Jaundice
Jaundice, Obstructive
Jaundice, Neonatal
Cholestasis
Cholestasis, Extrahepatic
Hyperbilirubinemia
Phototherapy
Common Bile Duct
Kernicterus
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis
Cholestasis, Intrahepatic
Common Bile Duct Diseases
Biliary Atresia
Hyperbilirubinemia, Neonatal
Common Bile Duct Neoplasms
Hepatic Duct, Common
Liver Function Tests
Ampulla of Vater
Cholangiography
Bile Ducts
Portoenterostomy, Hepatic
Gilbert Disease
Biliary Tract Diseases
Cholangiopancreatography, Magnetic Resonance
Jaundice, Chronic Idiopathic
Choledochostomy
Cholelithiasis
Jejunostomy
Pancreatic Neoplasms
Glucosephosphate Dehydrogenase Deficiency
Bile Ducts, Intrahepatic
Bile Ducts, Extrahepatic
Gallstones
Biliary Fistula
Pancreatitis
Cholecystostomy
Exchange Transfusion, Whole Blood
Pancreaticoduodenectomy
Klatskin's Tumor
Imino Acids
Bile Duct Diseases
Hepatitis A
Favism
Liver
Sphincterotomy, Endoscopic
Choledochal Cyst
Biliary Tract Neoplasms
Cholagogues and Choleretics
Cystic Duct
Drug-Induced Liver Injury
Technetium Tc 99m Disofenin
Ursodeoxycholic Acid
Liver Cirrhosis, Biliary
Peripheral hepatojejunostomy as palliative treatment for irresectable malignant tumors of the liver hilum. (1/378)
OBJECTIVE: To evaluate the concept of surgical decompression of the biliary tree by peripheral hepatojejunostomy for palliative treatment of jaundice in patients with irresectable malignant tumors of the liver hilum. SUMMARY BACKGROUND DATA: Jaundice, pruritus, and recurrent cholangitis are major clinical complications in patients with obstructive cholestasis resulting from malignant tumors of the liver hilum. Methods for palliative treatment include endoscopic stenting, percutaneous transhepatic drainage, and surgical decompression. The palliative treatment of choice should be safe, effective, and comfortable for the patient. METHODS: In a retrospective study, surgical technique, perioperative complications, and efficacy of treatment were analyzed for 56 patients who had received a peripheral hepatojejunostomy between 1982 and 1997. Laparotomy in all of these patients had been performed as an attempt for curative resection. RESULTS: Hepatojejunostomy was exclusively palliative in 50 patients and was used for bridging to resection or transplantation in 7. Anastomosis was bilateral in 36 patients and unilateral in 20. The 1-month mortality in the study group was 9%; median survival was 6 months. In patients surviving >1 month, a marked and persistent decrease in cholestasis was achieved in 87%, although complete return to normal was rare. Among the patients with a marked decrease in cholestasis, 72% had no or only mild clinical symptoms such as fever or jaundice. CONCLUSIONS: Peripheral hepatojejunostomy is a feasible and reasonably effective palliative treatment for patients with irresectable tumors of the liver hilum. In patients undergoing exploratory laparotomy for attempted curative resection, this procedure frequently leads to persistent-although rarely complete-decompression of the biliary tree. In a few cases it may also be used for bridging to transplantation or liver resection after relief of cholestasis. (+info)Liver disease in pregnancy. (2/378)
Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of acute hepatitis is unaffected by pregnancy, except in patients with hepatitis E and disseminated herpes simplex infections, in which maternal and fetal mortality rates are significantly increased. Chronic hepatitis B or C infections may be transmitted to neonates; however, hepatitis B virus transmission is effectively prevented with perinatal hepatitis B vaccination and prophylaxis with hepatitis B immune globulin. Cholelithiasis occurs in 6 percent of pregnancies; complications can safely be treated with surgery. Women with chronic liver disease or cirrhosis exhibit a higher risk of fetal loss during pregnancy. Preeclampsia is associated with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome, acute fatty liver of pregnancy, and hepatic infarction and rupture. These rare diseases result in increased maternal and fetal mortality. Treatment involves prompt delivery, whereupon the liver disease quickly reverses. Therapy with penicillamine, trientine, prednisone or azathioprine can be safely continued during pregnancy. (+info)Case of sepsis caused by Bifidobacterium longum. (3/378)
We report a case of sepsis caused by Bifidobacterium longum in a 19-year-old male who had developed high fever, jaundice, and hepatomegaly after acupuncture therapy with small gold needles. Anaerobic, non-spore-forming, gram-positive bacilli were isolated from his blood and finally identified as B. longum. He recovered completely after treatment with ticarcillin and metronidazole. To our knowledge, this is the first report of incidental sepsis caused by B. longum. (+info)The natural history of histologically proved drug induced liver disease. (4/378)
BACKGROUND: The long term outcome of drug related liver disease is unknown. AIMS: To study the natural history of histologically proved drug induced hepatotoxicity. METHODS: 110 patients with liver biopsies coded either as drug induced liver disease or hepatitis/cholestasis of unknown aetiology were identified from hospital records 1978-1996. Review of case notes and histology identified 44 patients with definite drug induced hepatotoxicity. Forty surviving patients were invited to attend a follow up clinic. History, examination, full liver screen, and isotope and ultrasound liver scans were repeated in all patients. Repeat liver biopsies were offered to patients with abnormal liver tests. RESULTS: Presentation at index biopsy was jaundice in 24 patients, abnormal liver tests in 17, and hepatic failure in three. Antibiotics (n=13) and non-steroidal anti-inflammatory drugs (n=11) were the most common drugs implicated. Initial histology showed acute hepatitis in six, chronic hepatitis in 20, and cholestasis in 18. At 1-19 years (median 5 years) follow up, 13/33 (39%) patients had persistent significant abnormalities in their liver blood tests and/or scans. Three of the five repeat liver biopsies performed showed significant abnormalities. Factors predicting persistence or development of chronic liver disease were fibrosis and continued exposure to the drug. CONCLUSIONS: Drugs should be considered in the differential diagnosis of abnormal liver function and/or histology, as failure to withdraw the offending drug is associated with a high risk of persistent liver damage. (+info)Biliary obstruction in hematopoietic cell transplant recipients: an uncommon diagnosis with specific causes. (5/378)
Jaundice is a common problem in marrow transplant recipients. The incidence of bile duct obstruction in this setting is unknown. The purpose of this study was to determine the incidence of biliary obstruction, the causes, and outcomes following marrow transplant. Consecutive cases were reviewed at two major transplant centers in the United States from 1969 to 1996 at the Fred Hutchinson Cancer Research Center and 1989 to 1996 at the City of Hope National Medical Center. Nine cases of biliary obstruction were identified as a cause of jaundice in 7412 marrow transplant recipients, an incidence of 0.12%. The presentation was bimodal, with seven cases occurring prior to day 100 and two occurring 2 to 4 years after transplantation. The age distribution was 15 to 50 years and all patients had received allogeneic transplants. The causes of obstruction included gallbladder sludge (n=1), a duodenal hematoma (n=1), choledocholithiasis with biliary pancreatitis (n=1), bile duct infection (n=2), recurrent malignancy (n=1), choledocholithiasis associated with a benign stricture (n=1), Epstein-Barr virus-related lymphoproliferative disorder (n=1), and a benign stricture of unknown etiology (n=1). Biliary obstruction is a rare cause of jaundice in the post-transplant period. The presentation was similar to that of other post-transplant hepatobiliary problems, but with disparate causes. (+info)Neonatal bilirubin production, reflected by carboxyhaemoglobin concentrations, in Down's syndrome. (6/378)
AIM: To determine whether increased bilirubin production, reflected by blood carboxyhaemoglobin (COHb) values, is responsible for hyperbilirubinaemia in cases of Down's syndrome with no obvious cause for excessive jaundice. METHODS: Blood was sampled on the third day of life for COHb, total haemoglobin (tHb), and serum total bilirubin, from 19 consecutively born neonates with Down's syndrome (a subset of 34 term babies), who had developed hyperbilirubinaemia (serum bilirubin >/= 256 micromol), and from 32 term controls. COHb, measured by gas chromatography, was corrected for inspired CO (COHbc) and expressed as a percentage of tHb. RESULTS: Significantly more of the Down's syndrome subset developed hyperbilirubinaemia than the controls (10/19 (52%) vs 7/32 (22%), relative risk 2.4, 95% confidence intervals (CI) 1.10 to 5.26). Third day serum bilirubin values (mean (SD)) were higher in the Down's syndrome neonates than in controls (214 +- 63 micromol/l vs 172 +- 54 micromol/l, respectively, p=0.015). Mean (SD) COHbc values were significantly higher in the Down's syndrome neonates than in controls (0.92 +- 0. 24% vs 0.63 +- 0.17%; p<0.0001). However, Down's syndrome neonates who became hyperbilirubinaemic had similar COHbc values to those who did not (0.87 +- 0.26% and 0.95 +- 0.23%, respectively). These values contrast with those of the controls, in whom a significant increase in COHbc was associated with hyperbilirubinaemia (0.74 +- 0. 15% vs 0.60 +- 0.16%, respectively; p<0.05). tHb values were similar in both groups. CONCLUSIONS: Down's syndrome neonates had a greater risk of hyperbilirubinaemia, and higher COHbc values, than controls. However, excessive bilirubin production could not be exclusively responsible for the hyperbilirubinaemia. By inference, decreased bilirubin elimination probably plays a greater part in its pathogenesis than in controls. Down's syndrome neonates may have abnormal erythropoiesis, leading to increased haem turnover. (+info)Determination of the sum of bilirubin sugar conjugates in plasma by bilirubin oxidase. (7/378)
