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The Effects of Bile Duct Obstruction on Liver Volume: An Experimental Study  [PDF]
Bahtiyar Ertor,Serdar Topaloglu,Adnan Calik,Umit Cobanoglu,Ali Ahmetoglu,Huseyin Ak,Erdem Karabulut,Mithat Kerim Arslan
ISRN Surgery , 2013, DOI: 10.1155/2013/156347
Abstract: Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group ( ) was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL ( ). It was increased up to 60% of baseline values 25 days after BDL ( ). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 ( ). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice. 1. Introduction Chronic cholestatic liver disease and bile duct tumors are the main causes of chronic cholestasis in daily clinical practice. Postcanalicular biliary obstruction leads to bile duct epithelial cell proliferation and periportal fibrosis [1–3]. Clinical and experimental studies have found that only the timely restoration of bile flow can halt fibrosis and reverse biliary hyperplasia [4–6]. The role of bile duct obstruction on liver volume has not been evaluated in detail. Thus, the aim of this study was to identify the time-dependent alterations on liver volume after bile duct ligation. 2. Materials and Methods Thirty-six male Sprague-Dawley rats weighing between 180 and 300?g were used for the study. They were kept under routine laboratory conditions and received standard laboratory chow with free access to food and water. The study protocol was approved by the institutional Ethics Committee for Experimental Studies at February 3, 2010, document number: 01/2010. 2.1. Experimental Design The animals were divided into four groups of 8 animals. Weight measurement and abdominal tomography under intraperitoneal ketamine (50?mg/kg, Ketalar, Parke-Davis, Ann Arbor, Michigan, USA) anesthesia for volumetric analyses were performed before bile duct ligation (BDL). In group 1 ( ), abdominal tomography (CT) was performed 3 days after BDL for
The Effect of Resveratrol on Bone Status in Rats with Bile Duct Obstruction  [PDF]
Helena Zivna, Stanislav Micuda, Eva Brcakova-Dolezelova, Pavel Zivny
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2013, DOI: 10.4236/ojemd.2013.31007

Objective: We studied the influence of bile duct obstruction (BDO) after 28 days on bone metabolism status and their modification by resveratrol in male Wistar rats. Methods: The rats were divided into 3 groups: Sham group with laparotomy and vehiculum application, group BDO—bile duct obstruction and vehiculum application, and group RBDO—bile duct obstruction and resveratrol application (10 mg/kg dose of resveratrol orally once daily). The bone mineral density (BMD; g/cm2) and body composition were measured by dual energy X-ray absorptiometry. The physiccal strenght of femur was examined by controlled break biomechanical testing. The osteocalcin, procollagen type I N-terminal propeptide (PINP) and carboxy-terminal collagen crosslinks (CTX) were analysed by EIA in the bone tissue homogenate. Results: The total BMD was lower in group BDO (0.176 ± 0.005; p = 0.01) and R-BDO (0.181 ± 0.004; p = 0.052) vs Sham (0.209 ± 0.003). BMD of femur diaphysis in BDO group decreased significantly (p = 0.01) but not in R-BDO animals (p = 0.052). Body fat (g, median) was lower in BDO (19.0) and R-BDO (26.0) than in Sham (35.0). The force needed for fracture of femurs (N) significantly decreased in BDO (154 ± 6) and R-BDO (151 ± 13) vs Sham group (208 ± 7). The force needed for neck fracture decreased in BDO (105 ± 3) and R-BDO (115 ± 8) vs Sham (135 ± 9). The osteocalcin decrease in group R-BDO (2.9 ± 0.1) vs Sham (3.7 ± 0.4). Higher PINP/CTX were in BDO (20 ±

Analysis of 777 cases with obstruction of the ureter or extrahepatic bile duct by ultrasonography after normal saline retention enema
Chong Tang, Xuegang Wu, Qiuhong Fan, Zhensheng Deng
Critical Ultrasound Journal , 2012, DOI: 10.1186/2036-7902-4-6
Abstract: The normal saline retention enema method, that is, using normal saline-filled colons to gain acoustic access to the bilateral ureters and extrahepatic bile duct and detecting the lesions with transabdominal ultrasonic diagnostic apparatus, was applied to 777 patients with obstructive lesions, including 603 with hydroureter and 174 with dilated common bile duct, which were not visualized by conventional ultrasonography. The follow-up data of all the patients were collected to verify the results obtained by this method.Of the 755 patients who successfully finished the examination after normal saline retention enema (the success rate of the enema is about 98%), the nature of obstruction in 718 patients was determined (the visualizing rate is approximately 95%), including 533 with ureteral calculus, 23 with ureteral stricture, 129 with extrahepatic bile duct calculus, and 33 with common bile duct tumor.Colons filled fully with normal saline can surely give acoustic access to the bilateral ureters and extrahepatic bile duct so as to determine the nature of obstruction of these structures when conventional transabdominal ultrasound fails.Obstructive diseases of the ureters and extrahepatic bile duct caused by lithiasis, cancer, stricture, etc. are commonly encountered in the clinical setting, and their diagnosis mainly relies on imaging, such as X-ray contrast radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography. Though CT and MRI are more convenient in getting reliable diagnostic results, there are some disadvantages such as much higher cost and higher risks caused by the ionizing radiation of CT and the strong magnetic field of an MRI scanner [1,2]. However, ultrasound is commonly available, inexpensive to operate, and has no risk from radiation exposure or strong magnetic field, so it is commonly used as a diagnostic tool in patients with obstructive diseases of the urinary system or extrahepatic bile duct [3].The disadvantage is
