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PubMedDate not supplied

Prostaglandin E1 maintains structural integrity of intestinal mucosa and prevents bacterial translocation during experimental obstructive jaundice.

The absence of bile in the gut lumen induces mucosal injury and promotes bacterial translocation (BT). Prostaglandin E (PGE) has a protective effect on the mucosal layer of the alimentary tract. We hypothesize that PGE1 may prevent BT by its beneficial action on the mucosa of the small bowel. Thirty Wistar albino rats were divided equally into 3 groups; Group 1 (control) underwent sham laparotomy, group 2 obstructive jaundice (OJ) and group 3 (OJ + PGE1) underwent common bile duct (CBD) ligation and transection. Groups 1 and 2 received; 1 mL normal saline and group 3 received 40 mg of the PGE1 analogue misoprostol dissolved in 1 mL normal saline administered by orogastric tube once daily. After 7 days, laparotomy and collection of samples for laboratory analyses were performed, including bacteriological analysis of intestine, mesenteric lymph nodes (MLNs), and blood, and histopathologic examination of intestinal mucosa to determine mucosal thickness and structural damage. Serum bilirubin and alkaline phosphatase levels confirmed OJ in all animals with CBD transection. The mucosal damage score was significantly reduced in jaundiced animals receiving PGE1 compared to jaundiced controls (2.15 +/- 0.74 vs 5.3 +/- 0.59; p < .00001) and mucosal thickness was greater (607 +/- 59.1 microm vs. 393 +/- 40.3 microm; p < .00001). The incidence of BT to MLNs decreased from 90% to 30% (p < .02) when jaundiced rats received PGE1. PGE1 treatment reduced the detection rate of viable enteric bacteria in the blood from 60% to 10% (p < .057). We conclude that administration of PGE1 provides protection against OJ-induced atrophy and damage of intestinal mucosa, and thereby prevents translocation of enteric bacteria to underlying tissues.

Alkaline Phosphatase↗
PubMed2002

Increased renal expression of bilirubin glucuronide transporters in a rat model of obstructive jaundice.

Regulation of bilirubin glucuronide transporters during hyperbilirubinemia in hepatic and extrahepatic tissues is not completely clear. In the present study, we evaluated the regulation of the bilirubin glucuronide transporters, multidrug resistance-associated proteins (MRP)2 and 3, in rats with obstructive jaundice. Bile duct ligation (BDL) or sham operation was performed in Wistar rats. Liver and kidneys were removed 1, 3, and 5 days after BDL (n = 4, in each group). Serum and urine were collected to measure bilirubin levels just before animal killing. MRP2 And MRP3 mRNA expressions were determined by real-time RT-PCR. Protein expression of MRP2 and MRP3 was determined by Western blotting. Renal MRP2 function was evaluated by para-aminohippurate (PAH) clearance. The effect of conjugated bilirubin, unconjugated bilirubin, human bile, and sulfate-conjugated bile acid on MRP2 gene expression was also evaluated in renal and hepatocyte cell lines. Serum bilirubin and urinary bilirubin excretion increased significantly after BDL. In the liver, the mRNA expression of MRP2 decreased 59, 86, and 82%, and its protein expression decreased 25, 74, and 93% compared with sham-operated animals after 24, 72, and 120 h of BDL, respectively. In contrast, the liver expression of MRP3 mRNA increased 138, 2,137, and 3,295%, and its protein expression increased 560, 634, and 612% compared with sham-operated animals after 24, 72, and 120 h of BDL, respectively. On the other hand, in the kidneys, the mRNA expression of MRP2 increased 162, 73, and 21%, and its protein expression increased 387, 558, and 472% compared with sham-operated animals after 24, 72, and 120 h of BDL, respectively. PAH clearance was significantly increased after BDL. The mRNA expression of MRP2 increased in renal proximal tubular epithelial cells after treatment with conjugated bilirubin, sulfate-conjugated bile acid or human bile. Upregulation of MRP2 in the kidneys and MRP3 in the liver may be a compensatory mechanism to improve bilirubin clearance during obstructive jaundice.