BACKGROUND: A reliable indicator of cholestasis is the presence of abnormal concentrations of bilirubin mono- and diglucuronide [conjugated bilirubin (CB)] in blood. A routine assay of CB is available only to those who possess a certain type of clinical analyzer. We describe a two-point manual method for CB that could be adapted as a rate assay to automated clinical analyzers. METHODS: The measurement of CB is based on its oxidation to biliverdin by bilirubin oxidase. The resulting decrease in absorbance at 460 nm is proportional to the CB concentration. The assay is calibrated with solutions of ditaurobilirubin in human serum. RESULTS: Under the conditions of the assay (0.1 mol/L glycine buffer, pH 10.0; reaction time, 2 min), only 5% of unconjugated bilirubin is oxidized and delta-bilirubin is not oxidized at all. Results obtained with the bilirubin oxidase method agreed well with those obtained by HPLC. The long-term CVs at CB concentrations of 6 and 63.4 mg/L were 20% and 2.6%, respectively. The reference values, established by analyzing 51 plasma specimens from healthy adults, were 0.0-1.2 mg/L, with a mean value of 0.2 mg/L. CONCLUSIONS: The proposed method for CB has good analytical specificity and obviates the requirement for HPLC or a dry chemistry analyzer. The measurement of CB in blood is superior to the measurement of direct bilirubin because an abnormal concentration of direct bilirubin does not necessarily indicate the presence of cholestasis. (+info)The prognostic and pathophysiologic role of pro- and antiinflammatory cytokines in severe malaria. (8/378)
Pro- and antiinflammatory cytokines were measured on admission in 287 consecutive Vietnamese adults with severe falciparum malaria. Plasma interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-alpha concentrations and the IL-6: IL-10 ratio were significantly higher in patients who died than in survivors (P<.001). On multivariate analysis, hyperparasitemia, jaundice, and shock were all associated independently with raised IL-6, IL-10, and interferon-gamma, and acute renal failure specifically with raised TNF-alpha levels. Cerebral malaria patients, particularly those without other vital organ dysfunction, had significantly lower levels of these cytokines (P=.006), reflecting a more localized pathology. Serial IL-6 and IL-10 measurements made on 43 patients who died and matched survivors indicated a relative deficiency in IL-10 production as death approached. Elevated plasma cytokines in severe malaria are associated with systemic pathologic abnormalities, not cerebral involvement. Both the overall magnitude of the cytokine responses and the eventual imbalance between the pro- and antiinflammatory responses are important determinants of mortality. (+info)Jaundice is a medical condition characterized by the yellowing of the skin, sclera (whites of the eyes), and mucous membranes due to an excess of bilirubin in the bloodstream. Bilirubin is a yellow-orange pigment produced when hemoglobin from red blood cells is broken down. Normally, bilirubin is processed by the liver and excreted through bile into the digestive system. However, if there's an issue with bilirubin metabolism or elimination, it can accumulate in the body, leading to jaundice.
Jaundice can be a symptom of various underlying conditions, such as liver diseases (hepatitis, cirrhosis), gallbladder issues (gallstones, tumors), or blood disorders (hemolysis). It is essential to consult a healthcare professional if jaundice is observed, as it may indicate a severe health problem requiring prompt medical attention.
Obstructive Jaundice is a medical condition characterized by the yellowing of the skin, sclera (whites of the eyes), and mucous membranes due to the accumulation of bilirubin in the bloodstream. This occurs when there is an obstruction or blockage in the bile ducts that transport bile from the liver to the small intestine.
Bile, which contains bilirubin, aids in digestion and is usually released from the liver into the small intestine. When the flow of bile is obstructed, bilirubin builds up in the blood, causing jaundice. The obstruction can be caused by various factors, such as gallstones, tumors, or strictures in the bile ducts.
Obstructive jaundice may present with additional symptoms like dark urine, light-colored stools, itching, abdominal pain, and weight loss, depending on the cause and severity of the obstruction. It is essential to seek medical attention if jaundice is observed, as timely diagnosis and management can prevent potential complications, such as liver damage or infection.
Neonatal jaundice is a medical condition characterized by the yellowing of a newborn baby's skin and eyes due to an excess of bilirubin in the blood. Bilirubin is a yellowish substance produced by the normal breakdown of red blood cells, which are then processed by the liver and excreted through the bile. In neonatal jaundice, the liver is not yet fully developed and cannot process bilirubin quickly enough, leading to its accumulation in the body.
Neonatal jaundice typically appears within the first 2-4 days of life and can range from mild to severe. Mild cases may resolve on their own without treatment, while more severe cases may require medical intervention such as phototherapy or a blood transfusion. Risk factors for neonatal jaundice include prematurity, bruising during birth, blood type incompatibility between mother and baby, and certain genetic disorders.
It is important to monitor newborns closely for signs of jaundice and seek medical attention if concerned, as untreated neonatal jaundice can lead to serious complications such as brain damage or hearing loss.
Cholestasis is a medical condition characterized by the interruption or reduction of bile flow from the liver to the small intestine. Bile is a digestive fluid produced by the liver that helps in the breakdown and absorption of fats. When the flow of bile is blocked or reduced, it can lead to an accumulation of bile components, such as bilirubin, in the blood, which can cause jaundice, itching, and other symptoms.
Cholestasis can be caused by various factors, including liver diseases (such as hepatitis, cirrhosis, or cancer), gallstones, alcohol abuse, certain medications, pregnancy, and genetic disorders. Depending on the underlying cause, cholestasis may be acute or chronic, and it can range from mild to severe in its symptoms and consequences. Treatment for cholestasis typically involves addressing the underlying cause and managing the symptoms with supportive care.
Bilirubin is a yellowish pigment that is produced by the liver when it breaks down old red blood cells. It is a normal byproduct of hemoglobin metabolism and is usually conjugated (made water-soluble) in the liver before being excreted through the bile into the digestive system. Elevated levels of bilirubin can cause jaundice, a yellowing of the skin and eyes. Increased bilirubin levels may indicate liver disease or other medical conditions such as gallstones or hemolysis. It is also measured to assess liver function and to help diagnose various liver disorders.
Extrahepatic cholestasis is a medical condition characterized by the impaired flow of bile outside of the liver. Bile is a digestive fluid produced by the liver that helps in the absorption and digestion of fats. When the flow of bile is obstructed or blocked, it can lead to an accumulation of bile components, such as bilirubin, in the bloodstream, resulting in jaundice, dark urine, light-colored stools, and itching.
Extrahepatic cholestasis can be caused by various factors, including gallstones, tumors, strictures, or inflammation of the bile ducts. It is essential to diagnose and treat extrahepatic cholestasis promptly to prevent further complications, such as liver damage or infection. Treatment options may include medications, endoscopic procedures, or surgery, depending on the underlying cause of the condition.
Hyperbilirubinemia is a medical condition characterized by an excessively high level of bilirubin in the bloodstream. Bilirubin is a yellowish pigment produced by the liver when it breaks down old red blood cells. Normally, bilirubin is conjugated (made water-soluble) in the liver and then excreted through the bile into the digestive system. However, if there is a problem with the liver's ability to process or excrete bilirubin, it can build up in the blood, leading to hyperbilirubinemia.
Hyperbilirubinemia can be classified as either unconjugated or conjugated, depending on whether the bilirubin is in its direct (conjugated) or indirect (unconjugated) form. Unconjugated hyperbilirubinemia can occur due to increased production of bilirubin (such as in hemolytic anemia), decreased uptake of bilirubin by the liver, or impaired conjugation of bilirubin in the liver. Conjugated hyperbilirubinemia, on the other hand, is usually caused by a problem with the excretion of conjugated bilirubin into the bile, such as in cholestatic liver diseases like hepatitis or cirrhosis.
Symptoms of hyperbilirubinemia can include jaundice (yellowing of the skin and eyes), dark urine, light-colored stools, itching, and fatigue. Treatment depends on the underlying cause of the condition and may involve medications, dietary changes, or surgery.
Phototherapy is a medical treatment that involves the use of light to manage or improve certain conditions. It can be delivered in various forms, such as natural light exposure or artificial light sources, including lasers, light-emitting diodes (LEDs), or fluorescent lamps. The wavelength and intensity of light are carefully controlled to achieve specific therapeutic effects.
Phototherapy is most commonly used for newborns with jaundice to help break down bilirubin in the skin, reducing its levels in the bloodstream. This type of phototherapy is called bilirubin lights or bili lights.
In dermatology, phototherapy can be applied to treat various skin conditions like psoriasis, eczema, vitiligo, and acne. Narrowband ultraviolet B (UVB) therapy, PUVA (psoralen plus UVA), and blue or red light therapies are some examples of dermatological phototherapies.
