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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical and epidemiological experience has shown that some subjects, such as diabetics and cirrhotics, are particularly prone to cholelithiasis. The cause of this association was sought, with particular reference to the biliary lipid pattern, since this was considered as a pathogenetic factor in high-risk patients of this kind. It was found that diabetics, like subjects with biliary lithiasis, have a high biliary cholesterol saturation index; this was not the case in cirrhosis. This increase was apparently due both to a fall in bile acids and an increase in bile cholesterol. On the other hand, no significant difference was found between diabetics and controls as far as the pool of bile acids was concerned. No important differences in bile acid pattern were noted. Deoxycolate tended to increase in subjects with cholelithiasis and fall (along with lithocolate) in those with cirrhosis. These findings were, however, devoid of statistical significance. The high incidence of cholelithiasis in diabetics is physiopathologically confirmed by significant "lithogenic" changes in bule lipid composition, whereas the high incidence in cirrhosis is not open to this explanation and probably rests on a different pathogenetic basis. The importance of bile saturation is clear, however, together with its therapeutic and prophylatic implications (chenodeoxycholic acid). The possible influence of unknown factors cannot be ruled out.
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PMID:[Bile composition in patients with high risk of cholelithiasis]. 99 95

The authors studied a total of 16557 necropsy reports for 20 years, at the Chair of Pathologic Anatomy, Medical Faculty, Sofia, as regards the incidence and complications of cholelithiasis. In order to determine the effect of the applied modern antibiotic treatment, the material studied covers the decades 1932-1941 and 1963-1972. Cholelithiasis incidence grew about five times during the second period. A change in the incidence of certain complications is also observed--a) there is a considerable decrease in the number of liver abscesses during the antibiotic period (about three times); b) the number of the developed biliary cirrhosis grew (about three times). With age aspect, the peak incidence has shifted with a decade backwards during the second period, life prolongation being the reason for it.
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PMID:[Frequency and complications of cholelithiasis]. 101 10

Intestinal perfusion methods with a nonabsorbable marker allow an exact quantitative determination of intestinal absorption and secretion provided that methodological pitfalls are avoided. A modified technique is applied to the simultaneous measurement of biliary and pancreatic secretion during and depending on emptying of a mixed test meal. A duodenal segment was perfused with an isotonic polyethyleneglycol solution (PEG). Reinjection of duodenal aspirates maintained a normal enterohepatic circulation of bile acids (interruption less than 10%). The perfusion was performed in healthy volonteers over a period of 12 to 24 hours, with three mixed formula meals containing 51CrCl3 as a marker ingested at conventional feeding hours. Influence of meal size was studied by means of a high caloric (40 Kcal/b. wt. per day) test meal. Patients with cholesterol gallstones and cirrhosis of the liver only received one formula test meal of 300 Kcal. Instead of concentrations output of trypsin, lipase, bile acids and cholesterol (the latter corrected for duodenal absorption) was calculated from the dilution of PEG in the duodenal juice and gastric emptying was determined by following quantitatively the flow of 51CrCl3. Gastric emptying can be expressed by a single exponential function over most of the time. Only the last 60-100 Kcals were expelled by the stomach at a faster rate. The daily biliary and pancreatic secretion depend indirectly on the amount of food ingested. But during the day light hours (with continuous meal flow), secretion was similar in high and low caloric subjects, while a significant difference became obvious during night hours corresponding to differences in gastric emptying time. Mean hourly output of bile acid, biliary cholesterol, trypsin and lipase is independent from meal size and secretion of pancreatic enzymes reaches the values close to those after maximal stimulation by i.v. CCK-PZ. Output of pancreatic enzymes does not differ in health and gallstone disease or cirrhosis of the liver respectively. Since during digestion in normals approximately one forth of the bile acid pool is secreted hourly into the gut, the number of daily enterohepatic cycles of bile acids can be calculated by 4-6. Patients with cholesterol gallstones maintain normal bile acid output by enhanced cycling of the small pool: An average of 50% of the pool passed the duodenum per hour. A decreased bile acid pool is also present in cases of advanced cirrhosis of the liver. However, hourly output of bile acids in these patients is significantly less than in mild cirrhosis (with normal bile acid pool) or normal controls. Therefore the hourly fraction of the pool secreted is similar to healthy subjects. These findings provide an important information to explain abnormalities in bile acid metabolism in cirrhosis.
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PMID:[Simultaneous determination of gastric emptying and bile and pancreatic enzyme secretion]. 106 80

The use of animal models in the experimental production of liver diseases similar to those of man is still in its infancy. There is a need to discover new models more closely related to counterpart syndromes in man in the fields of hepatorenal syndrome, neonatal jaundice, Wilson's disease, cholelithiasis, viral hepatitis, biliary atresia, and cirrhosis, to mention only a few. With the continued indiscriminate inbreeding of companion animals as well as the planned inbreeding of laboratory animals, there is little doubt that many more will soon be available. The current availability of mutant rats and sheep with bilirubin transport defects has allowed for a better understanding of how organic anions are transported by the liver. Many other currently available experimental animal models herein briefly reviewed have been only superficially studied. It is the intent of this chapter to provide for post-doctoral students an appreciation for the many animal model systems available for experimental hepatic research.
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PMID:Experimental liver diseases. 110 63

The prevalence of gallstones in Athens in 1973 was studied in an autopsy survey that covered 1,448 subjects of all ages and both sexes. Gallstones were found in 5.2% of all subjects and in 6.2% of subjects older than 40 years. The prevalence was higher in females and considerably higher in persons who died from cirrhosis of the liver or from ischaemic heart disease.
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PMID:Postmortem study of the prevalence of gallstones in Athens. 120 16

