Value of laparoscopy in hepatobiliary disease.
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A prospective study was made of the value of laparoscopy in hepatobiliary disease. The pathology was accurately diagnosed by laparoscopy alone in 21 out of 33 consecutive cases of cholestatic jaundice (36% failure rate). Laparoscopy gave a slightly better diagnostic yield for secondary tumour deposits than hepatic scintiscanning, and the simultaneous use of both procedures reduced the false negative rate to 2/18 (11%). Laparoscopic liver biopsy was superior to blind percutaneous biopsy in the retrieval of secondary malignant tissue, but it had no obvious advantage over the latter when performed on patients with diffuse disease (cirrhosis) or primary hepatic tumours. (+info)
False-positive acetaminophen results in a hyperbilirubinemic patient.
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BACKGROUND: Acetaminophen was falsely detected in the plasma of a severely jaundiced patient, and a methodologic interference from bilirubin was suspected. METHODS: Acetaminophen was measured by an enzymatic method (GDS Diagnostics). The putative bilirubin interference was investigated in 12 hyperbilirubinemic specimens and in bilirubin linearity calibrators. The analytical method was modified to correct for background absorbance at a second wavelength. Hyperbilirubinemic specimens were fortified with acetaminophen to assess the effect of the interference on acetaminophen measurements. RESULTS: Acetaminophen was detected in 12 specimens from hyperbilirubinemic patients without a history of recent acetaminophen exposure. Dilution of hyperbilirubinemic specimens produced a nonproportional decrease in apparent acetaminophen concentrations, and no acetaminophen was detected when bilirubin was <50 mg/L. Background correction at a second wavelength failed to compensate for the interference. Although erroneous acetaminophen concentrations were detected in all specimens with high bilirubin, acetaminophen measurements in fortified specimens were accurate. CONCLUSION: The data are consistent with bilirubin interference in the enzymatic and/or chromogenic reactions involved in the acetaminophen method. (+info)
Carcinoma of the ampulla of Vater: Review of 38 cases with emphasis on treatment and prognostic factors.
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Thirty-eight cases of carcinoma of the ampulla of Vater are presented. The diagnosis has been confirmed at laparatomy in all patients. Three operations were done, a pancreaticoduodenal resection in 23 patients, a biliary-enteric bypass in 7 patients and a biliary-enteric bypass plus excision of tumor in 8 patients. The operative mortality was 8% following resection, 14% following bypass plus excision of the ampulla and 13% following biliary-enteric bypass. Five patients survived 5 or more years. The longest survivors have followed pancreaticoduodenal resections (131 and 216 months). The level of bilirubin or presence of pain did not correlate with prognosis. Prognosis was better in the absence of nodal metastases, and in the presence of papillary tumors. (+info)
Transient relief of asthma symptoms during jaundice: a possible beneficial role of bilirubin.
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Bilirubin arises from enzymatic reduction by biliverdin reductase of biliverdin, a product of heme oxygenase activity. Recent literature describes that bilirubin is a major physiologic antioxidant that can protect cells from chemical oxidants such as hydrogen peroxide. Recently, it has been reported that oxidative stress may play a crucial role in the pathogenesis of asthma. We report a case of complete resolution of persistent difficult-to-control asthma in accordance with increased levels of serum bilirubin due to acute hepatitis B. The present case suggests that anti-oxidative agents might be effective for the treatment of asthma. (+info)
Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation.
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BACKGROUND: Little is known about the spontaneous passage of bile duct stones. The aim of this study was to determine the rate of spontaneous stone passage and relate it to the clinical presentation of the bile duct stone. PATIENTS AND METHODS: Prospectively collected data were studied on a total of 1000 consecutive patients undergoing laparoscopic cholecystectomy with or without laparoscopic common duct exploration. Comparisons were made between 142 patients with common bile duct stones (CBDS), 468 patients who had no previous or current evidence of duct stones, and 390 patients who had good evidence of previous duct stones but none at the time of cholecystectomy. The evidence used for previous duct stones included a good history of jaundice or pancreatitis. In patients with biliary colic or cholecystitis, abnormal pre-operative liver function tests and/or a dilated common bile duct were taken as evidence of bile duct stones. RESULTS: Of the 1000 patients studied, 532 had evidence of stones in the common bile duct at some time prior to cholecystectomy. At the time of operation, only 142 patients had bile duct stones. By implication, 80%, 84%, 93% and 55% of patients presenting with pancreatitis, colic, cholecystitis and jaundice (73% overall) had passed their bile duct stones spontaneously. All 4 patients with cholangitis had duct stones at the time of operation. CONCLUSIONS: It is likely that most bile duct stones (3 in 4) pass spontaneously, especially after pancreatitis, biliary colic and cholecystitis but less commonly after jaundice. Cholangitis appears to be always associated with the presence of duct stones at the time of operation. (+info)
Hepatocyte dysfunction and hepatic encephalopathy in Plasmodium falciparum malaria.
