Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The diagnostic value of serum gamma-glutamyl transferase (GGT) activity and serum alkaline phosphatase (ALP) activity in the detection of liver disease in the cat (n = 69) was compared. On the basis of histologic examination of the liver, cats were assigned to 8 groups: group 1--complete extrahepatic bile duct obstruction (n = 5), group 2--cholangiohepatitis-cholangitis syndrome (n = 11), group 3--hepatic lipidosis (n = 15), group 4--neoplasia, including lymphosarcoma and myeloproliferative disease (n = 9), group 5--hepatic necrosis (n = 7), group 6--cirrhosis (n = 3), group 7--portosystemic vascular anomaly (n = 4), and group 8--miscellaneous (n = 15). Cats assigned to group 8 lacked substantial histologic abnormalities of the liver. The mean value +/- SD of GGT in 20 clinically normal cats was 0.44 +/- 0.26 IU/L. The highest GGT activity in clinical patients developed in groups 1, 2, and 6. The highest ALP activity developed in groups 1 to 4. Significant correlations between GGT and ALP activities were detected only in groups 2 (P less than 0.001) and 5 (P less than 0.10). Among 54 cats with hepatic disease, only 11% had both the GGT and ALP activities within the normal ranges. Comparatively, 52% had ALP activities within the normal range, and 17% had GGT activities within the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnostic value of serum gamma-glutamyl transferase and alkaline phosphatase activities in hepatobiliary disease in the cat. 287 43

The purpose of this study was to determine the incidence of death as the initial manifestation of cholelithiasis. Records of patients who died or underwent cholecystectomy for gallstone-related disease at Duke University Medical Center between 1976 and 1985 were reviewed. Thirty patients died, six of whom (20%) had previous episodes of biliary pain and stone documentation. Twenty-four (80%) were asymptomatic (three with previous incidental diagnosis of cholelithiasis). Reason for admission included acute cholecystitis (nine), pancreatitis (eight), biliary pain (six), cholangitis (four), jaundice (one), and endocarditis (one). Three patients died of gallstone complications without surgical intervention; one patient had renal failure and two had septicemia. Other causes of death were: sepsis (seven patients), cardiac failure (six), pulmonary complications (four), renal failure (three), cerebrovascular accident (three), liver failure (two), pancreatitis (one), and gastrointestinal bleeding (one). During this period, 1731 cholecystectomies were performed without mortality. In this group, the patients were younger (50 +/- 8 years vs. 64 +/- 13 years, p less than 0.001), and had a lower incidence of cirrhosis (p less than 0.001) and diabetes (p less than 0.002). The sex ratio was inverted (p less than 0.001). This study demonstrates that death from gallstones is uncommon (three cases per year), as is death from their initial clinical manifestation (1.2%). The risk of death is two- and ninefold higher in patients with acute cholecystitis or acute pancreatitis. Age, cirrhosis, and diabetes are important determinants of outcome.
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PMID:Deaths from gallstones. Incidence and associated clinical factors. 291 58

In contrast to deficiencies of vitamins A, D and K, little is known of the prevalence, clinical manifestations and mechanisms of vitamin E deficiency in adult patients with cholestasis. We measured serum vitamin E levels in 45 patients with primary biliary cirrhosis, 20 with primary sclerosing cholangitis, 9 with cryptogenic cirrhosis and 12 with alcoholic cirrhosis. To correct for the hyperlipidemia often found in patients with primary biliary cirrhosis and primary sclerosing cholangitis, total serum lipids were measured and vitamin E levels were expressed as the vitamin E/total serum lipid ratio. Serum vitamin A and D levels and prothrombin time were also determined. Six of 45 patients with primary biliary cirrhosis (13%) but none of the patients with sclerosing cholangitis, cryptogenic cirrhosis or alcoholic cirrhosis and subnormal vitamin E/total serum lipids ratios. Vitamin E deficiency was found in two of eight patients with asymptomatic primary biliary cirrhosis. There was no correlation between standard liver biochemical tests, fasting serum cholylglycine and vitamin E levels. Patients with primary biliary cirrhosis and primary sclerosing cholangitis had significantly lower vitamin E/total serum lipids ratios than patients with either cryptogenic or alcoholic cirrhosis. Twenty-three percent of patients with primary biliary cirrhosis were vitamin D deficient and 14% had low vitamin A levels. Two of the six patients with vitamin E deficiency were also deficient in vitamin D, only one was vitamin A deficient and none had prolonged prothrombin time. We also investigated the gastrointestinal absorption of vitamin E in nine patients with primary biliary cirrhosis and normal vitamin E levels as well as in six normal controls.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Vitamin E deficiency in primary biliary cirrhosis: gastrointestinal malabsorption, frequency and relationship to other lipid-soluble vitamins. 292 55