The significant increase in the number of people older than seventy forces the physician to be acquainted with both psychological and physical alterations induced by aging and to devote an ever increasing proportion of time for recognition and treatment os such alterations. In the medical sense, the biological and physiological age is more important than the chronological age. With increasing age there is--especially concerning the digestive tract and its accessory organs--a rise in the incidence of organic affections and a decline in the frequency of functional disorders. Besides it is wise to know, that the increasing age there is often a coexistence of multiple degenerative disorders and disease states, involving many body systems and organs. On the background of this recognition it is also important to know, that prognosis too varies with age because of the coexistence of individually prognosticated disease states and moreover to realize, that elderly patients do not tolerate invasive and prolonged surgical procedures. Structural or functional disturbances of the digestive organs by aging processes do not cause death per se, but can become one important factor; degenerative sclerotic vascular alterations bear relationship to the poorly contractile vasculature that brings up difficulties in the control of hemorrhagic gastroduodenal ulcers. Many gastrointestinal disorders in elderly patients occur with an equal frequency in younger patients, some are more common in the geriatric population; these include hiatal hernia, carcinoma of esophagus, stomach, pancreas, bile ducts and colon, intestinal obstruction (ileus) by neoplastic growth, gallstone ileus, external hernia and operative adhesions and especially diverticular diseases of the colon and its complications and ischemic colitis by mesenteric vascular occlusion. Cirrhosis of the liver is often diagnosed for the first time in the older age groups while acute viral hepatitis uses to run a cholestatic course and is therefore often misdiagnosed as mechanical obstruction. In general history is difficult to obtain, the response of the organism with temperature and white blood count to stress is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often delayed and rigidity associated with an underlying inflammatory disease involving the peritoneum is often atypical. Because of this limited reaction to severe stress, early surgical intervention is imperative in the elderly patients.
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PMID:[Problems of the so-called geriatric gastrointestinal diseases]. 120 46

Endoscopic retrograde cholangiograms from 23 patients with primary biliary cirrhosis (PBC), 10 controls with either normal livers or hepatocellular disease, and 4 patients with sclerosing cholangitis, were compared. Of the PBC group, 39% had gallstones. The calibers of the common bile duct and left and right intrahepatic ducts were comparable in the PBC and control groups. The small intrahepatic ducts, while normal in the control group were abnormal in 7 of the 23 PBC patients. These small ducts were irregular in caliber and had a tortuous course. The changes were not related to the presence of gallstones or the duration of the disease, but all the patients had histologically proven cirrhosis. Two patients with cirrhosis had normal intrahepatic ducts. We conclude that whereas the major bile ducts are normal in PBC, there is a high incidence of gallstones (39%), and the changes that do occur in the intrahepatic ducts are probably related to the distorted hepatic architecture due to cirrhosis and may be used as a sign that cirrhosis has supervened.
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PMID:The biliary system in primary biliary cirrhosis. A study by endoscopic retrograde cholangiopancreatography. 124 84

Erythropoietic protoporphyria is an unusual autosomal dominant syndrome characterized by increased deposits of protoporphyrin in erythrocytes, liver, feces, and skin. Symptomatic chronic cutaneous papules in sun-exposed areas, cholelithiasis, cirrhosis, hepatic failure, and anemia are manifestations of this systemic disorder. Treatment of cutaneous symptoms is with oral beta-carotene, but there is no effective control for internal manifestations.
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PMID:Photosensitivity papules--a cutaneous sign of systemic disease: erythropoietic protoporphyria. 126 9

The biliary tree of 66 patients with cystic fibrosis was examined by conventional roentgenographic methods. Forty-five per cent of the oral cholecystograms were judged abnormal by our criteria. A study was considered abnormal if there was no visualization or if there was visualization of a microgallbladder or structural abnormality including marginal irregularities, septate gallbladder or cholelithiasis. Intravenous cholangiography was used to further study the 22 patients who did not visualize on the oral study. Again, anatomic abnormalities were prevalent but six patients in this group had normal appearing gallbladders. Abdominal pain, a frequent symptom in cystic fibrosis, was not associated with roentgenographic abnormality. No correlation was seen between the external biliary tree abnormalities and multifocal biliary cirrhosis which was present in 40% of these patients. Further, no correlation was seen between serum gamma glutamyl transpeptidase levels and either of these lesions.
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PMID:Clinical observations on the biliary system in cystic fibrosis. 127 40

The National Institutes of Health Consensus Development Conference on Gallstones and Laparoscopic Cholecystectomy brought together surgeons, endoscopists, hepatologists, gastroenterologists, internists, radiologists, and epidemiologists as well as other health care professionals and the public to address (1) the indications for treatment of patients with gallstones; (2) the role of laparoscopic cholecystectomy in treating patients with gallstones; (3) the role of alternative medical and surgical treatments for gallstones; (4) the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments; (5) techniques for detecting and treating bile duct stones with or without laparoscopic cholecystectomy; and (6) future directions for research in prevention and management of gallstone disease and in laparoscopic cholecystectomy. Following 2 days of presentations by experts and extensive discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) most patients who experience symptoms of gallstones should be treated; (2) in comparison with open cholecystectomy, laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients; (3) patients who are not good candidates for laparoscopic cholecystectomy include those with generalized peritonitis, septic shock from cholangitis, severe acute pancreatitis, endstage cirrhosis, and gallbladder cancer; (4) laparoscopic cholecystectomy decreases pain and disability without increasing mortality and morbidity and can be performed at an equal or lower cost than open cholecystectomy; and (5) every effort should be made to ensure that surgeons performing laparoscopic cholecystectomy are properly trained and credentialed. The full text of the consensus panel's statement follows.
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PMID:Gallstones and laparoscopic cholecystectomy. 130 Dec 17


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