Intrahepatic segmental bile duct B3 cholangiojejunostomy in the palliative management of high unresectable malignant biliary obstruction
Karamarkovi? Aleksandar P.,Mili? Nata?a M.,?uki? Vladimir R.,Radenkovi? Dejan
Acta Chirurgica Iugoslavica , 2004, DOI: 10.2298/aci0403085k
Abstract: Palliating the effects of biliary obstruction is a major goal of therapy in patients with unresectable cancer at the hepatic duct confluence. We reviewed our expirience with intrahepatic holangioenteric bypass to the segmental bile duct B3 as a palliative therapy in patients with unresectable malignant diseases involving the ductal confluence or the common hepatic duct. Since March 2001, we have performed intrahepatic segmental bile duct B3 cholangiojejunostomy by Roux-en-Y fashion utilizing a round ligament approach in 13 patients with malignant obstructive jaundice due to unresectable hilar holangiocarcinoma (8 cases) and gallbladder cancer (5 cases). Mean hospital stay was123 days and mean blood loss was 25060 mL. Postoperative complications occurred in 3 patients (23 %), but there was no surgical complications such as postoperative bleeding, bile leakage or abscess formation. 30-day mortality was 7.7% (1 patient). Late complications (37.5 %) were observed in 3 of the 8 patients who survived for more than 5 months after the surgery. Median survival after B3 cholangiojejunostomy was 9 months (range, 10 days-22 months). Median survival time was significantly greater in patients with hilar cholangio-carcinoma (11.8 months; range: 2-22 months) compared with those with gallbladder cancer (4.6 months; range: 10 days-11.5 months) ( P-0.032 log rank test; P-0.049 Tarone-Ware test). Intrahepatic B3 cholangiojejunostomy when combined with careful patient selection, can provide useful palliation from jaundice, pruritus and cholangitis with acceptable mortality and morbidity rates.
Reversibility of Hepatic Histological Damage after Surgical Temporary Obstruction of the Common Bile Duct in a Murine Model  [cached]
H. Juarez Olguín,R. Alemon Medina,J. L. Figueroa Hernandez,D. Calderon Guzman
International Journal of Biomedical Science , 2011,
Abstract: The reversibility of hepatic histological damage after restoring bile flow in a murine model was assessed. 25 male Balb C mice (25-35 g, age 6 weeks) were divided into 5 groups and their common bile duct (CBD) fastened to obstruct the release of gall bladder and liver contents. Group I, CBD untied at day 10, group II at day 15, and groups III and IV at days 20 and 30, respectively. Hematoxilin-eosin stained liver slices were analysed 0, 5, 10 and 20 days after restoring bile flow. Group I showed slight histological lesions (second stage), as cholangiolar bile pigment concretion, pericholangiolar and portal collagen accumulation; group II, mild lesions (third stage), as cholangiolar hamartomatous proliferation and bile duct portal fibrosis; group III showed severe lesions (fourth stage), as loss of functional parenchyma, and also the second and first stage lesions. Group IV died before 30 days. First stage corresponds to absent lesions (control group). Group I recovered totally, group II recovered only from slight lesions and group III had irreversible damage. Severity of lesions increased gradually and accumulatively, irreversible hepatic damage was achieved at 20 days and is deadly at 30 days. Our model of temporary CBD obstruction was suitable to assess reversibility of hepatic histological damage
Pancreaticobiliary malunion and incomplete pancreas divisum: an unusual cause of common bile duct obstruction
J Petrasek , , T Hucl , J Spicak
Advances in Medical Sciences , 2008, DOI: 10.2478/v10039-008-0002-3
Abstract: Purpose: Pancreaticobiliary malunion (PBM) is a distinct disease entity of the pancreatic and biliary ductal system defined as a condition in which the junction of the pancreatic and biliary ducts occurs above the duodenal wall. PBM may be combined with a stenosis of the distal common bile duct and pathological changes in the common bile duct wall (congenital cyst of bile duct), being a potentially malignant condition. Pancreas divisum, resulting from a fusion failure of the ventral and dorsal pancreatic buds, and characterized by a dominant Santorine duct, is considered to be a predisposing factor to recurrent attacks of acute pancreatitis. In incomplete pancreas divisum, the ventral and dorsal pancreas are connected by a segmental branch. Material and Methods: We report a case of a 33-year-old female patient with PBM associated with incomplete pancreas divisum, who had presented episodes of acute cholangitis due to a benign distal common bile duct stricture. Results: Treatment with choledochoduodenostomy and cholecystectomy provided thorough relief and resolution of symptoms. Conclusion: This is the first report of coexistent PBM and incomplete pancreas divisum in a Caucasian patient with unusually late clinical manifestation.