We carried out a retrospective investigation of the 89 patients with extrahepatic biliary atresia born in The Netherlands during a 10 year period. Of these 89 patients 10 had a diagnostic laparotomy only. Eight patients had an anastomosis between the proximal bile duct and the intestine, and the remaining 71 had hepatic portoenterostomies. Bile drainage was re-established in 46 (65%). After successful hepatic portoenterostomy the development of cholangitis was the most important determinant of long term survival; five year survival was 54% in the 19 patients who had cholangitis and 91% in the 27 who did not. In the whole group of 71 patients the five year survival was 47%. Seventeen patients were at least 5 years of age at the time of writing, three of whom had had liver transplantation. Three patients have cirrhosis and hyperbilirubinaemia, and the other 11 have normal bilirubin concentrations and normal or slightly raised transaminase activities. To improve these results early surgical intervention in all children with extrahepatic biliary atresia is necessary, as are better methods of prophylaxis and treatment of cholangitis.
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PMID:Prognosis of extrahepatic biliary atresia. 293 Feb 27

In order to identify risk factors in patients with acute cholangitis, 140 clinical, biochemical, etiologic, and pathologic variables of 449 attacks of acute cholangitis seen in one center over a 20-year period were analyzed. Simple regression revealed 24 factors with prognostic significance, but multivariate analysis detected only seven factors with independent significance in predicting mortality (acute renal failure, cholangitis associated with liver abscesses or liver cirrhosis, cholangitis secondary to high malignant biliary strictures or after percutaneous transhepatic cholangiography, female gender, and age). When the presence of each of these factors is weighted proportional to its coefficient of regression, patients with cholangitis could be scored on a scale of 0-27. A score of seven was clinically the most useful cut off--388 attacks of cholangitis associated with a score of less than 7 had a mortality rate of only 1.8%, whereas 61 attacks associated with a score greater than or equal to 7 had a mortality rate of 49%. The value of this scoring system needs to be confirmed in prospective studies, but it may prove useful, for example, in selecting a group of high-risk patients for urgent biliary decompression in an attempt to reduce the mortality associated with this pathology.
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PMID:Acute cholangitis. Multivariate analysis of risk factors. 293 Feb 89

Liver disease, although usually asymptomatic, is a frequent accompaniment of AIDS. Hepatomegaly and macrosteatosis are prevalent but non-specific findings. Evidence of remote hepatitis B virus infection is extremely common; however, the HBsAg carrier state, chronic active hepatitis, or cirrhosis occur no more frequently in AIDS patients than in the general population. Opportunistic intrahepatic infections (such as MAI, fungi, and CMV) or neoplasms (such as lymphoma or KS) usually reflect a disseminated process; liver involvement generally does not directly cause morbidity or result in death. Although biochemical liver tests are commonly elevated in the AIDS population, alkaline phosphatase has proved to be the most specific enzyme for infiltrative processes. Percutaneous liver biopsy has a high diagnostic yield, although the treatment options are currently limited. Acalculous cholecystitis and biliary tract obstruction have been recently described and probably result from CMV and/or cryptosporidial infection. Radiologic features of papillary stenosis and/or sclerosing cholangitis have been demonstrated. In contrast to hepatic parenchymal disease, these entities may be amenable to surgical or endoscopic therapeutic maneuvers.
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PMID:Hepatobiliary abnormalities of AIDS. 304 66

