Asunto(s)
Hepatectomía/métodos , Conducto Hepático Común/anatomía & histología , Conducto Hepático Común/fisiología , Trasplante de Hígado/métodos , Hígado/cirugía , Donadores Vivos , Arteria Hepática/anatomía & histología , Arteria Hepática/fisiología , Humanos , Vena Porta/anatomía & histología , Vena Porta/fisiologíaRESUMEN
Hepaticojejunostomy (HJ) is a common operation used to by-pass extrahepatic biliary obstructions and to establish biliary-enteric continuity after resections for benign and malignant diseases. Little is known about the effect of this procedure on hepatobiliary physiology. The aim of the present study was to investigate in a swine model the changes in biliary dynamics, bile composition, and hepatic histology induced by Roux-Y HJ. Twenty-four swine (57 (47 to 76) kg) underwent cholecystectomy, with HJ (Group I; n = 12) or without any biliodigestive anastomosis (Group II, n = 12), and were followed up for 6 or 12 mo by repeated weight scaling, blood, serum, and bile analysis, (99m)Technetium (Tc), diethyliminodiacetic acid (HIDA) dynamic biligraphy, and histological analysis. During follow-up, HJ was associated with less weight gain, colonization of the bile duct with aerobic bacteria Escherichia coli dominating (in 75% of the animals), a shortened hilum-intestine transit time but reduced liver clearance in dynamic biligraphy, and fibrous periportal changes in liver histology (in 50% of the animals). We conclude that during 1 y follow-up HJ with no anastomotic stricture formation is associated with improved extrahepatic bile drainage, but with ascending contamination of bile ducts with bacteria, which might be involved with the fibrous periportal changes in the liver resulting in diminished excretion of Tc-HIDA from the hepatocytes into the bile. The clinical significance of these changes, and the reduced weight gain observed is a topic of further investigations.
Asunto(s)
Anastomosis en-Y de Roux/efectos adversos , Conducto Hepático Común/fisiología , Conducto Hepático Común/cirugía , Yeyuno/fisiología , Yeyuno/cirugía , Complicaciones Posoperatorias/fisiopatología , Animales , Bilis/fisiología , Colecistectomía , Vesícula Biliar/fisiología , Vesícula Biliar/cirugía , Conducto Hepático Común/patología , Yeyuno/patología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , Cintigrafía , Radiofármacos , Sus scrofa , Lidofenina de Tecnecio Tc 99m , Aumento de PesoRESUMEN
The peculiarity of the digestive system of the ostrich (Struthio Camelus L.), which is characterized by the continuous production of bile, led us to undertake macroscopical and histological studies of the liver and its biliary system, since very little bibliographic data exist on the subject. For this purpose we observed the organs of male and female ostriches 16-18 months of age, in situ, in order to describe their location, relationships and morphology. Samples of the liver were processed for observation by light microscopy; samples of the hepatoenteric duct were processed for observation by light and electron microscopy. Our findings regarding the liver revealed the presence of two lobes: a left lobe, subdivided into three lobes, and a right undivided lobe. There was no gall-bladder. The histological picture showed unlimited hepatic lobules, with hepatocytes arranged in cord-like fashion two cells thick. A large hepatoenteric duct arose from the porta hepatis, and opened into a papilla in the descending limb of the duodenum. The mucosa of the duct was lined by simple columnar epithelium consisting of cells having the same morphological cytoplasmatic features but distinguished by either a light or a dark nucleus.