Phototherapy can also be used to alleviate symptoms of seasonal affective disorder (SAD) and other mood disorders by exposing patients to bright artificial light, which helps regulate their circadian rhythms and improve their mood. This form of phototherapy is called light therapy or bright light therapy.
It's essential to consult a healthcare professional before starting any phototherapy treatment, as inappropriate use can lead to adverse effects.
The common bile duct is a duct that results from the union of the cystic duct (which drains bile from the gallbladder) and the common hepatic duct (which drains bile from the liver). The common bile duct transports bile, a digestive enzyme, from the liver and gallbladder to the duodenum, which is the first part of the small intestine.
The common bile duct runs through the head of the pancreas before emptying into the second part of the duodenum, either alone or in conjunction with the pancreatic duct, via a small opening called the ampulla of Vater. The common bile duct plays a crucial role in the digestion of fats by helping to break them down into smaller molecules that can be absorbed by the body.
Kernicterus is a severe form of brain damage caused by high levels of bilirubin, a yellow pigment that forms when red blood cells break down. It's most commonly seen in newborns, particularly those with a condition called ABO or Rh incompatibility, where the baby's blood type is different from the mother's. This can lead to an increased breakdown of the baby's red blood cells and a buildup of bilirubin.
In kernicterus, the bilirubin reaches such high levels that it becomes toxic and can damage the brain, particularly areas like the basal ganglia and brainstem. This can result in symptoms such as severe jaundice (a yellowing of the skin and eyes), lethargy, high-pitched crying, poor feeding, and eventually seizures, hearing loss, and developmental delays.
Kernicterus is preventable with timely treatment, which may include phototherapy (using light to break down bilirubin) or exchange transfusion (replacing the baby's blood with fresh donor blood). If you suspect your newborn has jaundice or if their skin appears yellow, it's important to seek medical attention immediately.
Bile duct neoplasms, also known as cholangiocarcinomas, refer to a group of malignancies that arise from the bile ducts. These are the tubes that carry bile from the liver to the gallbladder and small intestine. Bile duct neoplasms can be further classified based on their location as intrahepatic (within the liver), perihilar (at the junction of the left and right hepatic ducts), or distal (in the common bile duct).
These tumors are relatively rare, but their incidence has been increasing in recent years. They can cause a variety of symptoms, including jaundice, abdominal pain, weight loss, and fever. The diagnosis of bile duct neoplasms typically involves imaging studies such as CT or MRI scans, as well as blood tests to assess liver function. In some cases, a biopsy may be necessary to confirm the diagnosis.
Treatment options for bile duct neoplasms depend on several factors, including the location and stage of the tumor, as well as the patient's overall health. Surgical resection is the preferred treatment for early-stage tumors, while chemotherapy and radiation therapy may be used in more advanced cases. For patients who are not candidates for surgery, palliative treatments such as stenting or bypass procedures may be recommended to relieve symptoms and improve quality of life.
Endoscopic retrograde cholangiopancreatography (ERCP) is a medical procedure that combines upper gastrointestinal (GI) endoscopy and fluoroscopy to diagnose and treat certain problems of the bile ducts and pancreas.
During ERCP, a flexible endoscope (a long, thin, lighted tube with a camera on the end) is passed through the patient's mouth and throat, then through the stomach and into the first part of the small intestine (duodenum). A narrow plastic tube (catheter) is then inserted through the endoscope and into the bile ducts and/or pancreatic duct. Contrast dye is injected through the catheter, and X-rays are taken to visualize the ducts.
ERCP can be used to diagnose a variety of conditions affecting the bile ducts and pancreas, including gallstones, tumors, strictures (narrowing of the ducts), and chronic pancreatitis. It can also be used to treat certain conditions, such as removing gallstones from the bile duct or placing stents to keep the ducts open in cases of stricture.
ERCP is an invasive procedure that carries a risk of complications, including pancreatitis, infection, bleeding, and perforation (a tear in the lining of the GI tract). It should only be performed by experienced medical professionals in a hospital setting.
Cholangitis is a medical condition characterized by inflammation of the bile ducts, which are the tubes that carry bile from the liver to the small intestine. Bile is a digestive juice produced by the liver that helps break down fats in food.
There are two types of cholangitis: acute and chronic. Acute cholangitis is a sudden and severe infection that can cause symptoms such as abdominal pain, fever, jaundice (yellowing of the skin and eyes), and dark urine. It is usually caused by a bacterial infection that enters the bile ducts through a blockage or obstruction.
Chronic cholangitis, on the other hand, is a long-term inflammation of the bile ducts that can lead to scarring and narrowing of the ducts. This can cause symptoms such as abdominal pain, itching, and jaundice. Chronic cholangitis can be caused by various factors, including primary sclerosing cholangitis (an autoimmune disease), bile duct stones, or tumors in the bile ducts.
Treatment for cholangitis depends on the underlying cause of the condition. Antibiotics may be used to treat bacterial infections, and surgery may be necessary to remove blockages or obstructions in the bile ducts. In some cases, medications may be prescribed to manage symptoms and prevent further complications.
Intrahepatic cholestasis is a medical condition characterized by the interruption or reduction of bile flow within the liver. Bile is a digestive fluid produced by the liver that helps in the absorption of fats and fat-soluble vitamins. Intrahepatic cholestasis occurs when there is a problem with the transport of bile components inside the liver cells (hepatocytes). This can lead to an accumulation of bile acids, bilirubin, and other substances in the liver, which can cause damage to liver cells and result in symptoms such as jaundice, itching, and dark urine.
Intrahepatic cholestasis can be caused by various factors, including medications, alcohol abuse, hepatitis viruses, autoimmune disorders, genetic defects, and cancer. Depending on the underlying cause, intrahepatic cholestasis can be acute or chronic, and it can range from mild to severe. Treatment typically involves addressing the underlying cause of the condition, as well as providing supportive care to manage symptoms and prevent complications.
Common bile duct diseases refer to conditions that affect the common bile duct, a tube that carries bile from the liver and gallbladder into the small intestine. Some common examples of common bile duct diseases include:
1. Choledocholithiasis: This is the presence of stones (calculi) in the common bile duct, which can cause blockage, inflammation, and infection.
2. Cholangitis: This is an infection or inflammation of the common bile duct, often caused by obstruction due to stones, tumors, or strictures.
3. Common bile duct cancer (cholangiocarcinoma): This is a rare but aggressive cancer that arises from the cells lining the common bile duct.
4. Biliary strictures: These are narrowing or scarring of the common bile duct, which can be caused by injury, inflammation, or surgery.
5. Benign tumors: Non-cancerous growths in the common bile duct can also cause blockage and other symptoms.
Symptoms of common bile duct diseases may include abdominal pain, jaundice (yellowing of the skin and eyes), fever, chills, nausea, vomiting, and dark urine or light-colored stools. Treatment depends on the specific condition and severity but may include medications, endoscopic procedures, surgery, or a combination of these approaches.
Biliary atresia is a rare, progressive liver disease in infants and children, characterized by the inflammation, fibrosis, and obstruction of the bile ducts. This results in the impaired flow of bile from the liver to the intestine, leading to cholestasis (accumulation of bile in the liver), jaundice (yellowing of the skin and eyes), and eventually liver cirrhosis and failure if left untreated.
The exact cause of biliary atresia is not known, but it is believed to be a combination of genetic and environmental factors. It can occur as an isolated condition or in association with other congenital anomalies. The diagnosis of biliary atresia is typically made through imaging studies, such as ultrasound and cholangiography, and confirmed by liver biopsy.
The standard treatment for biliary atresia is a surgical procedure called the Kasai portoenterostomy, which aims to restore bile flow from the liver to the intestine. In this procedure, the damaged bile ducts are removed and replaced with a loop of intestine that is connected directly to the liver. The success of the Kasai procedure depends on several factors, including the age at diagnosis and surgery, the extent of liver damage, and the skill and experience of the surgeon.
Despite successful Kasai surgery, many children with biliary atresia will eventually develop cirrhosis and require liver transplantation. The prognosis for children with biliary atresia has improved significantly over the past few decades due to earlier diagnosis, advances in surgical techniques, and better postoperative care. However, it remains a challenging condition that requires close monitoring and multidisciplinary management by pediatric hepatologists, surgeons, and other healthcare professionals.
Drainage, in medical terms, refers to the removal of excess fluid or accumulated collections of fluids from various body parts or spaces. This is typically accomplished through the use of medical devices such as catheters, tubes, or drains. The purpose of drainage can be to prevent the buildup of fluids that may cause discomfort, infection, or other complications, or to treat existing collections of fluid such as abscesses, hematomas, or pleural effusions. Drainage may also be used as a diagnostic tool to analyze the type and composition of the fluid being removed.
Neonatal hyperbilirubinemia is a condition characterized by an excessively high level of bilirubin in the blood of newborn infants. Bilirubin is a yellowish pigment produced by the normal breakdown of red blood cells. Normally, bilirubin is processed by the liver and excreted through the bile into the digestive system. However, in neonatal hyperbilirubinemia, the liver may be unable to process bilirubin quickly enough, leading to its accumulation in the bloodstream. This can cause the skin and eyes of the newborn to appear yellow, a condition known as jaundice.
