Biliary disease

Cirrhosis is among the top 10 causes of death in the Western World. This is largely the result of alcohol abuse, viral hepatitis and biliary diseases [75]. The causes for cirrhosis can be roughly divided into six categories ... 

In clinical experience the drug has shown the properties expected from earlier experimental work. It has been studied in biliary disease [412, 413] in general surgical work [414] and in a variety of pulmonary infections [415-8]. The results have justified early optimism in particular the very high concentrations achieved in bile make the drug eminently suitable for infections of the biliary tract. 

Indicationsand Dosages Alert Oral dosing is preferred. Administer the drugIM only in patients with GI, hepatic, or biliary disease associated with malabsorption of vitamin D. 

IM therapy should be reserved for patients with GI, liver, or biliary disease associated with vitamin D malabsorption... 

Among the different roles previously described, the liver exerts an excretory function, being involved in the formation of bile, which drains into the small intestine. Bile salts in the bile play an important role as emulsifying agents for the reabsorption of lipids and fatty acids from the intestine. Hepatic and obstructive biliary diseases lead to abnormal metabolism of bile acids (BAs). 

Liver cirrhosis is among the top 10 causes of death in the Western world. The disease occurs after chronic damage to hepatic cells, mainly hepatocytes, which can be caused by viral hepatitis, chronic alcohol abuse or toxic injury, biliary disease, and metabolic liver disorders [64], Liver cirrhosis is characterized by an abnormal deposition of connective tissue in the liver, which hampers the normal functions of the liver. Other features of the disease are general tissue damage, chronic inflammation, and the conversion of normal liver architecture into structurally abnormal nodules. Secondary to these anatomical changes are disturbances in the liver function and in the hemodynamics leading to portal hypertension and intrahepatic shunting [39, 64, 103],... 

S. L. Friedman, G. H. Millward-Sadler, and M. J. P. Arthur, Liver fibrosis and cMhosis, Wright s Liver and Biliary Disease. Pathophysiology, Diagnosis and Management, 3rd ed. (G. H. Millward-Sadler, R. Wright, M. J. P. Arthur, eds.), W. B. Saunders Company Ltd., London Philadelphia Toronto Sydney Tokyo, 1992,... 

The test is valid for diagnosing severe pancreatic exocrine insufficiency but has the sensitivity limitations described above with respect to detecting mild impairment of pancreatic function. Conversely, despite the inclusion of the control test, false-positive results may occur in patients with intestinal and biliary diseases, as well as following gastric resection or Yen-Roux procedures. In the latter patients, intraluminal lack of pancreatic enzymes (despite normal secretory... 

Secondary hyperlipidaemias results from liver and biliary disease, obesity, hypothyroidism, diabetes, diet, alcohol excess, renal disease (nephrotic syndrome) and drugs (including etretinate, HIV protease ir hibitors, thiazide diuretics, oral contraceptive steroids, glucorticosteroids, (3-adrenoceptor antagonists, ciclosporin). 

Elevation of 5 -NU is found in cholestasis, biliary diseases and liver tumours (in 80-90% of metastases). It not only precedes, but also persists longer than AP. The... 

In the case of suspected liver or biliary diseases, US is always indicated. Sonography has become a routine examination technique. (56, 75) (s. tab. 6.4)... 

Boyce, H.W. Diagnostic laparoscopy in hver and biliary disease. Endoscopy 1992 24 676-681... 

Teplick, St.K., Flick, P., Brandon, J.C. Transhepatic cholangiography in patients with suspected biliary disease and nondilated intrahepatic bile ducts. Gastrointest. Radiol. 1991 16 193-197... 

We do not consider the terminological demarcation of primary cirrhosis or the differentiation into primary and secondary cirrhosis to be acceptable because any kind of biliary cirrhosis constitutes the final stage of a preceding chronic biliary disease, (s. p. 646 )... 

Therapeutic drug concentrations within the bile duct and gall bladder are dependent upon biliary excretion. In the presence of biliary disease, such as gallstones or chronic inflammation, the drug... 

Laurent-Puig, P., Lubin, R Semhoun-Ducloux, S., Pelletier, G., Fourre, C., Ducreux, M., Briantais, M Buffet, C., and Soussi, T. (1995) Antibodies against p53 protein in serum of patients with benign or malignant pancreatic and biliary diseases. Gut 36,455 158. 

Kaplowitz N. Liver and biliary disease, 2nd ed. Baltimore Williams and Wilkins, 1996. 

The literature contains literally hundreds of reports on the influence of liver disease on drug elimination. Most commonly the patients in these studies have various degrees of fatty degeneration or cirrhosis (the former often associated with alcohol or diabetes, and the latter most commonly due to hepatitis viruses, alcohol, but sometimes obliterative biliary disease or autoimmune disease). These diseases are more often associated with intrinsic alterations in pharmacodynamic responses, for example liability to seizure is common in patients suddenly withdrawn from chronic alcohol abuse, and the encephalopathy associated with elevated circulating concentrations of ammonia or superimposed acute hepatic disease or gastrointestinal bleeding. 

Biliary disease Hours Visceral (wax and wane) Spontaneous, food Time, analgesia Epigastric, radiates Colic... 

Narcotics. Narcotics given to patients with proven biliary disease caused a significant rise in serum alkaline phosphatase within 6 hours of injection. Elevated activities persisted over the subsequent 18 hours (M26). No such elevations were noted in the absence of biliary disease (B16, S34). 

ABSORPTION, DISTRIBUTION, AND EXCRETION Gastrointestinal (Gl) absorption of amphotericin B is negligible and intravenous dehvery is used. Amphotericin B in plasma is >90% bound to proteins. Drag elimination apparently is unchanged in anephiic patients and those on hemodialysis. Hepatic or biliary disease has no known effect on drag metabolism in humans. The terminal phase of elimination has a tj, of 15 days. Concentrations of amphotericin B in fluids from inflamed pleura, peritoneum, synovium, and aqueous humor are approximately two-thirds of plasma trough concentrations. Little amphotericin B penetrates into cerebrospinal fluid (CSF), vitreous humor, or amniotic fluid. 

Alfthan H, Haglund C, Roberts P, Stenman UH (1992) Elevation of free beta subunit of human choriogonadotropin and core beta fragment of human choriogonadotropin in the serum and urine of patients with malignant pancreatic and biliary disease. Cancer Res 52 4628-4633... 

In order to evaluate these features best, it has been shown that a dual-phase MDCT protocol should be used (Goshima et al. 2006 Kim et al. 1999 Lu et al. 1997 Vargas et al. 2004 Prokesch et al. 2002 McNulty et al. 2001 Schueller et al. 2006) (Protocol 3.3). This protocol can be used for the following indications pancreatic mass, pancreatitis (initial study), jaundice, cholecystitis, gallbladder disease, biliary disease, severe epigastric pain, weight loss, gastric cancer evaluation. 

Morgan RA, Adam AN (2001) Malignant biliary disease percutaneous interventions. Tech Vase Interv Radiol 4 147-152 Mueller PR, Ferrucci JT Jr, Teplick SK et al (1985) Biliary stent endoprosthesis analysis of complications in 113 patients. Radiology 156 637-639... 

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