INTRODUCTION
Bile duct stricture is a rare but challenging clinical condition. There is often delay in diagnosis of biliary stricture because of its slow progression. Benign strictures develop due to injury of the bile ducts during surgery or trauma to the abdomen; a recurring condition like pancreatitis or bile duct stones or a chronic disease like primary sclerosing cholangitis (PSC). Inflammation occurs soon after injury, which is followed by fibrosis and narrowing of the bile duct lumen. Degeneration of the hepatic segment or lobe void by the involved bile ducts, associated with hypertrophy of the natural segments, can occur, especially with chronic strictures. These changes eventually develop to portal hypertension and secondary biliary
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Several studies have been done for detecting malignant biliary strictures .For example, osteopontin was the most consistently overexpressed gene in intrahepatic cholangiocarcinoma (Hass et al. ,2008). In this work, we have ana¬lyzed microarray data to identify differential expressed genes between malignant and benign biliary stricture and association of these genes with liver cancer using a computational bioinformatics analysis. These genes may be possible targets for future drug design or identification of cholangiocarcinoma …show more content…
Raw data were processed and normalized by the Robust Multichip Averaging (RMA) method (Irizarry et al., 2003) using affy packages of R(v. 3.1.3) (Team, 2004) .The linear regression model package limma (Smyth, 2004) was used to classify chips into each group. The Bayes method (Benjamini and Hochberg, 1995) was used to correct for multiple testing. |logFC| > 2 and P-value < 0.05 were used as cutoff to identify genes which are differentially expressed in
I knew the severe symptoms that I had were not characteristic of gallbladder disease. Particularly not in the beginning, when there was only a very small amount of gallbladder sludge. The very elevated liver enzymes I had were also a mystery because they also do not occur when there is gallbladder sludge alone. They can occur when there is sludge blocking a duct, but there never appeared to be any obstructed ducts in either of the ultrasounds I had during that
When a cystic duct is continuously obstructed inflammation occurs. Bile stasis triggers release of inflammatory enzymes and can be caused by fasting, obstruction, postsurgical/procedural irritation or ileus (total parenteral nutrition [TPN]), which can lead to bile inspissation that is directly toxic to the gallbladder epithelium. The damaged mucosa secretes more fluid into the gallbladder lumen than it absorbs. The resulting distention further releases inflammatory mediators (eg, prostaglandins), worsening mucosal damage and causing ischemia, all of which prolong inflammation and can cause a bacterial infection to occur later. The malicious circle of fluid secretion and inflammation leads to necrosis and perforation if it goes unchecked. If acute inflammation resolves then continues to recur, the gallbladder becomes fibrotic and contracted and does not concentrate bile or empty normally which is a feature of chronic cholecystitis. (Huffman, J. et al.,
Further study demonstrated that the patients with higher expression levels of PTMA/PTMS have shorter average survival period, suggesting that the expression levels of PTMA/PTMS were closely associated with tumorigenesis, tumor progression, and prognosis in the patients with SC/ASC and AC of the gallbladder. These evidences indicated that PTMA/PTMS may be the potential independent prognostic factors for the treatments of SC/ASC and AC of the
Primary sclerosing cholangitis (PSC) is a slow progressive liver disease that ultimately leads to liver cirrhosis and liver failure. Primary sclerosing cholangitis is characterized by inflammation, fibrosis, and the structuring of the intrahepatic and extrahepatic bile ducts. PSC is closely associated with inflammatory bowel disease (IBD) and ulcerative colitis (UC). ) Approximately 75% of these patients were congruently diagnosed with IBD and of the patients, 80-90% were diagnosed with ulcerative colitis.
Cholemia is a condition where there is an excessive accumulation of bile salts in the blood and these bile salts are circulating in the blood stream. Bile is a yellowish fluid produced by the liver. It aids by digesting the fat in your diet. Bile is stored in the gallbladder, which is located inferior to the liver. Some individuals develop Cholemia when their gallbladder has been surgically removed. As stated before, the liver makes bile and bile is stored in the gallbladder. When a person eats, their normal gallbladder constricts and lets out the stored bile salts into the small intestines. This helps with digestion. Once the food is digested and absorbed, bile salts are then absorbed again at the other end of the small intestines and recycled to be used over and over.