Neonatal hyperbilirubinemia is relatively common and usually resolves on its own within a few days or weeks. However, if bilirubin levels become too high, they can cause brain damage (kernicterus) in severe cases. Treatment may include phototherapy to help break down bilirubin, exchange transfusions, or other interventions to support liver function and reduce bilirubin levels.
Common bile duct neoplasms refer to abnormal growths that can occur in the common bile duct, which is a tube that carries bile from the liver and gallbladder into the small intestine. These growths can be benign or malignant (cancerous).
Benign neoplasms of the common bile duct include papillomas, adenomas, and leiomyomas. Malignant neoplasms are typically adenocarcinomas, which arise from the glandular cells lining the duct. Other types of malignancies that can affect the common bile duct include cholangiocarcinoma, gallbladder carcinoma, and metastatic cancer from other sites.
Symptoms of common bile duct neoplasms may include jaundice (yellowing of the skin and eyes), abdominal pain, dark urine, and light-colored stools. Diagnosis may involve imaging tests such as CT scans or MRCP (magnetic resonance cholangiopancreatography) and biopsy to confirm the type of neoplasm. Treatment options depend on the type and stage of the neoplasm and may include surgery, radiation therapy, chemotherapy, or a combination of these approaches.
The common hepatic duct is a medical term that refers to the duct in the liver responsible for carrying bile from the liver. More specifically, it is the duct that results from the convergence of the right and left hepatic ducts, which themselves carry bile from the right and left lobes of the liver, respectively. The common hepatic duct then joins with the cystic duct from the gallbladder to form the common bile duct, which ultimately drains into the duodenum, a part of the small intestine.
The primary function of the common hepatic duct is to transport bile, a digestive juice produced by the liver, to the small intestine. Bile helps break down fats during the digestion process, making it possible for the body to absorb them properly. Any issues or abnormalities in the common hepatic duct can lead to problems with bile flow and potentially cause health complications such as jaundice, gallstones, or liver damage.
Liver function tests (LFTs) are a group of blood tests that are used to assess the functioning and health of the liver. These tests measure the levels of various enzymes, proteins, and waste products that are produced or metabolized by the liver. Some common LFTs include:
1. Alanine aminotransferase (ALT): An enzyme found primarily in the liver, ALT is released into the bloodstream in response to liver cell damage. Elevated levels of ALT may indicate liver injury or disease.
2. Aspartate aminotransferase (AST): Another enzyme found in various tissues, including the liver, heart, and muscles. Like ALT, AST is released into the bloodstream following tissue damage. High AST levels can be a sign of liver damage or other medical conditions.
3. Alkaline phosphatase (ALP): An enzyme found in several organs, including the liver, bile ducts, and bones. Elevated ALP levels may indicate a blockage in the bile ducts, liver disease, or bone disorders.
4. Gamma-glutamyl transferase (GGT): An enzyme found mainly in the liver, pancreas, and biliary system. Increased GGT levels can suggest liver disease, alcohol consumption, or the use of certain medications.
5. Bilirubin: A yellowish pigment produced when hemoglobin from red blood cells is broken down. Bilirubin is processed by the liver and excreted through bile. High bilirubin levels can indicate liver dysfunction, bile duct obstruction, or certain types of anemia.
6. Albumin: A protein produced by the liver that helps maintain fluid balance in the body and transports various substances in the blood. Low albumin levels may suggest liver damage, malnutrition, or kidney disease.
7. Total protein: A measure of all proteins present in the blood, including albumin and other types of proteins produced by the liver. Decreased total protein levels can indicate liver dysfunction or other medical conditions.
These tests are often ordered together as part of a routine health checkup or when evaluating symptoms related to liver function or disease. The results should be interpreted in conjunction with clinical findings, medical history, and other diagnostic tests.
The ampulla of Vater, also known as hepatopancreatic ampulla, is a dilated portion of the common bile duct where it joins the main pancreatic duct and empties into the second part of the duodenum. It serves as a conduit for both bile from the liver and digestive enzymes from the pancreas to reach the small intestine, facilitating the digestion and absorption of nutrients. The ampulla of Vater is surrounded by a muscular sphincter, the sphincter of Oddi, which controls the flow of these secretions into the duodenum.
Cholangiography is a medical procedure that involves taking X-ray images of the bile ducts (the tubes that carry bile from the liver to the small intestine). This is typically done by injecting a contrast dye into the bile ducts through an endoscope or a catheter that has been inserted into the body.
There are several types of cholangiography, including:
* Endoscopic retrograde cholangiopancreatography (ERCP): This procedure involves inserting an endoscope through the mouth and down the throat into the small intestine. A dye is then injected into the bile ducts through a small tube that is passed through the endoscope.
* Percutaneous transhepatic cholangiography (PTC): This procedure involves inserting a needle through the skin and into the liver to inject the contrast dye directly into the bile ducts.
* Operative cholangiography: This procedure is performed during surgery to examine the bile ducts for any abnormalities or blockages.
Cholangiography can help diagnose a variety of conditions that affect the bile ducts, such as gallstones, tumors, or inflammation. It can also be used to guide treatment decisions, such as whether surgery is necessary to remove a blockage.
Bile ducts are tubular structures that carry bile from the liver to the gallbladder for storage or directly to the small intestine to aid in digestion. There are two types of bile ducts: intrahepatic and extrahepatic. Intrahepatic bile ducts are located within the liver and drain bile from liver cells, while extrahepatic bile ducts are outside the liver and include the common hepatic duct, cystic duct, and common bile duct. These ducts can become obstructed or inflamed, leading to various medical conditions such as cholestasis, cholecystitis, and gallstones.
Biliary tract surgical procedures refer to a range of operations that involve the biliary system, which includes the liver, gallbladder, and bile ducts. These procedures can be performed for various reasons, including the treatment of gallstones, bile duct injuries, tumors, or other conditions affecting the biliary tract. Here are some examples of biliary tract surgical procedures:
1. Cholecystectomy: This is the surgical removal of the gallbladder, which is often performed to treat symptomatic gallstones or chronic cholecystitis (inflammation of the gallbladder). It can be done as an open procedure or laparoscopically.
2. Bile duct exploration: This procedure involves opening the common bile duct to remove stones, strictures, or tumors. It is often performed during a cholecystectomy if there is suspicion of common bile duct involvement.
3. Hepaticojejunostomy: This operation connects the liver's bile ducts directly to a portion of the small intestine called the jejunum, bypassing a damaged or obstructed segment of the biliary tract. It is often performed for benign or malignant conditions affecting the bile ducts.
4. Roux-en-Y hepaticojejunostomy: This procedure involves creating a Y-shaped limb of jejunum and connecting it to the liver's bile ducts, bypassing the common bile duct and duodenum. It is often performed for complex biliary tract injuries or malignancies.
5. Whipple procedure (pancreaticoduodenectomy): This extensive operation involves removing the head of the pancreas, the duodenum, a portion of the jejunum, the gallbladder, and the common bile duct. It is performed for malignancies involving the pancreas, bile duct, or duodenum.
6. Liver resection: This procedure involves removing a portion of the liver to treat primary liver tumors (hepatocellular carcinoma or cholangiocarcinoma) or metastatic cancer from other organs.
7. Biliary stenting or bypass: These minimally invasive procedures involve placing a stent or creating a bypass to relieve bile duct obstructions caused by tumors, strictures, or stones. They can be performed endoscopically (ERCP) or percutaneously (PTC).
8. Cholecystectomy: This procedure involves removing the gallbladder, often for symptomatic cholelithiasis (gallstones) or cholecystitis (inflammation of the gallbladder). It can be performed laparoscopically or open.
9. Biliary drainage: This procedure involves placing a catheter to drain bile from the liver or bile ducts, often for acute or chronic obstructions caused by tumors, strictures, or stones. It can be performed endoscopically (ERCP) or percutaneously (PTC).
10. Bilioenteric anastomosis: This procedure involves connecting the biliary tract to a portion of the small intestine, often for benign or malignant conditions affecting the bile ducts or pancreas. It can be performed open or laparoscopically.
The biliary tract is a system of ducts that transport bile from the liver to the gallbladder and then to the small intestine. Bile is a digestive fluid produced by the liver that helps in the breakdown and absorption of fats in the small intestine. The main components of the biliary tract are:
1. Intrahepatic bile ducts: These are the smaller branches of bile ducts located within the liver that collect bile from the liver cells or hepatocytes.
2. Gallbladder: A small pear-shaped organ located beneath the liver, which stores and concentrates bile received from the intrahepatic bile ducts. The gallbladder releases bile into the small intestine when food is ingested, particularly fats, to aid digestion.
3. Common hepatic duct: This is a duct that forms by the union of the right and left hepatic ducts, which carry bile from the right and left lobes of the liver, respectively.
4. Cystic duct: A short duct that connects the gallbladder to the common hepatic duct, forming the beginning of the common bile duct.
5. Common bile duct: This is a larger duct formed by the union of the common hepatic duct and the cystic duct. It carries bile from the liver and gallbladder into the small intestine.
6. Pancreatic duct: A separate duct that originates from the pancreas, a gland located near the liver and stomach. The pancreatic duct joins the common bile duct just before they both enter the duodenum, the first part of the small intestine.
7. Ampulla of Vater: This is the dilated portion where the common bile duct and the pancreatic duct join together and empty their contents into the duodenum through a shared opening called the papilla of Vater.
