Bile-duct obstruction

Hepatobiliary disease occurs due to bile duct obstruction from abnormal bile composition and flow. Hepatomegaly, splenomegaly, and cholecystitis may be present. Hepatic steatosis may also be present due to effects of malnutrition. The progression from cholestasis (impaired bile flow) to portal fibrosis and to focal and multilobar cirrhosis, esophageal varices, and portal hypertension takes several years. Many patients are compensated and asymptomatic but maybe susceptible to acute decompensation in the event of extrinsic hepatic insult from viruses, medications, or other factors.7... 

Malabsorption of protein and fat occurs when the capacity for enzyme secretion is reduced by 90%. A minority of patients develop complications including pancreatic pseudocyst, abscess, and ascites or common bile duct obstruction leading to cholangitis or secondary biliary cirrhosis. 

A portion of the urobilinogen is further converted to bile pigments (stercobdin) and excreted in the feces producing their characteristic red-brown color. Bile duct obstruction results in day-colored stools. 

Conditicms that increase direct bilirubin Hepatic damage Bile duct obstruction... 

C. Albrecht, B. N. Melgert, J. Reichen, K. Poelstra, and D. K. F. Meijer, Effect of chronic bile duct obstruction and LPS upon targeting of naproxen to the fiver using naproxen-albumin conjugate, J. Drug Target 6 105-117 (1998). 

It should be noted that deficiency states for some vitamins (e.g., pantothenic acid) are practically unknown in human beings. In such cases, deficiency states may be simulated by feeding the subject an appropriate vitamin antagonist. In another series of situations, vitamin deficiencies can be brought about by interfering with their absorption intentionally or may be the result of a disease process. Thus, fat-soluble vitamin deficiency may develop in cases of fat malabsorption syndromes (steatorrhea) sprue, pancreatic insufficiency, and bile duct obstruction. 

Normally there is very little fat in the feces. However, fat content in stools may increase because of various fat malabsorption syndromes. Such increased fat excretion is steatorrhea. Decreased fat absorption may be the result of failure to emulsify food contents because of a deficiency in bile salts, as in liver disease or bile duct obstruction (stone or tumor). Pancreatic insufficiency may result in an inadequate pancreatic lipase supply. Finally, absorption itself may be faulty because of damage to intestinal mucosal cells through allergy or infection. An example of allergy-based malabsorption is celiac disease, which is usually associated with gluten intolerance. Gluten is a wheat protein. An example of intestinal infection is tropical sprue, which is often curable with tetracycline. Various vitamin deficiencies may accompany fat malabsorption syndromes. 

Unusually large bile duct obstruction, for example gallstone in common bile duct, tumour obstructing common bile duct. Choledocholithiasis (chronic or acute) is the presence of gallstones in the common bile duct Severe liver failure with cirrhosis Severe hepatitis. 

Cholangiodestmctive cholestasis is caused by bile duct obstruction which may be intrahepatic or extrahepatic. Bile duct injury may lead to sloughing of epithelial cells into the lumen, cell edema, and inflammation, which may contribute to obstruction (Treinen-Moslen, 2001 Plumlee, 2004). Chronic lesions associated with cholangiodestmctive cholestasis typically include bile duct prohferation and periductular fibrosis. Vanishing bile duct syndrome, characterized by a loss of bile ducts, has been seen in chronic cholestatic disease in humans (Zimmerman, 1999 Treinen-Moslen, 2001) and has been produced experimentally in dogs (Uchida, 1989). 

Percutaneous liver biopsy in patients with large bile duct obstruction. Gastroenterology 1975 750-754... 

Scintigraphic assessment of liver transplants is helpful (e.g. perfusion, rejection, bile-duct obstruction or bile leakage). (28)... 

Carstensen, H., Nilsson, K.O., Nettleblad, S.-C., Cederlund, C.-G., Hild-ell, J. Common bile duct obstruction due to an intraluminal mass of candidiasis in a previously healthy child. Pediatrics 1986 77 858-861... 

Marcucd, R.A., Whitely, H., Armstrong, D. Common bile duct obstruction secondary to infection with Candida. J. Clin. Microbiol. 1978 7 490-492... 