Primary biliary cholangitis (PBC) is a rare, autoimmune cholestatic liver disease that puts patients at risk for life-threatening complications. PBC primarily affects women, afflicting approximately one in 1,000 women over the age of 40. If left untreated, or if a patient does not adequately respond to treatment, chronic inflammation and fibrosis can advance to
Bile duct leak is an infrequent but serious disorder. The cause of bile duct leak can be either iatrogenic or more rarely, traumatic. (1) The great majority (95%) occurs after hepatobiliary surgery and the most common cause is related to open and laparoscopic cholecystectomy. (2) Biliary injury occur in 0.1 - 0.2 % and 0.3 - 0.8 % after open and laparoscopic cholecystectomy respectively. (3)
The following questions may be asked to aid in helping to assess Patient A for cholelithiasis or cholescystitis: “Have you had any trouble with heartburn, passing gas, epigastric pain, or any trouble with eating fatty food or cabbage?” (Huether & McCance, 2012). The patient may be able to describe pain in the right upper quadrant 30 minutes after eating a fatty meal. If the pain is intermittent or steady with pain radiating to the mid upper back it could indicate a gallstone is located in the common duct (Huether & McCance, 2012). Ultrasounds and abdominal CT scans with contrast would be beneficial in helping to determining if there is any blockage and the next step in treatment. The doctor may also chose to have lab work done and order the follow lab work: amylase, and lipase, bilirubin, CBC, and liver function tests. AST and ALT values may be elevated as well as increased Bilirubin levels if a patient is suffering from cholelithiasis. The greater the serum Bilirubin level (greater than 3mg/dL) the greater indicator the patient has gallstones (Heuman, 2015). If the Patient A is suffering from acute cholecystitis (inflammation of the bile duct) it may clear up on its own with antibiotics dietary changes, pain medications and rest. If Patient A is dealing with acute cholethiasis (gallstones visible on ultrasounds and CT scans) then laparoscopic cholecystectomy is recommended course of treatment verses open abdominal
The incidence of postoperative bile leak cannot be assessed accurately as many cases may heal spontaneously. (14) Postoperative bile leak usually occurs from the liver bed or bile duct injury, (15) as a result of pressure gradient created by the sphincter of Oddi. (16) The commonest cause of postoperative bile leak was post-cholecystectomy and the commonest site was the cystic duct stump, and this was comparable with the previously published results. (17) Cholangiogram was the standard method of the diagnosis in most cases, however, the leak was minimal and not evident in 25 cases, such cases may heal spontaneously according to the literature.
The gallbladder stores and concentrates bile. If the gallbladder was damaged or dysfunctional there would be softer and more frequent stools. (Audesirk, T., & Audesirk, G. (1999). Retrieved November 21, 2015 from Chapter 29: Nutrition and Digestion. In Biology: Life on Earth (5th ed., p. 585, 586). Upper Saddle River, N.J.: Prentice Hall.) (General Surgery- Gallstones (Cholelithiasis). (n.d.). Retrieved November 21, 2015, from
Welch et al.4 analysed MRP4 and BSEP inhibition data of previously generated data5 in order to illustrate compounds in the dataset that inhibit only MRP4, BSEP or both transporters simultaneously and correlate the inhibition info to the DILI data for this compounds. The analysis of the data demonstrated that most of the BSEP inhibitors were also MRP4 inhibitors and that most of the cholestatic compounds were inhibiting both BSEP and MRP4 or only MRP4. Finally, only one of the cholestatic compounds was identified to inhibit only BSEP4. For one more time the fact that the MRP4 inhibition itself without the inhibition of BSEP is capable of resulting to DILI is difficult to rationalise based upon a two transporter system as investigated in this work. Because as it has been highlighted before MRP4 is hypothesised to act as a backup mechanism and not as the main efflux mechanism of bile acids. The paper in this instance is lacking of sufficient explanation in this
The patient's symptoms along with the lab results provided a very similar match to Acute Acalculous Cholecystitis. Acalculous Cholecystitis refers to inflammation of the gallbladder where gallstones are NOT the contributing factor. This is significant because patient had a negative test result for gallstones. In this case, i think that it was most likely caused by an increase in bile viscosity that occurs from stasis. And in turn, leads to blockage of the cystic duct. The cystic duct connects the gallbladder to the common bile duct.
instrumentation of the biliary tree. A cannulation attempt was defi ned as sustained contact between
The meticulous identification of gallbladder and extrahepatic biliary tract and its normal anatomy that facing a surgeon during surgical operations is essential in the prevention of iatrogenic injury. Equally important, an understanding of congenital variation of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their operative implications [1]. This study reviews the world literature on congenital variation of extrahepatic biliary anatomy. Further studies on image techniques and hepatobiliary scintigraphy for diagnosis of biliary diseases may details of the whole biliary ductal system and show some kinds of biliary malformation,
Bootstrap sampling in cluster analysis is a valuable tool that can be used in bioinformatics as well as in other areas of research. In bioinformatics, clustering can be used in genetics studies to find clusters of subjects according to their gene expression levels. We can then see if subjects with the same disease state or treatment have the same gene profiles, which can give us more information about diseases or treatments and their relations to genetics.