Disorders related to the biliary tract include gallstones, cholecystitis (inflammation of the gallbladder), bile duct stones, bile duct strictures or obstructions, and primary sclerosing cholangitis, among others.
A hepatic portoenterostomy, also known as Kasai procedure, is a surgical operation performed on infants with extrahepatic biliary atresia. This condition is characterized by the absence or abnormal formation of the bile ducts that carry bile from the liver to the small intestine, leading to obstruction and damage to the liver.
During a hepatic portoenterostomy, the surgeon creates an anastomosis (connection) between the portal vein, which brings blood to the liver, and a loop of intestine. This connection allows bile to flow directly from the liver into the intestine, bypassing the blocked or absent bile ducts. The goal of the procedure is to restore bile flow and prevent further damage to the liver.
The success of the procedure varies, but it can help improve the child's quality of life and delay or prevent the need for a liver transplant in some cases. However, many children with biliary atresia will eventually require a liver transplant as the disease progresses.
Gilbert's disease, also known as Gilbert's syndrome, is a common and mild condition characterized by **intermittent** elevations in bilirubin levels in the bloodstream without any evidence of liver damage or disease. Bilirubin is a yellowish pigment that forms when hemoglobin breaks down. Normally, it gets processed in the liver and excreted through bile.
In Gilbert's disease, there is an impaired ability to conjugate bilirubin due to a deficiency or dysfunction of the enzyme UDP-glucuronosyltransferase 1A1 (UGT1A1), which is responsible for the glucuronidation process. This results in mild unconjugated hyperbilirubinemia, where bilirubin levels may rise and cause mild jaundice, particularly during times of fasting, illness, stress, or dehydration.
Gilbert's disease is typically an incidental finding, as it usually does not cause any significant symptoms or complications. It is often discovered during routine blood tests when bilirubin levels are found to be slightly elevated. The condition is usually harmless and does not require specific treatment, but avoiding triggers like fasting or dehydration may help minimize the occurrence of jaundice.
Biliary tract diseases refer to a group of medical conditions that affect the biliary system, which includes the gallbladder, bile ducts, and liver. Bile is a digestive juice produced by the liver, stored in the gallbladder, and released into the small intestine through the bile ducts to help digest fats.
Biliary tract diseases can cause various symptoms such as abdominal pain, jaundice, fever, nausea, vomiting, and changes in stool color. Some of the common biliary tract diseases include:
1. Gallstones: Small, hard deposits that form in the gallbladder or bile ducts made up of cholesterol or bilirubin.
2. Cholecystitis: Inflammation of the gallbladder, often caused by gallstones.
3. Cholangitis: Infection or inflammation of the bile ducts.
4. Biliary dyskinesia: A motility disorder that affects the contraction and relaxation of the muscles in the biliary system.
5. Primary sclerosing cholangitis: A chronic autoimmune disease that causes scarring and narrowing of the bile ducts.
6. Biliary tract cancer: Rare cancers that affect the gallbladder, bile ducts, or liver.
Treatment for biliary tract diseases varies depending on the specific condition and severity but may include medications, surgery, or a combination of both.
Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive medical imaging technique that uses magnetic resonance imaging (MRI) to visualize the bile ducts and pancreatic duct. This diagnostic test does not use radiation like other imaging techniques such as computed tomography (CT) scans or endoscopic retrograde cholangiopancreatography (ERCP).
During an MRCP, the patient lies on a table that slides into the MRI machine. Contrast agents may be used to enhance the visibility of the ducts. The MRI machine uses a strong magnetic field and radio waves to produce detailed images of the internal structures, allowing radiologists to assess any abnormalities or blockages in the bile and pancreatic ducts.
MRCP is often used to diagnose conditions such as gallstones, tumors, inflammation, or strictures in the bile or pancreatic ducts. It can also be used to monitor the effectiveness of treatments for these conditions. However, it does not allow for therapeutic interventions like ERCP, which can remove stones or place stents.
Chronic Idiopathic Jaundice is not a widely accepted medical diagnosis and the term "idiopathic" is used to denote that the cause of the jaundice is unknown. However, it is generally used to describe a condition where a person has persistent jaundice without any identifiable underlying cause.
Jaundice itself refers to the yellowing of the skin, sclera (whites of the eyes), and mucous membranes due to an accumulation of bilirubin in the body. Bilirubin is a yellowish substance that is produced when hemoglobin, the protein in red blood cells that carries oxygen, breaks down. Normally, bilirubin is processed by the liver and excreted through the bile ducts into the digestive system.
In Chronic Idiopathic Jaundice, the bilirubin level remains elevated over an extended period of time without any apparent explanation. The condition may be asymptomatic or associated with symptoms such as fatigue, itching, and abdominal discomfort. It is important to note that while "idiopathic" implies an unknown cause, further investigation and monitoring are often necessary to rule out any underlying liver disease or other conditions that may contribute to the jaundice.
A newborn infant is a baby who is within the first 28 days of life. This period is also referred to as the neonatal period. Newborns require specialized care and attention due to their immature bodily systems and increased vulnerability to various health issues. They are closely monitored for signs of well-being, growth, and development during this critical time.
Choledochostomy is a surgical procedure that involves creating an opening (stoma) into the common bile duct, which carries bile from the liver and gallbladder to the small intestine. This procedure is typically performed to relieve obstructions or blockages in the bile duct, such as those caused by gallstones, tumors, or scar tissue.
During the choledochostomy procedure, a surgeon makes an incision in the abdomen and exposes the common bile duct. The duct is then cut open, and a small tube (catheter) is inserted into the duct to allow bile to drain out of the body. The catheter may be left in place temporarily or permanently, depending on the underlying condition causing the obstruction.
Choledochostomy is typically performed as an open surgical procedure, but it can also be done using minimally invasive techniques such as laparoscopy or robotic-assisted surgery. As with any surgical procedure, choledochostomy carries risks such as bleeding, infection, and damage to surrounding tissues. However, these risks are generally low in the hands of an experienced surgeon.
Cholelithiasis is a medical term that refers to the presence of gallstones in the gallbladder. The gallbladder is a small pear-shaped organ located beneath the liver that stores bile, a digestive fluid produced by the liver. Gallstones are hardened deposits that can form in the gallbladder when substances in the bile, such as cholesterol or bilirubin, crystallize.
Gallstones can vary in size and may be as small as a grain of sand or as large as a golf ball. Some people with gallstones may not experience any symptoms, while others may have severe abdominal pain, nausea, vomiting, fever, and jaundice (yellowing of the skin and eyes) if the gallstones block the bile ducts.
Cholelithiasis is a common condition that affects millions of people worldwide, particularly women over the age of 40 and those with certain medical conditions such as obesity, diabetes, and rapid weight loss. If left untreated, gallstones can lead to serious complications such as inflammation of the gallbladder (cholecystitis), infection, or pancreatitis (inflammation of the pancreas). Treatment options for cholelithiasis include medication, shock wave lithotripsy (breaking up the gallstones with sound waves), and surgery to remove the gallbladder (cholecystectomy).
A jejunostomy is a surgical procedure where an opening (stoma) is created in the lower part of the small intestine, called the jejunum. This stoma allows for the passage of nutrients and digestive enzymes from the small intestine into a tube or external pouch, bypassing the mouth, esophagus, stomach, and upper small intestine (duodenum).
Jejunostomy is typically performed to provide enteral nutrition support in patients who are unable to consume food or liquids by mouth due to various medical conditions such as dysphagia, gastroparesis, bowel obstruction, or after certain surgical procedures. The jejunostomy tube can be used for short-term or long-term nutritional support, depending on the patient's needs and underlying medical condition.
Liver diseases refer to a wide range of conditions that affect the normal functioning of the liver. The liver is a vital organ responsible for various critical functions such as detoxification, protein synthesis, and production of biochemicals necessary for digestion.
Liver diseases can be categorized into acute and chronic forms. Acute liver disease comes on rapidly and can be caused by factors like viral infections (hepatitis A, B, C, D, E), drug-induced liver injury, or exposure to toxic substances. Chronic liver disease develops slowly over time, often due to long-term exposure to harmful agents or inherent disorders of the liver.
Common examples of liver diseases include hepatitis, cirrhosis (scarring of the liver tissue), fatty liver disease, alcoholic liver disease, autoimmune liver diseases, genetic/hereditary liver disorders (like Wilson's disease and hemochromatosis), and liver cancers. Symptoms may vary widely depending on the type and stage of the disease but could include jaundice, abdominal pain, fatigue, loss of appetite, nausea, and weight loss.
Early diagnosis and treatment are essential to prevent progression and potential complications associated with liver diseases.
Hepatitis is a medical condition characterized by inflammation of the liver, often resulting in damage to liver cells. It can be caused by various factors, including viral infections (such as Hepatitis A, B, C, D, and E), alcohol abuse, toxins, medications, and autoimmune disorders. Symptoms may include jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, and dark urine. The severity of the disease can range from mild illness to severe, life-threatening conditions, such as liver failure or cirrhosis.
Pancreatic neoplasms refer to abnormal growths in the pancreas that can be benign or malignant. The pancreas is a gland located behind the stomach that produces hormones and digestive enzymes. Pancreatic neoplasms can interfere with the normal functioning of the pancreas, leading to various health complications.