An 87-year-old man took cinnarizine 75 mg/day for tinnitus and developed jaundice 7 weeks later, with dark urine and pale stools (6). He had taken no other drugs. Bile duct obstruction was ruled out and serological tests for viral hepatitis were negative. A liver biopsy 6 weeks later showed distinct centrilobular cholestasis and a shght lymphocytic infiltrate. He recovered completely and the hver tests were normal after another 3 months without cinnarizine. Rechallenge was not performed. 

In 27 patients who received intrahepatic floxuridine, total dose 20-41 mg/kg extrahepatic biliary sclerosis was discovered by CT scan and ultrasound, followed by endoscopic retrograde cholangiopancreatography and/or percutaneous cholangiography in three cases (4). Radiological findings included complete obstruction of the common hepatic duct in one case, common hepatic duct stenosis in two cases, common bile duct obstruction in one case, and intrahepatic bile duct dilatation without identifiable obstruction in one case... 

Although vitamin K deficiency in the adult is uncommon, the risk is increased for fat malabsorption states (bile duct obstruction, cystic fibrosis, and chronic pancreatitis) and liver disease. Risk is also increased by the use of drugs that interfere with vitamin K metabolism, such as the coumarin anticoagulants (e.g., warfarin) and antibiotics containing the N-methylthiotetrazole side chain (e.g., cephalosporin). ... 

Acute fatty liver of pregnancy Bile duct obstruction Budd-Chiari syndrome Drug-induced hepatitis... 

Dietrich, C.G. et al. (2004) Consequences of bile duct obstruction on intestinal expression and function of multidrug resistance-associated protein 2. Gastroenterology, 126 (4), 1044—1053. 

The liver can be involved in CF. Biliary cirrhosis secondary to bile duct obstruction occurs in as many as 18% of patients, whereas fatty infiltration occurs in about 30% of patients in a pattern unrelated to nutritional status. Bile ducts may be obstructed by inspissated mucus, which may lead to focal or multilobar cirrhosis. Such hepatic involvement can occur at any age but is more common with advancing age and can lead to portal hypertension, esophageal varices, and hypersplenism. The most common laboratory abnormality associated with hepatic involvement is elevated serum hepatic isoenzymes (gamma-glutamyltranspeptidase, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase)." ... 

Includes primary biliary cirrhosis, bile duct obstruction. 

Kaplan MM, Righetti A (1970) Induction of rat liver alkaline phosphatase the mechanism of the serum elevation in bile duct obstruction. J Clin Invest 49 508-516... 

Fig. 10. Serum alkaline phosphatase values (King-Armstrong units/deciliter) in 49 patients with documented bile duct obstruction (solid circles) and in 49 patients with hepatic cirrhosis or hepatitis (open circles). Note the si ficant overlap between the groups. Note also that the highest value in biliary obstruction was Iras than ten times the upper limit of normal. From Hill and Zieve (H14) with permission.

Normal serum alkaline phosphatase activities are found in patients with acute cholecystitis provided there is no associated bile duct obstruction (G19). 

Snape, W. J., Long, W. B., Trotman, B. W., Marin, G. A., and Czaja, A. J., Marked alkaline phosphatase elevation with partial common bile duct obstruction due to calcific pancreatitis. Gastroenterology 70, 70-73 (1976). 

Nordyke, R. A., Diagnosis of distal common bile duct obstruction with radio-iodinated rose bengal. Clin. Res. 7, 295 (1959). 

An obstruction or occlusion of the common bile duct affects the clearance of the Tc-IDA complex into the duodenum, resulting in an increased transit time and an abnormal scintigram. The absence of biliary tract visualization in the presence of normal hepatic extraction indicates an acute common bile duct obstruction from a stone in the common bile duct (Fink-Bennett 1995). 

Chapter 2). Plasma ALT can increase or decrease following microsomal enzyme induction effects in the rat and the dog (Amacher, Schomaker, and Burkhardt 1998 Amacher et al. 2001) and when there is a heavy fatty infiltration of hepatic cells, where plasma enzymes may reflect the displacement of cytoplasm as the fat load increases. This enzyme may also be increased in biliary toxicity and following bile duct obstruction through the effects of bile salts on the neighboring hepatocyte cell membranes. ALT can be affected by food intake and stress (Chapter 11). Plasma ALT is the most useful enzyme for detecting hepatocellular injury in most laboratory animal species. 

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