To compare the contribution of clinical, laboratory and imaging data for the diagnostic accuracy in establishing the cause of obstructive jaundice, the records of 333 patients operated on for a presumed obstruction of the biliary ducts were analysed. The final diagnoses, after surgery, were divided into six groups: stones of the gallbladder and biliary tract, pancreatic cancer, biliary tract neoplasms, ampullary carcinoma, postoperative stenosis of the bile ducts, intrahepatic cholestasis (biliary cirrhosis, chronic cholangitis) and other causes of jaundice (liver tumours, cysts, extended cancer of the upper abdomen). Twenty-three parameters (9 clinical symptoms and signs, 10 biochemical alterations and 4 imaging methods) were examined. Not every case had all the investigations performed but the number of each group of data was large enough to allow a statistically significant conclusion. The contribution of each of the 23 parameters in increasing the probability of correct diagnosis was determined using a computer program based on Bayes' theorem. This analysis showed that for patients which presented suggestive clinical signs and symptoms for stones of the gallbladder and biliary tract and for pancreatic cancer, the diagnosis can be predicted with a probability of 90% only on the basis of clinical findings. The probability of a correct preoperative diagnosis was increased to 99% by imaging methods. On the contrary, for patients with a less clear diagnostic probability (with ampullary carcinoma, intrahepatic cholestasis and other causes) only ultrasonography and computed tomography could increase the probability of correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The causal diagnosis of obstructive jaundice. A Bayesian approach. 305 42

Eleven patients with cicatricial stenosis in the junction area of hepatic ducts were evaluated. In all patients the injury occurred during cholescystectomy and no operative cholangiography was performed. In 3 patients the injury was recognized during the initial cholecistectomy. Ten patients had been operated on at least one time to correct the injury in other Services. Four cases had duct or peritoneal drainage. There was an attempt of reanastomosis in two cases. Five patients had a bilio-digestive anastomosis performed in variable occasions. Two patients were reoperated 5 times, one patient 3 times. The others were submitted to one or 2 reoperations. There were a period of 1 to 72 months between the injury and last reoperation. Jaundice was the most common presenting manifestation since it appeared in all patient except one. Five patients had biliary cirrhosis. Roux-en-Y hepaticojejunostomy was carried out in all cases after enlarging the biliar stoma by longitudinal section on the left hepatic duct and performing a termino-terminal anastomosis. The 10 or 12 caliber Kehr drain used was taken out after the control cholangiography, carried around the second postoperative week. Concerning the long term results, one patient died of recurrent cholangitis six months after the 6th reoperation and one patient 14 months after the 4th reoperation of liver failure. Both had biliary cirrhosis. Two patients, remained assymptomatic for 60 months and 3 patients for 24, 37 and 56 months. The importance of preventing this severe complication is stressed by the authors. Patients with such lesions need be referred to specialized centers where well trained surgeons are available. The technique herein presented seems us to be a good option.
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PMID:[Treatment of cicatricial stenosis of the proximal common hepatic duct. Study of 11 cases]. 325 80

Cirrhosis of the liver was diagnosed in an 18-year-old man with histiocytosis X. Electron microscopy and immunohistochemistry revealed infiltration of the liver by the typical cellular elements of histiocytosis X. Endoscopic retrograde cholangiography showed alterations resembling those of sclerosing cholangitis. Sixteen months later, the patient died of recurrent variceal bleeding and cholangiosepsis. Autopsy confirmed that cirrhosis was the main manifestations of the underlying disease. Thus, cirrhosis of liver can be a main and potentially fatal manifestation of histiocytosis X beyond the pediatric age range. Histiocytosis X may lead to parenchymal infiltration of the liver and to changes of the major bile ducts resembling sclerosing cholangitis. The diagnosis of hepatic histiocytosis X can easily be missed without relying on appropriate electron microscopic and immunohistochemical investigations.
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PMID:Liver cirrhosis in histiocytosis X. 326 77

This report reviews the results of some paediatric surgical departments and points out the unsolved problems in biliary atresia disease. The authors conclude that a 5-year survival rate of 60% may be achieved in long-term follow-up, but a complete cure is observed only in 30%. Children who develop a cirrhosis and portal hypertension without or in spite of bile flow can benefit only by liver transplantation. As a result of long-term clinical experience conditions are defined that should be taken in consideration in the surgical treatment of bile duct atresia. In respect of liver transplantation the disadvantages of an external bile draining fistula to prevent cholangitis, an extensive mobilisation of the liver for HPE procedure, and the disadvantages of reoperation are discussed. By avoiding these disadvantages liver transplantation procedure will be facilitated and a 1-2 year survival rate of 80% may be achieved.
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PMID:Liver transplantation for biliary atresia: indications and results. 329 71


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