Benign pancreatic neoplasms are non-cancerous growths that do not spread to other parts of the body. They are usually removed through surgery to prevent any potential complications, such as blocking the bile duct or causing pain.
Malignant pancreatic neoplasms, also known as pancreatic cancer, are cancerous growths that can invade and destroy surrounding tissues and organs. They can also spread (metastasize) to other parts of the body, such as the liver, lungs, or bones. Pancreatic cancer is often aggressive and difficult to treat, with a poor prognosis.
There are several types of pancreatic neoplasms, including adenocarcinomas, neuroendocrine tumors, solid pseudopapillary neoplasms, and cystic neoplasms. The specific type of neoplasm is determined through various diagnostic tests, such as imaging studies, biopsies, and blood tests. Treatment options depend on the type, stage, and location of the neoplasm, as well as the patient's overall health and preferences.
Gallbladder neoplasms refer to abnormal growths in the tissue of the gallbladder, which can be benign or malignant. Benign neoplasms are non-cancerous and typically do not spread to other parts of the body. Malignant neoplasms, also known as gallbladder cancer, can invade nearby tissues and organs and may metastasize (spread) to distant parts of the body. Gallbladder neoplasms can cause symptoms such as abdominal pain, jaundice, and nausea, but they are often asymptomatic until they have advanced to an advanced stage. The exact causes of gallbladder neoplasms are not fully understood, but risk factors include gallstones, chronic inflammation of the gallbladder, and certain inherited genetic conditions.
Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is a genetic disorder that affects the normal functioning of an enzyme called G6PD. This enzyme is found in red blood cells and plays a crucial role in protecting them from damage.
In people with G6PD deficiency, the enzyme's activity is reduced or absent, making their red blood cells more susceptible to damage and destruction, particularly when they are exposed to certain triggers such as certain medications, infections, or foods. This can lead to a condition called hemolysis, where the red blood cells break down prematurely, leading to anemia, jaundice, and in severe cases, kidney failure.
G6PD deficiency is typically inherited from one's parents in an X-linked recessive pattern, meaning that males are more likely to be affected than females. While there is no cure for G6PD deficiency, avoiding triggers and managing symptoms can help prevent complications.
Intrahepatic bile ducts are the small tubular structures inside the liver that collect bile from the liver cells (hepatocytes). Bile is a digestive fluid produced by the liver that helps in the absorption of fats and fat-soluble vitamins from food. The intrahepatic bile ducts merge to form larger ducts, which eventually exit the liver and join with the cystic duct from the gallbladder to form the common bile duct. The common bile duct then empties into the duodenum, the first part of the small intestine, where bile aids in digestion. Intrahepatic bile ducts can become obstructed or damaged due to various conditions such as gallstones, tumors, or inflammation, leading to complications like jaundice, liver damage, and infection.
Extrahepatic bile ducts refer to the portion of the biliary system that lies outside the liver. The biliary system is responsible for producing, storing, and transporting bile, a digestive fluid produced by the liver.
The extrahepatic bile ducts include:
1. The common hepatic duct: This duct is formed by the union of the right and left hepatic ducts, which drain bile from the corresponding lobes of the liver.
2. The cystic duct: This short duct connects the gallbladder to the common hepatic duct, allowing bile to flow into the gallbladder for storage and concentration.
3. The common bile duct: This is the result of the fusion of the common hepatic duct and the cystic duct. It transports bile from the liver and gallbladder to the duodenum, the first part of the small intestine, where it aids in fat digestion.
4. The ampulla of Vater (or hepatopancreatic ampulla): This is a dilated area where the common bile duct and the pancreatic duct join and empty their contents into the duodenum through a shared opening called the major duodenal papilla.
Extrahepatic bile ducts can be affected by various conditions, such as gallstones, inflammation (cholangitis), strictures, or tumors, which may require medical or surgical intervention.
Gallstones are small, hard deposits that form in the gallbladder, a small organ located under the liver. They can range in size from as small as a grain of sand to as large as a golf ball. Gallstones can be made of cholesterol, bile pigments, or calcium salts, or a combination of these substances.
There are two main types of gallstones: cholesterol stones and pigment stones. Cholesterol stones are the most common type and are usually yellow-green in color. They form when there is too much cholesterol in the bile, which causes it to become saturated and form crystals that eventually grow into stones. Pigment stones are smaller and darker in color, ranging from brown to black. They form when there is an excess of bilirubin, a waste product produced by the breakdown of red blood cells, in the bile.
Gallstones can cause symptoms such as abdominal pain, nausea, vomiting, and bloating, especially after eating fatty foods. In some cases, gallstones can lead to serious complications, such as inflammation of the gallbladder (cholecystitis), infection, or blockage of the bile ducts, which can cause jaundice, a yellowing of the skin and eyes.
The exact cause of gallstones is not fully understood, but risk factors include being female, older age, obesity, a family history of gallstones, rapid weight loss, diabetes, and certain medical conditions such as cirrhosis or sickle cell anemia. Treatment for gallstones may involve medication to dissolve the stones, shock wave therapy to break them up, or surgery to remove the gallbladder.
'Digestive System Neoplasms' refer to new and abnormal growths of tissue in the digestive system that can be benign or malignant. These growths are also known as tumors, and they can occur in any part of the digestive system, including the esophagus, stomach, small intestine, large intestine (colon and rectum), liver, bile ducts, pancreas, and gallbladder. Neoplasms in the digestive system can interfere with normal digestion and absorption of nutrients, cause bleeding, obstruct the digestive tract, and spread to other parts of the body (metastasis) if they are malignant.
Benign neoplasms are not cancerous and do not usually spread to other parts of the body. They can often be removed surgically and may not require further treatment. Malignant neoplasms, on the other hand, are cancerous and can invade nearby tissues and organs and spread to other parts of the body. Treatment for malignant neoplasms in the digestive system typically involves a combination of surgery, radiation therapy, and chemotherapy.
The causes of digestive system neoplasms are varied and include genetic factors, environmental exposures, lifestyle factors (such as diet and smoking), and infectious agents. Prevention strategies may include maintaining a healthy diet, avoiding tobacco and excessive alcohol consumption, practicing safe sex, getting vaccinated against certain viral infections, and undergoing regular screenings for certain types of neoplasms (such as colonoscopies for colorectal cancer).
Cholangiocarcinoma is a type of cancer that arises from the cells that line the bile ducts, which are small tubes that carry digestive enzymes from the liver to the small intestine. It can occur in different parts of the bile duct system, including the bile ducts inside the liver (intrahepatic), the bile ducts outside the liver (extrahepatic), and the area where the bile ducts join the pancreas and small intestine (ampulla of Vater).
Cholangiocarcinoma is a relatively rare cancer, but its incidence has been increasing in recent years. It can be difficult to diagnose because its symptoms are often nonspecific and similar to those of other conditions, such as gallstones or pancreatitis. Treatment options depend on the location and stage of the cancer, and may include surgery, radiation therapy, chemotherapy, or a combination of these approaches.
A biliary fistula is an abnormal connection or passage between the biliary system (which includes the gallbladder, bile ducts, and liver) and another organ or structure, usually in the abdominal cavity. This connection allows bile, which is a digestive fluid produced by the liver, to leak out of its normal pathway and into other areas of the body.
Biliary fistulas can occur as a result of trauma, surgery, infection, or inflammation in the biliary system. Symptoms may include abdominal pain, fever, jaundice (yellowing of the skin and eyes), nausea, vomiting, and clay-colored stools. Treatment typically involves addressing the underlying cause of the fistula, such as draining an infection or repairing damaged tissue, and diverting bile flow away from the site of the leak. In some cases, surgery may be necessary to repair the fistula.
Pancreatitis is a medical condition characterized by inflammation of the pancreas, a gland located in the abdomen that plays a crucial role in digestion and regulating blood sugar levels. The inflammation can be acute (sudden and severe) or chronic (persistent and recurring), and it can lead to various complications if left untreated.
Acute pancreatitis often results from gallstones or excessive alcohol consumption, while chronic pancreatitis may be caused by long-term alcohol abuse, genetic factors, autoimmune conditions, or metabolic disorders like high triglyceride levels. Symptoms of acute pancreatitis include severe abdominal pain, nausea, vomiting, fever, and increased heart rate, while chronic pancreatitis may present with ongoing abdominal pain, weight loss, diarrhea, and malabsorption issues due to impaired digestive enzyme production. Treatment typically involves supportive care, such as intravenous fluids, pain management, and addressing the underlying cause. In severe cases, hospitalization and surgery may be necessary.
Cholecystostomy is a medical procedure that involves the creation of an opening or fistula between the gallbladder and the stomach or the skin surface to drain bile from the gallbladder. This procedure is typically performed when there is an obstruction in the cystic duct or common bile duct, leading to inflammation or infection of the gallbladder (cholecystitis).
There are two types of cholecystostomy: percutaneous and open. Percutaneous cholecystostomy is a minimally invasive procedure that involves inserting a small tube through the skin and into the gallbladder under the guidance of imaging techniques such as ultrasound or CT scan. Open cholecystostomy, on the other hand, requires an open surgical incision to access the gallbladder and create the fistula.
