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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Percutaneous transhepatic catheterization of the biliary tree was performed in 41 patients with obstructive jaundice. In 39 patients, the catheter was successfully advanced past the obstructing lesion into the distal common duct and duodenum to establish internal biliary drainage. The remaining two patients had the obstructed biliary tract drained externally. Chronic internal catheter drainage was instituted in five patients with stricture and ten with malignant obstruction as a means of palliating symptomatic jaundice. Twenty-two patients had marked reduction in serum bilirubin levels and pruritus, eight patients had moderate decreases in serum bilirubin levels, and six patients did not improve despite adequate catheterization due to hepatic parenchymal disease. This procedure effectively decompresses the severely obstructed biliary tree prior to surgery and can also palliate patients with unresectable malignant biliary obstruction and stent high-risk, benign strictures.
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PMID:Percutaneous decompression of benign and malignant biliary obstruction. 21 26

Pruritus in hepatobiliary disease is commonly believed to be caused by retention of bile acids with their sequestration in the skin. HOwever, we have recently demonstrated that skin levels of bile acids in patients with cholestasis correlate poorly with pruritus. In this report, we present additional data concerning the relationship of pruritus to bile acid retention: (1) the urinary excretion of sulfated and nonsulfated bile acids was not significantly different in patients with cholestasis who itched compared to those who did not; (2) one patient with itch associated with a liver abscess had normal levels of bile acids in serum, skin, and urine; (3) patients with primary biliary cirrhosis who itched had lower serum bile acid levels than patients with mechanical biliary obstruction who did not itch.These studies support our premise that pruritus in hepatobiliary diseases is not directly related to bile acid retention. They suggest that the type of cholestatic disorder, and not simply the magnitude of the cholestasis, as estimated by the elevation of serum bile acids, is important. We propose that the agent responsible for pruritus is produced in response to cholestasis, possibly through activation of the alternate pathway of bile acid synthesis. Properties of the hypothetical pruritogen are discussed.
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PMID:Itch in liver disease: facts and speculations. 45 25

Phenobarbital was administered to a patient with extrahepatic biliary obstruction who was initially thought to have cholestatic hepatitis. On two occasions, administration of the drug was associated with a decrease of jaundice, pruritus, and serum bile acid levels. This strongly suggests that phenobarbital may be effective not only in intrahepatic cholestasis, as reported earlier, but also in extrahepatic obstruction, and therefore cannot be used for the differention of these two types of cholestasis.
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PMID:Effect of phenobarbital in a case of extrahepatic cholestasis. 111 59

Pruritus is an important sign of localized or systemic disease and sometimes may be the only symptom of potentially fatal illness. Localized causes of pruritus include stasis dermatitis, atopic dermatitis, contact dermatitis, neurodermatitis and scabies. Generalized pruritus may be caused by environmental factors such as low humidity, skin diseases such as urticaria, or internal diseases such as biliary obstruction, renal failure, hematologic malignancy or acquired immunodeficiency syndrome. Therapy for pruritus depends on identification and treatment of the underlying cause. If no specific etiology is found, therapy is palliative. Avoidance of frequent bathing may be helpful, especially when xerosis plays a role. Topical emollients or short-term therapy with low-potency steroids may also be effective. Oral antihistamines provide nonspecific relief for many patients with intractable pruritus.
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PMID:Pruritus. 159 16

