Biliary tract

The Group II (biliary tract) enzymes are abnormal usually when the serum bilirubin concentration is also abnormal. Most commonly used is alkaline phosphatase which is a highly sensitive indicator of biliary tract obstruction, perhaps because the enzyme is synthesized as an induced response to obstruction of even small bile ducts. Most techniques used to identify the origin of an elevated serum alkaline phosphatase are not very useful from a clinical viewpoint (23). The simultaneous measurement of GMT activity has been found to be useful in differentiating between the hepatic and bony origin of alkaline phosphatase. An increased GMT activity in a patient with an increased ALP activity is a good indication that there is biliary biliary tract disease (62,63). 

Elevated alkaline phosphatase is nonspecific and may correlate with liver or bone disease it tends to be elevated in biliary tract disease. 

FIGURE 20-1. Anatom ic structure of the pancreas and biliary tract. (From Berardi RR, Montgomery PA. Pancreatitis. In DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 722, with permission.)... 

Biliary tract E. coli, Klebsiella, enterococci Clostridium or Bacteroides (infrequent)... 

Perforated peptic ulcer First-generation cephalosporins 1. Antianaerobic cephalosporins3 2. Possibly add aminoglycoside if patient condition is poor 3. Aminoglycoside with clindamycin or metronidazole add ampicillin if patient is immunocompromised or if biliary tract origin of infection... 

Biliary tract (high-risk only Cefazolin 1-2 g IV or cefoxitin 1-2 g IV Ciprofloxacin 400 mg IV... 

Docetaxel Neutropenia (DLT), hyperlacrimation, fluid retention, nail disorders, myelosuppression Use with caution in liver dysfunction. Do not give if biliary tract is obstructed. Premedicate dexamethasone. 

Removal of biliary tract gallstones with endoscopic retrograde cholangiopancreatography or surgery usually resolves AP and reduces the risk of recurrence. Surgery may be indicated in AP to treat pseudocyst, pancreatic abscess, and to drain the pancreatic bed if hemorrhagic or necrotic material is present. 

Biliary tract infections Necrotizing pancreatitis Neoplasms... 

Aminoglycoside with clindamycin or metronidazole add ampicillin if patient is immunocompromised or if biliary tract origin of infection... 

Antibiotic prophylaxis has been proven beneficial for surgery involving the biliary tract. 

Nutrients are absorbed across the intestinal cell membrane and reach the systemic circulation through the portal venous or splanchnic lymphatic systems, provided the GI or biliary tract does not excrete them. 

Most of the forementioned studies which examined the influence of various dietary fiber on the bioavailability of calcium by human subjects have depended upon the comparative measurements of calcium content of diets and calcium contents of stools and urine. As reviewed by Allen (3), calcium balance studies have distinct limitations relative to accuracy and precision. However, their ease of application and cost, laboratory equipment requirements, and real (or perceived) safety in comparison to available radioactive or stable isotope methods continue to make their use popular. In calcium balance studies, calcium absorption is assumed to be the difference between calcium excretion in the feces and calcium intake. Usually this is expressed as a percent of the calcium intake. This method assumes that all fecal calcium loss is unabsorbed dietary calcium which is, of course, untrue since appreciable amounts of calcium from the body are lost via the intestinal route through the biliary tract. Hence, calcium absorption by this method may underestimate absorption of dietary calcium but is useful for comparative purposes. It has been estimated that bile salts may contribute about 100 g calcium/day to the intestinal calcium contents. Bile salt calcium has been found to be more efficiently absorbed through the intestinal mucosa than is dietary calcium (20) but less so by other investigators (21). 

Liver (human hepatoma cell line) Biliary tract (immortalised mouse cholangioc5hes)... 

Anohina GA, Harchenko W, Harchenko NV, MyhaUchenko IS. (2008) Diet Therapy in Diseases of Liver, Biliary Tract and Pancreas, pp. 184. Kyiv, Ukraine. 

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. 

Mortality studies provide suggestive evidence that occupational exposure to PCB s containing 54% chorine are associated with cancer at several sites, particularly liver, biliary tract, intestines, and skin. ... 

A large multicentric cohort study of European vinyl chloride workers revealed a nearly threefold increase in liver cancer based on 24 observed deaths vs. 8.4 expected. The excess was clearly related to time since first exposure, duration of employment, and estimated ranked and quantitative exposures. A cohort study of 10,173 US men who had worked at least 1 year in jobs involving exposure to vinyl chloride confirmed a significant mortality excess in angiosarcoma (15 deaths), cancer of the liver and bilary tract [standardized mortality ratio (SMR) = 641], and cancer of central nervous system (SMR = 180). ° A recent follow-up of this cohort found that excess mortality risk from cancer of the liver and biliary tract, largely due to angiosarcoma, continued risk of mortality from brain cancer had attenuated and excess of deaths from cancer of connective and soft tissue appeared for the first time but was based on few cancers of assorted histology."... 

IR concentrated oral solution and tablets/suppositories - Respiratory insufficiency or depression severe CNS depression attack of bronchial asthma heart failure secondary to chronic lung disease cardiac arrhythmias increased intracranial or CSF pressure head injuries brain tumor acute alcoholism delirium tremens convulsive disorders after biliary tract surgery suspected surgical abdomen surgical anastomosis concomitantly with MAOIs or within 14 days of such treatment paralytic ileus. 

Administer opioids with caution to patients in circulatory shock, because vasodilation produced by the drug may further reduce cardiac output and blood pressure. Pancreatitis/Biliary tract disease Use opioids with caution in patients with biliary tract disease, including acute pancreatitis and in those about to undergo surgery of the biliary tract. 

Biliary tract pressure elevation Biliary tract pressure elevation generally occurs for varying periods following narcotic use. However, some evidence suggests pentazocine causes little or no elevation in biliary tract pressures. 

Biliary tract surgery Use with caution in patients about to undergo biliary tract surgery because it may cause spasm of the sphincter of Oddi. 

Biliary tract For spastic disorders of the biliary tract. Given in conjunction with a narcotic analgesic. 

Biliary tract Administer with caution to patients with known or suspected cholelithiasis or biliary tract disease. Contractions of the gallbladder or biliary smooth muscle could precipitate complications including cholecystitis, cholangitis, and biliary obstruction. 

Combined Modality Therapy for Gastric, Pancreatic, and Biliary Tract Carcinomas... 

Malignancies of the biliary tract are uncommon in the United States, with approx 8000 cases reported annually nearly two-thirds of these cases arise in the gallbladder, while the remainder (cholangiocarcinoma) originate from the bile ducts and periampullary region. However, gallbladder cancer occurs in epidemic proportions in many South American and Asian countries, particularly affecting women. 

Gallbladder carcinoma is diagnosed approx 5000 times a year in the United States, making it the most common biliary tract cancer and fifth most common gastrointestinal tract cancer. Also, approx 4500 cases of bile duct cancer occur each year in the United States. Women are more commonly afflicted than men, with a female-to-male ratio of 2.7 1.0. The median age at presentation of gallbladder cancer is 73 yr. In addition, an incidence five to six times that in the general population is seen in southwestern Native Americans, Mexicans, Hispanics, and Alaskans. 

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