Aged↗
PubMed2006

[A case of primary duodenal cancer near the papilla of Vater which had initial symptoms of obstructive jaundice].

A 63-year-old man visited our hospital complaining of brown urine. A physical examination showed jaundice of the skin and conjunctiva bulbar. Blood tests showed elevated serum levels of bilirubin and hepatobiliary enzymes. A type 2-like mass lesion was found near the papilla of Vater during the endoscopic retrograde cholangiopancreatography and was histologically proven to be a well-differentiated adenocarcinoma. A diagnosis of obstructive jaundice due to primary duodenal cancer arising near the papilla of Vater was made. After the jaundice was decreased by endoscopic biliary stenting, a pancreatoduodenectomy was performed. A histopathological examination of the resected specimen concerning the location and manner of invasion of cancer cells revealed that the cancer arose from the duodenal mucosa near the papilla of Vater.

Adenocarcinoma↗
PubMed2006

[A case of gastric cancer presenting with obstructive jaundice and responding to biweekly CPT-11 and CDDP combination administration].

A 74-year-old man was suffering from Borrmann type 2 advanced gastric cancer with abdominal lymph node metastases and multiple lung metastases. He started to undergo outpatient treatment with oral administration of TS-1. But pyloric stenosis was found after 6 courses of TS-1 chemotherapy, so he underwent palliative distal gastrectomy. TS-1 chemotherapy was continued afterwards, however obstructive jaundice was found. So combination chemotherapy of CPT-11 60 mg/m(2)and CDDP 30 mg/m(2)biweekly was selected as a second-line therapy after PTCD. As no side effects were found, he could be treated on an outpatient basis by CPT-11 60 mg/body and CDDP 30 mg/body biweekly. Four months has passed since the palliative operation, and the PTCD tube was successfully removed. The abdominal lymph nodes had decreased in size and the patient has maintained good QOL. Thus, combination CPT-11 and CDDP therapy could well be a new candidate for a second-line chemotherapy in outpatients.

Adenocarcinoma, Mucinous↗
PubMed1984

[Gastric mucosal defensive factor in various gastric diseases--with special reference to the influence of the operative insult and obstructive jaundice].

Gastric mucosal defensive factor plays an important role in the pathogenesis of various gastric diseases as well as aggressive factor such as acid. Gastric mucosal defensive factor of various gastric diseases and the relation to acid secretion were studied. The influence of operative insult and obstructive jaundice on gastric aggressive and defensive factors was also studied. Defensive factor was investigated using gastric transmucosal potential difference (PD). The results obtained were as follows: PD showed low value in the gastric diseases with the mucosal lesion such as gastric ulcer, stress ulcer and bleeding gastric ulcer. Particularly the last two diseases, which had active mucosal bleeding, showed remarkably low values. PD tended to increase following acid secretion but had no significance. Operative insult seemed to cause transient increase of intragastric pH and deterioration of gastric defensive factor, and the change was enhanced by obstructive jaundice.

Adult↗
PubMed1986

Obstructive jaundice in the South African black population.

We report the causes of obstructive jaundice in 56 black South African patients. Chronic pancreatitis and malignant biliary obstruction occurred with equal frequency. These two conditions may be difficult to differentiate clinically and radiologically, and only operative pancreatic biopsy may be diagnostic. Choledocholithiasis caused jaundice in only 7.1% of the patients, reflecting the relatively low prevalence of gallstones in this population.

Adult↗
PubMed2002

Internal hernia presenting as obstructive jaundice and acute pancreatitis.

We report the first case of obstructive jaundice and acute pancreatitis caused by herniation of the small bowel through the foramen of Winslow in a 45-year-old man. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed dilated small-bowel loops positioned in the gastrohepatic space, dilatation of the gallbladder and both intrahepatic bile ducts, and mild swelling of the pancreas. A small-bowel series revealed a cluster of small-bowel loops in the mid-upper abdomen, with displacement of the stomach to the left. At laparotomy, there was an internal herniation of jejunal loop through the defect of gastrocolic ligament into the lesser sac and finally passing through the foramen of Winslow. The common bile duct was compressed externally by the herniated bowel and the pancreas was mildly swollen. To the best of our knowledge, these complications of internal hernia have not been reported previously.