Fifty-three patients with biliary obstruction caused by unresectable malignancy were treated by attempted insertion of an endoprosthesis by the percutaneous-endoscopic route. This was successful in 50 patients. A single endoprosthesis was inserted in each case. Both right and left hepatic duct decompression were obtained in 31 patients, but only unilateral or segmental drainage was achieved in 19 patients. Procedure-related complications occurred in 18 (36%) patients, and 15 (30%) patients died within 30 days of the procedure. Satisfactory resolution of jaundice was obtained in 26 (84%) patients with bilateral decompression and in 12 (63%) of those with unilateral drainage. The 30-day mortality rate was 26% for patients with bilateral and 37% for those with unilateral drainage. The morbidity rate from cholangitis after endoprosthesis insertion was 10% after bilateral and 32% after unilateral drainage. None of these differences was statistically significant. Surviving patients with satisfactory bile drainage were relieved of symptoms such as pruritus. The combined percutaneous-endoscopic technique enables difficult biliary strictures to be intubated. Although bilateral duct drainage is preferable, the palliation is often worthwhile even when segmental ducts alone are drained.
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PMID:Percutaneous-endoscopic placement of endoprostheses for relief of jaundice caused by inoperable bile duct strictures. 168 81

This report compares the efficacy of cholecystoenterostomy and choledochoenterostomy for relief of biliary obstruction due to pancreatic cancer. From 1976 to 1988, 109 biliary enteric bypass procedures were performed on patients with pancreatic carcinoma considered unresectable at exploration. Sixty-four of these patients underwent cholecystoenteric anastomosis (CCEA) and 45 choledochoenteric anastomosis (CDEA). Thirty-day operative mortality was 6.3 per cent for CCEA and 8.8 per cent for CDEA; the mean length of survival after operation was 7.8 months for CCEA and 8.9 months for CDEA. Of the 64 patients who underwent CCEA, all but two experienced short-term (greater than 60 days) relief of jaundice and pruritus. These patients were found to have an obstructed cystic duct and a cholecystectomy and choledochojejunostomy were performed. Five other patients in the CCEA group had recurrence of jaundice for an overall failure rate of 10.9 per cent. Operative morbidity in this group was 14 per cent. One of the patients in the CDEA group had an early recurrence of jaundice and three others experienced late recurrence, for an overall failure rate of 8.8 per cent. Operative morbidity in this group was 16 per cent. We conclude that these procedures have comparable morbidity and mortality. Although a few patients with cholecystoenteric anastomosis will develop recurrent jaundice, the simplicity of the procedure, the shorter operative time, and the equivalent relief of symptoms make it a useful procedure and one we believe preferable in high-risk patients.
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PMID:A comparison of cholecysto- and choledochoenterostomy for obstructing pancreatic cancer. 236 87

Debate concerning the superiority of cholecystoenteric bypass (CCEB) vs. choledochoenteric bypass (CDEB) in patients with pancreatic cancer and biliary obstruction prompted this review. Thirty-six patients with biliary duct obstruction due to pancreatic cancer underwent 37 operations for biliary decompression between 1976 and 1986: 22 CCEB, 15 CDEB. Age, sex, race, preoperative health, and preoperative symptoms and signs were similar for both groups. Seven CDEB patients had previous cholecystectomy (n = 5) and failed CCEB (n = 2). Twenty CCEB patients and 13 CDEB patients had elevated preoperative total bilirubin with an average abnormal bilirubin of 15.3 mg per cent and 12.0 mg per cent, respectively. Perioperative significant morbidity/mortality was seen in 59.1 per cent and 22.7 per cent, respectively, in CCEB and 53.3 per cent and 6.7 per cent in CDEB. Twenty (90.9%) CCEB patients and 15 (100%) CDEB eventually succumbed to either their operation or pancreatic cancer: average survival was 7.5 months (range, 2-41 months) and 10.4 months (range, 2-30 months), respectively. Two CCEB patients were alive at 15 and 41 months. Eleven out of 22 CCEB patients (50%) experienced short term (within 2 months of surgery) absence of jaundice, icterus, pruritus, and biliary tract disease symptoms or signs, and six out of 12 experienced long term (more than 3 months after surgery) absence of these problems; with CDEB, 14 patients out of 15 (93%) experienced short term and 10 out of 12 patients (83%) experienced long term absence of these problems. Cholecystoenteric bypass is a significantly morbid procedure and yet does not reliably palliate biliary obstruction due to pancreatic cancer; it is not preferred.
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PMID:A comparison of choledochoenteric bypass and cholecystoenteric bypass in patients with biliary obstruction due to pancreatic cancer. 246 97

