasis as assessed by maternal serum cholic acid levels, and the occurrence of signs of fetal distress was compared between these subgroups. The only intrauterine fetal loss in the series belonged to the severe cholestasis group. The incidence of meconium-stained amniotic fluid also increased significantly in this group, and 21 of the 24 cases with other signs of fetal distress were in the groups of moderate and severe cholestasis.
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PMID:Serum bile acids in cholestasis of pregnancy. 89 1

The case of a 23-year-old male patient with benign intrahepatic recurrent cholestasis of Summerskill-Tygstrup and Walshe type is presented. The patient had suffered 9 attacks up to 1974. The clinical and histological data of this patient were compared with those in the 65 cases described previously. The most characteristic signs were that the disease began before puberty and the attacks of jaundice with direct hyper bilirubmemia were induced by infections. Histology obtained in acute phase of the disease revealed intrahepatic cholestasis, and there were signs of a non-specific mesenchymal reaction of the liver tissue while the patients were asymptomatic. The serum activity of alkaline phosphatase was increased, gamma-glutamyltranspeptidase and transaminases being normal or close to normal. The pattern of the biochemical findings was characteristic and the patient was recognized among 19,035 other patients hospitalized from 1972-1975 by means of a special computer program. This program may be helpful in detecting patients with this disease from computerized data of hospitalized patients and avoiding unnecessary surgical intervention.
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PMID:[A case of benign recurring intrahepatic cholestasis (Tygstrup-Summerskill and Walshe syndrome)]. 91 34

Earlier studies have identified two main isoenzymes of alkaline phosphatase in the sera of patients with obstructive liver disease. This paper reports on a study of these isoenzymes in specific types of liver disease where the pathology in relation to bile duct obstruction is known. The results have been used to support the theory that in biliary obstruction the increase in serum alkaline phosphatase is in part due to regurgitation of the biliary isoenzymes.
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PMID:An interpretation of the serum alkaline phosphatase isoenzyme patterns in patients with obstructive liver disease. 100 41


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