Evaluation of the mitochondrial respiration of cardiac myocytes in rats submitted to mechanical bile duct obstruction
Kemp, Rafael;Castro-e-Silva, Orlando de;Santos, José Sebasti?o dos;Sankarankutty, Ajith Kumar;Correa, Rodrigo Borges;Baldo, Caroline Floreoto;Souza, Maria Elisa Jordani;Jordani, Maria Cecilia;
Acta Cirurgica Brasileira , 2008, DOI: 10.1590/S0102-86502008000700012
Abstract: purpose: the objective of the present study was to evaluate the capacity of the myocardium for energy production by the analysis of mitochondrial respiration in rats with jaundice submitted to bile duct ligature. methods: sixteen male wistar rats were divided into 2 groups: group so submitted to nontherapeutic laparotomy (sham operation) and group ic (icteric group) submitted to bile duct ligature. after 7 days, laparotomy was again performed in all animals for cardiac muscle extraction and analysis. mitochondrial oxygen consumption was determined by stage 3 velocity and stage 4 velocity. the respiratory control ratio (rcr) was obtained by the ratio of stage 3 to stage 4 velocity. statistical analysis was performed by the mann-whitney test, with the level of significance set at 5% (p<0.05). results: statistical analysis revealed a significant drop in oxygen consumption during stage 3 mitochondrial respiration in group ic compared with so, whereas the values obtained during stage 4 were basically identical for the two groups. likewise, rcr values exhibited a significant reduction. conclusion: the cellular respiration of the "jaundiced heart" is depressed. this was demonstrated by the reduced capacity of cardiac mitochondria to consume oxygen and synthesize atp, supporting the idea of a latent cardiac impairment responsible for the hemodynamic decompensation occurring during cholestasis.
Obstructive jaundice secondary to bile duct involvement with Hodgkin's disease: a case report
Di Sena, Veruska;Thuler, Fernanda Prata Borges Martins;Macedo, Erika Pereira;Paulo, Gustavo Andrade de;Della Libera, Ermelindo;Ferrari, Angelo Paulo;
Sao Paulo Medical Journal , 2005, DOI: 10.1590/S1516-31802005000100007
Abstract: context: obstructive jaundice due to lymphoma is very rare. it may be difficult to distinguish between this condition and a large number of causes of extrahepatic bile duct obstruction, even by endoscopic retrograde cholangiography. its prognosis is poor. combined chemotherapy and/or radiotherapy with bile duct drainage is a therapeutic option. case report: we describe a case of obstructive jaundice as the initial presentation of hodgkin's disease. after chemotherapy and endoscopic bile duct stenting, it was noted that the enlarged lymph nodes, jaundice and bile duct dilation disappeared.
Strategies for endoscopic and surgical management of common bile duct stones  [PDF]
Stojanovi? Drago? Lj.,Stojanovi? Mirjana,Milojevi? Predrag S.,?aparevi? Zorica
Medicinski Pregled , 2003, DOI: 10.2298/mpns0302069s
Abstract: Introduction Common bile duct calculi represent a pathologic entity involving obstructive icterus, cholangitis, hepatic cirrhosis or pancreatitis. Common bile duct calculi mostly have a secondary origin (from gallbladder) in 95% of cases, while primary choledocholithiasis is rare. Classification From surgical aspect, common bile duct calculi can be: 1. Asymptomatic, without manifested symptoms or signs,2. Mobile, with intermittent biliar obstruction and disobstruction, 3. Fixed, with obstruction and signs of hepato-biliary and/or bilio-pancreatic duct, 4. Transitory, microcalculi which pass through Vater's Papilla by propulsion into duodenum with symptoms. Discussion Modern biliary surgery includes diagnosis of common bile duct calculi, and if possible preoperative endoscopic (endoluminal) surgery, which is less invasive for patients. If such approach is not possible, it is necessary to perform stone extraction and cholecystectomy. Conclusion Common bile duct calculi represent a common disease of the digestive system. Endoscopic diagnostic procedure is very important in management of choledocholithiasis Endoscopic treatment of common bile duct calculi prior to cholecystectomy is a method of choice and a strategy for associated cholecysto-choledocholithiasis.
Hydatid cyst of common bile duct mimicking type 1 choledochal cyst  [cached]
De Utpal,Basu Mina
Journal of Indian Association of Pediatric Surgeons , 2007,
Abstract: A 11 year-old girl presented with pain in the abdomen, an abdominal mass and jaundice. Clinical examination and investigations suggested a diagnosis of a type 1 choledochal cyst. Upon operation, a solitary, unruptured hydatid cyst was found obstructing the common bile duct. Intrinsic obstruction of the extrahepatic bile duct by a solitary hyatic cyst without any hepatic involvement as seen in this unique case, has not been reported until now.

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