The occurrence of hepatobiliary disease with or without jaundice during pregnancy provides both the hepatologist and obstetrician with an interesting and urgent diagnostic challenge. Advances in our understanding and management of liver disorders unique to pregnancy and hepatobiliary disease in general have resulted in a significant improvement in the outcome for both mother and fetus. Certain disorders such as acute fatty liver of pregnancy and hepatic haemorrhage associated with toxaemia should be considered medical emergencies and delay in diagnosis of these conditions will probably adversely affect maternal and fetal outcome. A careful clinical history, physical examination, appropriate laboratory tests and radiological investigations should allow a diagnosis within 24-48 hours of presentation. Liver biopsy is rarely required. A careful history may provide important information. Does the patient have pre-existent liver disease? Has there been contact with hepatitis, intravenous drug abuse or any other factor predisposing to acute viral hepatitis? Does the patient have a family history of pruritus and/or jaundice to suggest intrahepatic cholestasis of pregnancy? Is the patient's alcohol consumption excessive? Has the patient received any hepatotoxic medications? Has there been abdominal pain and/or fever to suggest gallstones, hepatic bleeding or acute fatty liver of pregnancy? Laboratory investigations may give valuable diagnostic clues. Marked aminotransferase elevation would suggest acute viral or 'ischaemic' hepatitis. Haematological features of microangiopathic haemolysis would point towards toxaemia or AFLP. Hepatitis A and B serological tests may be helpful in viral liver disease. Radiological investigations may be indicated depending on the clinical context. Abdominal ultrasonography may be useful in the diagnosis of gallstones, biliary obstruction, liver tumours or intrahepatic bleeding. Fatty infiltration of the liver may be diagnosed by ultrasonography but computed tomography (CT) of the abdomen is probably more reliable for a diagnosis of acute fatty liver of pregnancy as it allows measurement of liver density which is typically reduced by fatty infiltration. CT scanning is also probably more valuable than ultrasound in assessing the extent of capsular rupture and haemorrhage into the liver and peritoneal cavity.
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PMID:Jaundice in pregnancy. 265 65

Eleven patients with benign strictures (after choledochojejunostomy, n = 10; chronic pancreatitis, n = 1) and 16 with malignant biliary strictures (cancer of the pancreas, n = 7; cholangiocarcinoma, n = 5) were treated with a self-expanding metallic biliary stent. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilation. All patients had immediate relief of jaundice and cholangitis. In a follow-up period of 6-21 months, nine of the 11 patients with benign disease had no difficulties with infection, pruritus, or recurrent jaundice. In patients with malignant strictures, the stent produced relief of biliary obstruction unless recurrent tumor invaded the bile ducts. With careful patient selection, this stent appears to be useful in the management of biliary obstruction, particularly in benign disease.
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PMID:Gianturco expandable metallic biliary stents: results of a European clinical trial. 266 61

Primary bile duct carcinoma is a malignancy with a poor prognosis, but recent diagnostic developments allow earlier detection and possibly improved chances for effective palliation or surgical cure. In order to increase the clinical understanding and awareness of this disorder, 43 patients with primary adenocarcinoma of the bile ducts were reviewed. The mean patient age was 63, and symptoms of nausea, abdominal pain, and pruritus were reported in a majority of patients. Documented weight loss, alcoholic stools, cutaneous icterus, and hepatomegaly were each present in a majority of patients. Serum bilirubin and alkaline phosphatase determinations were abnormal in 40 of 43 patients (93%), and cholangiography was the diagnostic study providing the most discriminating information. Locally invasive disease and biliary obstruction was the major cause of morbidity and mortality, and there was only one surgical cure. These data suggest that cholangiography and nonsurgical techniques for biliary drainage should be employed in most patients who are not optimal surgical candidates.
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PMID:Primary adenocarcinoma of the bile ducts. Clinical characteristics and natural history. 352 44


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