Asunto(s)
Sistema Biliar/citología , Hígado/ultraestructura , Struthioniformes/anatomía & histología , Animales , Sistema Biliar/fisiología , Sistema Biliar/ultraestructura , Núcleo Celular/fisiología , Núcleo Celular/ultraestructura , Digestión/fisiología , Células Epiteliales/fisiología , Células Epiteliales/ultraestructura , Femenino , Vesícula Biliar/anatomía & histología , Vesícula Biliar/fisiología , Conducto Hepático Común/citología , Conducto Hepático Común/fisiología , Conducto Hepático Común/ultraestructura , Hepatocitos/fisiología , Hepatocitos/ultraestructura , Uniones Intercelulares/fisiología , Uniones Intercelulares/ultraestructura , Hígado/fisiología , Masculino , Microscopía Electrónica de Transmisión , Microvellosidades/fisiología , Microvellosidades/ultraestructura , Especificidad de la Especie , Struthioniformes/fisiologíaRESUMEN
The anatomy and physiology of the cystic duct have been relatively neglected by anatomists and the function of the spiral mucosal folds or "valves" of Heister, first described in 1732, remains obscure. The gross and microscopic anatomy of the cystic duct is reviewed together with results from laboratory investigations into the function of the cystic duct and its spirally arranged folds. The duct and spiral folds contain muscle fibers responsive to pharmacologic, hormonal, and neural stimuli. There is, however, no convincing evidence of a discrete muscular sphincter within the duct. Although the cystic duct is unlikely to play a major role in gallbladder filling and emptying, it appears to function as more than a passive conduit. Coordinated, graded muscular activity in the cystic duct in response to hormonal and neural stimuli may facilitate gallbladder emptying. The principal function of the internal spiral folds that are found in man and other animals may be to preserve patency of this narrow, tortuous tube rather than to regulate bile flow.
Asunto(s)
Conducto Cístico/anatomía & histología , Conducto Cístico/fisiología , Animales , Enfermedades de los Conductos Biliares/etiología , Enfermedades de los Conductos Biliares/patología , Colecistectomía , Conducto Colédoco/anatomía & histología , Conducto Colédoco/fisiología , Conducto Cístico/irrigación sanguínea , Conducto Cístico/inervación , Perros , Vesícula Biliar/anatomía & histología , Vesícula Biliar/fisiología , Conducto Hepático Común/anatomía & histología , Conducto Hepático Común/fisiología , Humanos , Laparoscopía , Membrana Mucosa/ultraestructura , Músculo Liso/ultraestructura , Presión , Esfínter de la Ampolla Hepatopancreática/fisiologíaRESUMEN
OBJECTIVE: Tegaserod is a 5-HT(4) receptor partial agonist that increases peristaltic activity of the intestinal tract. It is approved for the treatment of patients with irritable bowel syndrome with constipation (IBS-C). IBS is a chronic gastrointestinal disorder of function that is reported to be associated with an increased incidence of abdominal surgery including cholecystectomy. The effect of tegaserod on nongut digestive organs, such as the gallbladder and biliary tract, has not been previously investigated. Therefore, this study aimed to evaluate the effects of tegaserod on gallbladder contractility and on functional status of the sphincter of Oddi during both the interdigestive and the digestive periods in healthy female subjects and in female patients with IBS-C. METHODS: During a 6-wk, double-blind, placebo-controlled crossover study, gallbladder contractility and concomitant change in luminal diameter of the common hepatic duct (CHD) and the common bile duct (CBD, both proximal and distal) in response to a standard liquid meal were quantified using real-time ultrasonography. Changes in luminal diameter of the CHD and the CBD were used as a surrogate marker for sphincter of Oddi function. Ultrasound measurements were conducted every 15 min from 45 min before, to 60 min after the test meal to observe the impact of tegaserod on gallbladder volume and any concomitant change in the diameters of the CHD and the CBD that developed in response to gallbladder contraction. The ultrasound measurements of gallbladder contractility, along with the CHD and the CBD diameters, were repeated after each of the two 2-wk periods of treatment with tegaserod or placebo. The recommended dose of tegaserod (6 mg b.i.d.) for IBS-C patients was used in healthy female subjects (n = 13) and female patients with IBS-C (n = 20). Twice this dose (12 mg b.i.d.) was also evaluated in an additional 20 female patients with IBS-C. Statistical evaluations were conducted using a two-sided analysis of variance (ANOVA). RESULTS: Gallbladder contractility variables including ejection fraction, ejection rate and ejection period, fasting and residual volume, and maximal emptying, were similar after 2 wk of treatment with tegaserod 6 mg b.i.d. and placebo in healthy female subjects and female patients with IBS-C. There were no significant changes in the luminal diameters of the CHD or the CBD after tegaserod compared to placebo in any cohort. Additionally, no significant dilation (> or =7 mm in diameter) of the CHD or CBD was observed during maximal gallbladder emptying. Similar results were also observed when tegaserod was given at 12 mg b.i.d. in patients with IBS-C. Tegaserod treatment had no significant effect on plasma CCK concentration in response to the test meal. No significant abdominal pain or unexpected adverse events were reported during the study. CONCLUSIONS: This study showed no significant pharmacodynamic effect of tegaserod on gallbladder contractility or on CBD and CHD diameters as a surrogate marker of sphincter of Oddi function during both the interdigestive (fasting) and the digestive (postprandial) periods in healthy female subjects and female patients with IBS-C.