Acute Disease↗
PubMed1984

Upper gastrointestinal bleeding. A significant complication after surgery for relief of obstructive jaundice.

A retrospective review of 409 patients with bile duct obstruction (373 undergoing definitive surgery and 36 undergoing laparotomy only) identified 27 patients who developed significant postoperative gastrointestinal bleeding necessitating transfusion. All 27 had undergone a definitive procedure to relieve obstruction. Nineteen patients required blood replacement of six or more units. The majority of patients bled in the first four postoperative days. The sites of hemorrhage were identified in 25 patients, gastric erosions being the most common lesions detected. Thirteen of the 27 patients died, seven due to overwhelming blood loss despite massive transfusion. Eight of the 27 required an operation because of bleeding. An analysis of the relationship between preoperative factors and gastrointestinal bleeding identified three factors that were independently associated with this complication. These were: 1) an initial hematocrit of 30% or less; 2) an initial leukocyte count in excess of 10 X 10(9)/l; and 3) a malignant obstructing lesion. Patients with two or all three of these factors were identified as being at very high risk of developing postoperative gastrointestinal hemorrhage. Bleeding into the upper gastrointestinal tract has been confirmed to be a major problem in the surgical management of patients with obstructive jaundice. Further studies of the etiology and prevention of this complication are indicated.

Analysis of Variance↗
PubMed1970

Endotoxin and acute renal failure associated with obstructive jaundice.

A single dose of endotoxin given to rats with obstructive jaundice produced death with intravascular coagulation. This action was apparently due to delayed clearance of endotoxin from the circulation. The finding is relevant to "hepatorenal failure," which can be caused by bacteraemia after biliary tract operations.

Acute Kidney Injury↗
PubMed1999

Mirizzi syndrome: A rare cause of obstructive jaundice.

Mirizzi syndrome is a rare cause of bile duct obstruction secondary to extrinsic compression of the hepatic duct by stones impacted in the cystic duct or infundibulum of the gallbladder. The suspicion of Mirizzi syndrome primarily relies on radiographic means such as ultrasound, computed tomography and cholangiography. The recognition of this rare syndrome is crucial in developing the proper treatment approach. We present 3 cases of Mirizzi syndrome and a review of the literature pertaining to the diagnosis and treatment of this rare cause of obstructive jaundice.

Adult↗
PubMed1993

Quality of Life in palliative management of malignant obstructive jaundice.

Studies comparing different methods of palliating patients with malignant obstructive jaundice have mainly concentrated on short-term success and complication rates. Seen from the patients perspective, Quality of Life issues may be of equal importance. Instruments are being developed and modified to permit sequential assessment of Quality of Life as an essential part of any studies attempting to evaluate the contribution of different palliative procedures.

Biliary Tract Neoplasms↗
PubMed1999

[Effective chemo-endocrine combination therapy for obstructive-jaundice caused by multiple liver metastasis of recurrent breast cancer--a case report].

A 68-year-old woman complained of obstructive jaundice 9 years after a radical mastectomy. CT scan demonstrated multiple metastasis of the liver and two coin lesions of the right lung. The biliary tract was completely obstructed at the portal fissure. Multiple liver and lung metastasis of breast cancer were diagnosed because of high CA 15/3 serum levels and normal gastrointestinal study. Following unsuccessful treatment with tamoxifen (TAM), we used toremifene (TORE) and 5'-deoxy-5-fluorouridine (5'-DFUR) followed by percutaneous transhepatic cholangiodrainage (PTCD). The biliary tract was reopening and jaundice disappeared with improvement of the general condition. Then endocrine therapy with medroxy progesterone acetate and UFT and chemotherapy with CAF (Cyclophosphamide, Adriamycin, 5-FU) were begun. A partial response (PR) was obtained with the disappearance of liver metastasis and two coin lesions of the lung 5 months after the first treatment. The effect of chemo-endocrine combination therapy continued for 5 months. Survival time from recurrence was 13 months. In our case, PR was obtained by using chemo-endocrine combination therapy, although a poor prognosis has been reported in patients with obstructive jaundice caused by multiple liver metastasis of recurrent breast cancer.