Cholecystostomy is usually a temporary measure to manage acute cholecystitis in high-risk patients who are not suitable candidates for surgery or until they become stable enough to undergo a more definitive treatment, such as cholecystectomy (surgical removal of the gallbladder).
Leptospirosis is a bacterial infection caused by pathogenic serovars of the genus Leptospira. It's primarily a zoonotic disease, meaning it can be transmitted from animals to humans. The bacteria are often found in the urine of infected animals and can survive in freshwater environments for weeks or even months.
Humans typically get infected through direct contact with the urine of infected animals or contaminated soil or water. This can occur through cuts or abrasions on the skin, mouth, eyes, or through mucous membranes. Occupational groups like farmers, sewer workers, slaughterhouse workers, and veterinarians are at a higher risk of infection.
The symptoms of leptospirosis can vary widely, but they often include high fever, severe headache, muscle aches, and general weakness. In some cases, it can cause potentially serious complications like meningitis (inflammation of the membrane around the brain and spinal cord), liver damage, kidney failure, and respiratory distress. Early diagnosis and treatment with antibiotics are crucial to prevent these complications.
Cholecystectomy is a medical procedure to remove the gallbladder, a small pear-shaped organ located on the right side of the abdomen, just beneath the liver. The primary function of the gallbladder is to store and concentrate bile, a digestive fluid produced by the liver. During a cholecystectomy, the surgeon removes the gallbladder, usually due to the presence of gallstones or inflammation that can cause pain, infection, or other complications.
There are two primary methods for performing a cholecystectomy:
1. Open Cholecystectomy: In this traditional surgical approach, the surgeon makes an incision in the abdomen to access and remove the gallbladder. This method is typically used when there are complications or unique circumstances that make laparoscopic surgery difficult or risky.
2. Laparoscopic Cholecystectomy: This is a minimally invasive surgical procedure where the surgeon makes several small incisions in the abdomen, through which a thin tube with a camera (laparoscope) and specialized surgical instruments are inserted. The surgeon then guides these tools to remove the gallbladder while viewing the internal structures on a video monitor.
After the gallbladder is removed, bile flows directly from the liver into the small intestine through the common bile duct, and the body continues to function normally without any significant issues.
An exchange transfusion of whole blood is a medical procedure in which a patient's blood is gradually replaced with donor whole blood. This procedure is typically performed in newborns or infants who have severe jaundice caused by excessive levels of bilirubin, a yellowish pigment that forms when hemoglobin from red blood cells breaks down.
During an exchange transfusion, the baby's blood is removed through a vein or artery and replaced with donor whole blood through another vein or artery. The process is repeated several times until a significant portion of the baby's blood has been exchanged with donor blood. This helps to reduce the levels of bilirubin in the baby's blood, which can help prevent or treat brain damage caused by excessive bilirubin.
Exchange transfusions are typically performed in a neonatal intensive care unit (NICU) and require close monitoring by a team of healthcare professionals. The procedure carries some risks, including infection, bleeding, and changes in blood pressure or heart rate. However, it can be a lifesaving treatment for newborns with severe jaundice who are at risk of developing serious complications.
Pancreaticoduodenectomy, also known as the Whipple procedure, is a complex surgical operation that involves the removal of the head of the pancreas, the duodenum (the first part of the small intestine), the gallbladder, and the distal common bile duct. In some cases, a portion of the stomach may also be removed. The remaining parts of the pancreas, bile duct, and intestines are then reconnected to allow for the digestion of food and drainage of bile.
This procedure is typically performed as a treatment for various conditions affecting the pancreas, such as tumors (including pancreatic cancer), chronic pancreatitis, or traumatic injuries. It is a major surgical operation that requires significant expertise and experience to perform safely and effectively.
A Klatskin's tumor, also known as a perihilar cholangiocarcinoma, is a rare and aggressive form of cancer that occurs at the junction where the right and left hepatic ducts come together to form the common hepatic duct, which then becomes the common bile duct. This type of tumor can obstruct the flow of bile from the liver into the small intestine, leading to jaundice, itching, abdominal pain, and other symptoms. Klatskin's tumors are often difficult to diagnose and treat due to their location and tendency to spread quickly. Surgical resection is the preferred treatment option when possible, although chemotherapy and radiation therapy may also be used in some cases.
Imino acids are organic compounds that contain a nitrogen atom as part of an amide-like structure. They are structurally similar to amino acids, which contain a carboxyl group and an amino group, but instead of the amino group, imino acids have a structural unit known as an imine or Schiff base, which is a carbon-nitrogen double bond with a hydrogen atom attached to the nitrogen atom.
One example of an imino acid is proline, which is a cyclic imino acid that plays important roles in protein structure and function. Proline is unique among the 20 standard amino acids because its side chain is linked to the nitrogen atom of the backbone, forming a ring-like structure. This structural feature gives proline unique properties, such as restricted rotation around the bond between the nitrogen and alpha carbon atoms, which can affect protein folding and stability.
Other imino acids may be formed through chemical reactions or enzymatic processes, and they can play important roles in various biological pathways, including the biosynthesis of amino acids, nucleotides, and other biomolecules. However, imino acids are not typically considered to be part of the standard set of 20 amino acids that make up proteins.
Bile duct diseases refer to a group of medical conditions that affect the bile ducts, which are tiny tubes that carry bile from the liver to the gallbladder and small intestine. Bile is a digestive juice produced by the liver that helps break down fats in food.
There are several types of bile duct diseases, including:
1. Choledocholithiasis: This occurs when stones form in the common bile duct, causing blockage and leading to symptoms such as abdominal pain, jaundice, and fever.
2. Cholangitis: This is an infection of the bile ducts that can cause inflammation, pain, and fever. It can occur due to obstruction of the bile ducts or as a complication of other medical procedures.
3. Primary Biliary Cirrhosis (PBC): This is a chronic autoimmune disease that affects the bile ducts in the liver, causing inflammation and scarring that can lead to cirrhosis and liver failure.
4. Primary Sclerosing Cholangitis (PSC): This is another autoimmune disease that causes inflammation and scarring of the bile ducts, leading to liver damage and potential liver failure.
5. Bile Duct Cancer: Also known as cholangiocarcinoma, this is a rare form of cancer that affects the bile ducts and can cause jaundice, abdominal pain, and weight loss.
6. Benign Strictures: These are narrowing of the bile ducts that can occur due to injury, inflammation, or surgery, leading to blockage and potential infection.
Symptoms of bile duct diseases may include jaundice, abdominal pain, fever, itching, dark urine, and light-colored stools. Treatment depends on the specific condition and may involve medication, surgery, or other medical interventions.
Hepatitis A is a viral infection that specifically targets the liver, causing inflammation and impaired function. This disease is caused by the hepatitis A virus (HAV), which spreads primarily through the fecal-oral route, often due to poor sanitation and hygiene. Individuals can become infected by consuming food or water contaminated with HAV or by coming into direct contact with an infected person's stool.
The symptoms of hepatitis A may include fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay-colored bowel movements, joint pain, and jaundice (yellowing of the skin and eyes). However, in some cases, particularly in children under six years old, the infection may be asymptomatic.
While hepatitis A can be unpleasant and cause serious complications, it is rarely fatal and most people recover completely within a few months. Preventive measures include vaccination, practicing good hygiene, and avoiding potentially contaminated food and water.
Favism is a genetic disorder that results in a sensitivity to broad beans (Vicia faba) and related plants. It is most commonly found in populations from the Mediterranean, Middle East, and Asia. The disorder is caused by a deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD), which is necessary for protecting red blood cells from damage.
When individuals with favism eat broad beans or inhale their pollen, the beans' metabolites can cause the release of harmful oxidative agents that destroy red blood cells, leading to hemolytic anemia. Symptoms of favism can include weakness, fatigue, abdominal pain, dark urine, and jaundice. In severe cases, it can lead to kidney failure, seizures, or even death.
Avoiding broad beans and related plants is the primary treatment for favism. In some cases, blood transfusions or medications that boost red blood cell production may be necessary to manage symptoms. It's important to note that not all people with G6PD deficiency will develop favism, and not all people with favism have G6PD deficiency.
The liver is a large, solid organ located in the upper right portion of the abdomen, beneath the diaphragm and above the stomach. It plays a vital role in several bodily functions, including:
1. Metabolism: The liver helps to metabolize carbohydrates, fats, and proteins from the food we eat into energy and nutrients that our bodies can use.
2. Detoxification: The liver detoxifies harmful substances in the body by breaking them down into less toxic forms or excreting them through bile.
3. Synthesis: The liver synthesizes important proteins, such as albumin and clotting factors, that are necessary for proper bodily function.
4. Storage: The liver stores glucose, vitamins, and minerals that can be released when the body needs them.
5. Bile production: The liver produces bile, a digestive juice that helps to break down fats in the small intestine.
6. Immune function: The liver plays a role in the immune system by filtering out bacteria and other harmful substances from the blood.
Overall, the liver is an essential organ that plays a critical role in maintaining overall health and well-being.
Hepatomegaly is a medical term that refers to an enlargement of the liver beyond its normal size. The liver is usually located in the upper right quadrant of the abdomen and can be felt during a physical examination. A healthcare provider may detect hepatomegaly by palpating (examining through touch) the abdomen, noticing that the edge of the liver extends past the lower ribcage.