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BACKGROUND: According to the WHO, signs of hepatic dysfunction are unusual, and hepatic encephalopathy is never seen in malaria. However, in recent years, isolated cases have been reported from different parts of world. AIM: To identify the evidence for hepatocyte dysfunction and/or encephalopathy in jaundiced patients with falciparum malaria. DESIGN: Prospective observational study. METHODS: We studied 86 adult patients of both sexes who had malaria with jaundice (serum bilirubin > 3 mg%). The main outcome measures were: flapping tremor, deranged psychometric test, level of consciousness, serum bilirubin level, serum aspartate transaminase (AST) and alanine transaminase (ALT) levels, blood ammonia level, viral markers for hepatitis, ultrasonography of liver and gall bladder and electroencephalography (EEG). RESULTS: The range of serum bilirubin was 3-48.2 mg% (mean +/- SD 10.44 +/- 8.71 mg%). The ranges of AST and ALT levels were 40-1120 IU/l (294.47 +/- 250.67 IU/l) and 40-1245 IU/l (371.12 +/- 296.76 IU/l), respectively. Evidence of hepatic encephalopathy was seen in 15 patients. Asterexis was observed in 9 patients, impaired psychometric tests in 12 and altered mental state in 13. Arterial blood ammonia level was 120-427 meq/l (310 +/- 98.39 meq/l). EEG findings included presence of large bilateral synchronous slow waves, pseudo burst suppression and triphasic waves. Four patients died due to multiple organ dysfunction; the others made rapid recoveries. DISCUSSION: There is strong evidence of hepatocyte dysfunction and hepatic encephalopathy in some of these patients, with no obvious non-malarial explanation. Current guidelines may need to be revised. (+info)
Jaundice in mice due to anomalies of the biliary tract.
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There has been described a previously unrecognized disease of mice, characterized by progressive jaundice, first appearing during the nursing period. This has been shown to be due to congenital absence of the terminal segment of the common bile duct, or to the absence of intrahepatic ducts. In the former case, there is distension of the cystic and hepatic ducts, and of the gall bladder, with mucoid material. Biliary cirrhosis and infarct-like areas of necrosis are commonly found in the liver. The cause of the necroses has not been positively determined, but it is suggested that they result from defective arteriolization of the hepatic parenchyma. Inflammatory lesions of the biliary passages, when present, are attributed to secondary bacterial infection. Protozoan-like parasites were present in the gastric epithelium of all mice examined. Their relationship to the biliary and hepatic lesions is as yet undetermined. (+info)
An assessment of the value of serum cholinesterase as a liver function test and in the diagnosis of jaundice.
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This report assesses the value of cholinesterase (ChE) activity as an indicator of liver function and analyses its usefulness in the diagnosis of jaundice. A rapid method of determination has been used, and alterations in ChE activity in conditions other than liver disease have been studied to permit a fuller and more accurate survey of its value as a liver function test. The level of serum cholinesterase activity remains constant under normal circumstances, and follows the pattern of protein metabolism, falling in catabolism and rising in anabolism.In hepatocellular disease cholinesterase activity is lowered. Very low levels in cirrhosis with jaundice indicate a grave prognosis. Normal levels are usual in post-hepatic jaundice unless complicating factors are present, such as cholangitis or liver metastases. Serum cholinesterase is useful both as a liver function test and in the diagnosis of jaundice provided consideration is given to the other factors which affect the level of activity of the enzyme. (+info)