Aged↗
PubMed2006

Pleomorphic rhabdomyosarcoma within a choledochal cyst; a rare cause of obstructive jaundice.

Bile duct cysts are rare and of uncertain origin. Most have been reported in young females of Asian Descent. The long term complication of choledochal cysts includes malignant transformation in the epithelial lining of biliary tree. Histopathologically it is Cholangiocarcinoma in the majority of cases with poor long-term prognosis. However, Rhabdomyosarcoma associated with choledochal cyst in an adult is rarely reported before. The authors report one such case in an adult female patient who presented to us with features of obstructive jaundice.

Bile Duct Neoplasms↗
PubMed2005

Extra-hepatic hepatocellular carcinoma presenting as obstructive jaundice.

Hepatocellular carcinoma is a neoplasm with a uniformly poor prognosis. Risk factors for its development include chronic hepatitis B or C infection, haemochromatosis and alpha-1-antitrypsin deficiency, but individuals with any type of chronic liver disease are predisposed. The incidence is significantly higher in Asia and Africa although it has been noted to be increasing in the United States. We present a patient with notable atypical clinical features for hepatocellular carcinoma. The patient had neither predisposing risk factors nor a primary liver lesion causing obstructive jaundice. After multiple tissue specimens were obtained, the final pathological diagnosis was established. Hepatocellular carcinoma generally requires a surgical cure, but patients who are icteric often portend poorer prognoses. For those at high risk, screening may be indicated to identify early curative treatment.

Adult↗
PubMed2007

[A case of recurrent gastric cancer with obstructive jaundice successfully treated by docetaxel].

Recently, treatment by taxane regimen for advanced gastric cancer as second-line chemotherapy has been increasingly reported. A 58-year-old man underwent distal gastrectomy for advanced gastric cancer on November 25, 2002. There was permeation through the duodenum side, and a Billroth II operation was done for repair. Although a relapse was not clear from the picture image, due to the tumor marker increase since July 2004, chemotherapy using TS-1 100 mg/day was given. On February 2005, liver dysfunction and obstructive jaundice appeared, and the patient was diagnosed with a recurrence in the hilar lymph node of the liver through PET and CT. Because of the Billroth II operation for repair, ERBD was impossible, and we performed PTCD to decrease jaundice. Treatment by docetaxel 60 mg/m(2) every three weeks was given since March 15. After two courses of chemotherapy with docetaxel, the insertion of the guide wire was possible from the part of PTCD. Implantation of the stent became possible after four courses. PTCD could be removed, and the patient QOL has effectively improved. Outpatient treatment became possible for him in January 2006.

Adenocarcinoma↗
PubMed1995

[Comparative assessment of methods of extracorporeal detoxication in obstructive jaundice].

Comparative analysis of the methods of extracorporeal detoxification in 168 patients was conducted. Endoscopic and surgical methods of treatment were applied in 40 patients without extracorporeal detoxification. Various types of extracorporeal detoxification were used along with endoscopic and operative methods in 168 patients: plasmapheresis (PP) in 72, thoracic duct (TD) drainage in 45, and hemosorption in 41 patients. In another 10 patients various types of detoxification were combined. TD drainage is indicated in prolonged obstructive jaundice, particularly when attended with cholangitis. TD drainage or PP is advisable in concomitant renal failure, PP and hemosorption have a good effect in obstructive jaundice as methods of emergency detoxification. Their efficacy increases if they are applied after endoscopic detoxification of the biliary tract.

Adult↗
PubMed1988

Amputation neuroma after cholecystectomy. A cause of intermittent obstructive jaundice.

A 43-year-old woman developed recurrent attacks of intermittent obstructive jaundice 5 years after cholecystectomy. After 6 years of recurrent attacks, an obstructive lesion was finally demonstrated, and was diagnosed at surgery as an amputation (traumatic) neuroma of the midcommon bile duct (CBD). Symptoms disappeared following surgical removal of the lesion. We review the clinical picture of this relatively rare problem, along with its diagnosis, pathogenesis, and treatment.

Adult↗