Biliary tract obstruction

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). 

Intrahepatic and Extrahepatic Sepsis. Bacterial infection of the liver, with microscopic or macroscopic abscess formation, results in hyperbilirubinemia and a rise in serum alkaline phosphatase (B53). Hyperphosphatasemia is greater in patients with microabscesses, particularly in cases of biliary tract obstruction, than in patients with macroscopic abscesses, who show only modest serum alkaline phosphatase elevation (R32). 

Marked elevation of serum alkaline phosphatase in an alcoholic patient usually denotes the presence of biliary tract obstruction or space occupying lesions within the liver. However, in a few patients, alcoholic hepatitis and cirrhosis may be present, with marked hyperphosphatasemia due to intrahepatic cholestasis (PIO). 

Increased RBC turnover (hemolytic anemias) Biliary tract obstruction... 

Several references on herbal safety contraindicate the use of turmeric in persons with biliary tract obstruction (Brinker 2001 De Smet 1993 Mills and Bone 2005) due to reported bile-stimulating activity (De Smet 1993) observed in rats administered the compound curcumin (Bhat et al. 1984), and gallbladder contraction (50% contraction after 40 mg dose) observed in humans administered the compound curcumin (Rasyid et al. 2002). Such concerns are theoretical, and no clinical evidence for turmeric has been reported to support or refute these concerns. 

Bloom R, Sybert A, Mascetello VJ. Granulomatous biliary tract obstruction due to sarcoidosis. Am Rev Respir Dis 1978 117 783-787. 

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. 

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. 

G. Other applications Micromedex notes that glucagon (rDNA origin) may also be used to reduce smooth muscle tone in the gastrointestinal tract. It has also shown to be effective in the treatment of anaphylaxis, biliary tract pain, beta-adrenergic blocker overdose, esophageal obstruction, and as premedication in endoscopic procedures. 

If more cholesterol enters the bile than can be solubilized by the available bile salts and phosphatidylcholine, cholesterol gallstone disease (cholelithiasis) can occur. This is generally caused by gross malabsorption of bile acids from the intestine, obstruction of the biliary tract, or severe hepatic dysfunction, leading to abnormalities in bile or bile salt production. 

Codeine and morphine should be used with caution in hypotension, hypothyroidism, asthma (avoid during an attack) and decreased respiratory reserve, shock, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, pregnancy and breastfeeding. They may precipitate coma in patients with hepatic impairment and as such, they should be avoided or a reduced dose used. In patients with renal impairment, the dose should be reduced or they should be avoided. If used in the elderly and debilitated, the dose should be reduced. 

In cases of mechanical jaundice, not only the location of the obstruction in the biliary tract is determinable, but usually the type and extent of the (partial or complete) obstruction as well. (s. fig. 8.14) As a result, a decision can often be taken during the same examination concerning causal or palliative treatment. The coagulation parameters should be within a range which renders papillotomy, stone extraction or tissue biopsy possible without danger to the patient. 

Greulich, T., Kohler, B. Obstruction jaundice caused by rupture of cystic echinococcosis into the biliary tract. Zschr. Gastroenterol. 2000 38 301-306... 

Hanger, F.M., Gutman, AJI. Post-arsphenamine jaundice. Apparently due to obstruction of intrahepatic biliary tract. J. Amer. Med. Ass. 1940 115 263-271... 

Pancreatitis, any cause (P-AMY T) Pancreatic trauma (P-AMYT) Biliary tract disease (P-AMYT) - Intestinal obstruction (PtAMYT) Mesenteric infarction (P-Alv4Y(t Perforated peptic ulcer (P-AMYiT) Gastritis, duodenitis (P-AMY ) Ruptured aortic aneurysm Acute appendicitis Peritonitis Trauma... 

Obstruction of the pancreatic duct by a calculus or by carcinoma of the pancreas may increase serum LPS activity depending on the location of the obstruction and the amount of remaining functioning tissue. In patients with a reduced glomerular filtration rate, the serum LPS activity is increased. Thus care should be exercised in the interpretation of elevated serum LPS values in the presence of renal disease. Finally, investigation of the biliary tract by endoscopic retrograde pancreatography or treatment with opiates (which causes the sphincter of Oddi to contract) may increase serum LPS activity. 

Elevated levels of alkaline phosphatase and GGT occur with obstructive disorders that disrupt the flow of bile from the hepatocytes to the bile ductules, or from the biliary tree to the intestines. Examples of the former include primary biliary cirrhosis and drug-induced cholestasis examples of the latter include gallstone disease and malignancies of the pancreas and bile ducts. In liver disease, the levels of GGT correlate well with elevations of the alkaline phosphatase, and their combination is a sensitive and specific marker for biliary tract disease. ... 

Endoscopic retrograde cholangiography with biliary obstruction Biliary tract surgery... 

Biliary tract infections Necrotizing pancreatitis Neoplasms Intestinal obstruction Perforation... 

Most adenomas of the extrahepatic biliary tract (EHBT) occur in the gallbladder and are usually detected incidentally." In contrast, those in the extrahepatic bile ducts (EHBDs) present with signs and symptoms of obstruction. They can be multifocal, especially those with a papillary architecture. On the basis of the growth pattern, they have been classihed traditionally as tubular, papillary, or tubulopapillary, although the relevance of this classihcation independent of the degree of dysplasia is debatable. ... 

Palmer [56-58] first reported the presence in human bile of a sulfate ester of lithocholate in as much as 40-80% of the small amounts of available glyco- and taurolithocholate. Following intragastric or intraduodenal intubation of glyco-[24- C]lithocholic acid 3-sulfate to rats with bile fistulas, 70-89% of the radioactivity was recovered in bile [59] allolithocholate 3-sulfate was also reported in rat bile [60]. The radioactive conjugate was absorbed intact without loss of the sulfate, and was not metabolized in the liver (e.g., to the muricholates or chenodeoxycholate) [58,59]. Similarly, chenodeoxycholate 3-sulfate was not metabolized after intravenous infusion into rats or hamsters with or without obstruction of the biliary tract [58,59,61]. Lithocholate 3-sulfate is efficiently removed from the body [62]. 

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