There are several possible causes for hepatomegaly, including:
- Fatty liver disease (both alcoholic and nonalcoholic)
- Hepatitis (viral or autoimmune)
- Liver cirrhosis
- Cancer (such as primary liver cancer, metastatic cancer, or lymphoma)
- Infections (e.g., bacterial, fungal, or parasitic)
- Heart failure and other cardiovascular conditions
- Genetic disorders (e.g., Gaucher's disease, Niemann-Pick disease, or Hunter syndrome)
- Metabolic disorders (e.g., glycogen storage diseases, hemochromatosis, or Wilson's disease)
Diagnosing the underlying cause of hepatomegaly typically involves a combination of medical history, physical examination, laboratory tests, and imaging studies like ultrasound, CT scan, or MRI. Treatment depends on the specific cause identified and may include medications, lifestyle changes, or, in some cases, surgical intervention.
Endoscopic sphincterotomy is a medical procedure that involves the use of an endoscope (a flexible tube with a light and camera) to cut the papilla of Vater, which contains the sphincter of Oddi muscle. This procedure is typically performed to treat gallstones or to manage other conditions related to the bile ducts or pancreatic ducts.
The sphincterotomy helps to widen the opening of the papilla, allowing stones or other obstructions to pass through more easily. It may also be used to relieve pressure and pain caused by spasms of the sphincter of Oddi muscle. The procedure is usually done under sedation or anesthesia and carries a risk of complications such as bleeding, infection, perforation, and pancreatitis.
A Choledochal cyst is a congenital dilatation or abnormal enlargement of the bile ducts, which are the tubes that carry bile from the liver to the small intestine. Bile is a digestive juice produced by the liver that helps in the digestion of fats.
Choledochal cysts can be classified into several types based on their location and the anatomy of the biliary tree. The most common type, called Type I, involves dilatation of the common bile duct. Other types include dilatation of the intrahepatic bile ducts (Type II), dilatation of both the intrahepatic and extrahepatic bile ducts (Type III), and multiple cystic dilatations of the bile ducts (Type IV).
Choledochal cysts are more common in females than males, and they can present at any age. Symptoms may include abdominal pain, jaundice, vomiting, and fever. Complications of choledochal cysts can include bile duct stones, infection, and cancer. Treatment typically involves surgical removal of the cyst, followed by reconstruction of the biliary tree.
Biliary tract neoplasms refer to abnormal growths or tumors that develop in the biliary system, which includes the gallbladder, bile ducts inside and outside the liver, and the ducts that connect the liver to the small intestine. These neoplasms can be benign (non-cancerous) or malignant (cancerous).
Malignant biliary tract neoplasms are often referred to as cholangiocarcinoma if they originate in the bile ducts, or gallbladder cancer if they arise in the gallbladder. These cancers are relatively rare but can be aggressive and difficult to treat. They can cause symptoms such as jaundice (yellowing of the skin and eyes), abdominal pain, weight loss, and dark urine.
Risk factors for biliary tract neoplasms include chronic inflammation of the biliary system, primary sclerosing cholangitis, liver cirrhosis, hepatitis B or C infection, parasitic infections, and certain genetic conditions. Early detection and treatment can improve outcomes for patients with these neoplasms.
Cholagogues and choleretics are terms used to describe medications or substances that affect bile secretion and flow in the body. Here is a medical definition for each:
1. Cholagogue: A substance that promotes the discharge of bile from the gallbladder into the duodenum, often by stimulating the contraction of the gallbladder muscle. This helps in the digestion and absorption of fats. Examples include chenodeoxycholic acid, ursodeoxycholic acid, and some herbal remedies like dandelion root and milk thistle.
2. Choleretic: A substance that increases the production of bile by the liver or its flow through the biliary system. This can help with the digestion of fats and the elimination of waste products from the body. Examples include certain medications like ursodeoxycholic acid, as well as natural substances such as lemon juice, artichoke extract, and turmeric.
It is important to note that while cholagogues and choleretics can aid in digestion, they should be used under the guidance of a healthcare professional, as improper use or overuse may lead to complications like diarrhea or gallstone formation.
The cystic duct is a short tube that connects the gallbladder to the common bile duct, which carries bile from the liver and gallbladder into the small intestine. The cystic duct allows bile to flow from the gallbladder into the common bile duct when it is needed for digestion. It is a part of the biliary system and plays an important role in the digestive process.
Drug-Induced Liver Injury (DILI) is a medical term that refers to liver damage or injury caused by the use of medications or drugs. This condition can vary in severity, from mild abnormalities in liver function tests to severe liver failure, which may require a liver transplant.
The exact mechanism of DILI can differ depending on the drug involved, but it generally occurs when the liver metabolizes the drug into toxic compounds that damage liver cells. This can happen through various pathways, including direct toxicity to liver cells, immune-mediated reactions, or metabolic idiosyncrasies.
Symptoms of DILI may include jaundice (yellowing of the skin and eyes), fatigue, abdominal pain, nausea, vomiting, loss of appetite, and dark urine. In severe cases, it can lead to complications such as ascites, encephalopathy, and bleeding disorders.
The diagnosis of DILI is often challenging because it requires the exclusion of other potential causes of liver injury. Liver function tests, imaging studies, and sometimes liver biopsies may be necessary to confirm the diagnosis. Treatment typically involves discontinuing the offending drug and providing supportive care until the liver recovers. In some cases, medications that protect the liver or promote its healing may be used.
Technetium Tc 99m Disofenin is not a medical condition, but rather a radiopharmaceutical used in diagnostic imaging. It is a radioactive tracer used in nuclear medicine scans, specifically for liver and biliary system imaging. The compound consists of the radioisotope Technetium-99m (Tc-99m) bonded to the pharmaceutical Disofenin.
The Tc-99m is a gamma emitter with a half-life of 6 hours, making it ideal for diagnostic imaging. When administered to the patient, the compound is taken up by the liver and excreted into the bile ducts and gallbladder, allowing medical professionals to visualize these structures using a gamma camera. This can help detect various conditions such as tumors, gallstones, or obstructions in the biliary system.
It's important to note that Technetium Tc 99m Disofenin is used diagnostically and not for therapeutic purposes. The radiation exposure from this compound is generally low and considered safe for diagnostic use. However, as with any medical procedure involving radiation, the benefits and risks should be carefully weighed and discussed with a healthcare professional.
Choledocholithiasis is a medical condition characterized by the presence of one or more gallstones in the common bile duct, which is the tube that carries bile from the liver and gallbladder to the small intestine. Bile is a digestive fluid produced by the liver that helps break down fats in the small intestine. Gallstones are hardened deposits of digestive fluids that can form in the gallbladder or, less commonly, in the bile ducts.
Choledocholithiasis can cause a variety of symptoms, including abdominal pain, jaundice (yellowing of the skin and eyes), nausea, vomiting, and fever. If left untreated, it can lead to serious complications such as infection or inflammation of the bile ducts or pancreas, which can be life-threatening.
The condition is typically diagnosed through imaging tests such as ultrasound, CT scan, or MRI, and may require endoscopic or surgical intervention to remove the gallstones from the common bile duct.
Ursodeoxycholic acid (UDCA) is a naturally occurring bile acid that is used medically as a therapeutic agent. It is commonly used to treat gallstones, particularly cholesterol gallstones, and other conditions associated with abnormal liver function, such as primary biliary cholangitis (PBC). UDCA works by decreasing the amount of cholesterol in bile and protecting liver cells from damage. It is also known as ursodiol or Ursotan.
Biliary cirrhosis is a specific type of liver cirrhosis that results from chronic inflammation and scarring of the bile ducts, leading to impaired bile flow, liver damage, and fibrosis. It can be further classified into primary biliary cholangitis (PBC) and secondary biliary cirrhosis. PBC is an autoimmune disease, while secondary biliary cirrhosis is often associated with chronic gallstones, biliary tract obstruction, or recurrent pyogenic cholangitis. Symptoms may include fatigue, itching, jaundice, and abdominal discomfort. Diagnosis typically involves blood tests, imaging studies, and sometimes liver biopsy. Treatment focuses on managing symptoms, slowing disease progression, and preventing complications.
Palliative care is a type of medical care that focuses on relieving the pain, symptoms, and stress of serious illnesses. The goal is to improve quality of life for both the patient and their family. It is provided by a team of doctors, nurses, and other specialists who work together to address the physical, emotional, social, and spiritual needs of the patient. Palliative care can be provided at any stage of an illness, alongside curative treatments, and is not dependent on prognosis.
The World Health Organization (WHO) defines palliative care as: "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual."
Adenoma of the bile duct is a benign (noncancerous) tumor that develops in the bile ducts, which are tiny tubes that carry bile from the liver to the gallbladder and small intestine. Bile is a digestive fluid produced by the liver.
Bile duct adenomas are rare and usually do not cause any symptoms. However, if they grow large enough, they may obstruct the flow of bile and cause jaundice (yellowing of the skin and whites of the eyes), abdominal pain, or itching. In some cases, bile duct adenomas may become cancerous and develop into bile duct carcinomas.
The exact cause of bile duct adenomas is not known, but they are more common in people with certain genetic disorders, such as Gardner's syndrome and von Hippel-Lindau disease. Treatment for bile duct adenomas typically involves surgical removal of the tumor.