Asunto(s)
Sistema Biliar/efectos de los fármacos , Ingestión de Alimentos/fisiología , Indoles/farmacología , Agonistas de Receptores de Serotonina/farmacología , Sistema Biliar/diagnóstico por imagen , Sistema Biliar/fisiología , Conducto Colédoco/efectos de los fármacos , Conducto Colédoco/fisiología , Estudios Cruzados , Método Doble Ciego , Femenino , Vesícula Biliar/efectos de los fármacos , Vesícula Biliar/fisiología , Conducto Hepático Común/efectos de los fármacos , Conducto Hepático Común/fisiología , Humanos , Síndrome del Colon Irritable/fisiopatología , Contracción Muscular/efectos de los fármacos , Contracción Muscular/efectos de la radiación , UltrasonografíaRESUMEN
The effects of endothelin-1 on motility of guinea pig extra-hepatic biliary tract portions were studied. Endothelin-1 (< or =100 nM) failed to contract rings of hepatic, cystic, proximal or distal common bile ducts, or choledochal or papillary halves of sphincter of Oddi. At 100 nM, endothelin-1 or sarafotoxin S6c (selective endothelin ET(B) receptor agonist) inhibited contractions of choledochal (but not papillary) sphincter of Oddi to carbachol (1 microM) by 63+/-5 and 45+/-9%, respectively. In distal common bile duct, indomethacin (5.6 microM) unmasked potent contractile effects of endothelin-1 [EC(50) 7.8 (5.5-11.1) nM; E(MAX) 80+/-6% of response to 80 mM KCl] and enhanced the contractile potency of carbachol (585-fold at EC(50) level), but not cholecystokinin C-terminal octapeptide. Inhibition of cholinergic responsiveness of the choledochal sphincter of Oddi by endothelin-1 was reduced by BQ-123 (1 microM; endothelin ET(A) receptor antagonist; cyclo[DTrp-DAsp-Pro-DVal-Leu]) and abolished by either BQ-123 plus BQ-788 (1 microM; endothelin ET(B) receptor antagonist; N-cis-2,6-dimethylpiperidinocarbonyl-L-gamma-methylleucyl-D-1-methoxycarboyl-D-norleucine) or indomethacin. Thus, eicosanoids of the cyclo-oxygenase pathway (i.e. prostanoids) suppress endothelin-1-induced contractions of distal common bile duct and mediate endothelin ET(A) and ET(B) receptor-dependent inhibition of cholinergic responsiveness of the choledochal portion of the sphincter of Oddi.
Asunto(s)
Endotelina-1/farmacología , Indometacina/farmacología , Esfínter de la Ampolla Hepatopancreática/efectos de los fármacos , Animales , Fármacos Cardiovasculares/farmacología , Conducto Colédoco/efectos de los fármacos , Conducto Colédoco/fisiología , Conducto Cístico/efectos de los fármacos , Conducto Cístico/fisiología , Interacciones Farmacológicas , Femenino , Cobayas , Conducto Hepático Común/efectos de los fármacos , Conducto Hepático Común/fisiología , Técnicas In Vitro , Masculino , Esfínter de la Ampolla Hepatopancreática/fisiologíaRESUMEN
The bile duct is a distensible tube serving to transport bile from the liver and gallbladder to the duodenum. The purpose of this study was to characterize the luminal cross-sectional area (CSA) and tension-strain properties during distension of the normal isolated porcine common bile duct in vitro. An impedance planimetric system located inside a balloon was used. Eleven porcine bile ducts were examined in two locations, in the hepatic duct and in the common bile duct. The CSAs obtained in the common bile duct were significantly higher than those in the hepatic duct in the pressure range 0-8 kPa (P < 0.001). The circumferential wall tension (T)-strain (epsilon) relations for both locations fitted to the exponential equation T = a.eb. epsilon with determination coefficients of 0.97 +/- 0.01. The a and b constants were not statistically different between the two locations indicating that the elastic properties did not differ. In conclusion, the luminal CSAs were larger in the common bile duct when compared to the hepatic duct and the tension-strain relations did not differ between the two segments of the bile duct.
Asunto(s)
Conducto Colédoco/anatomía & histología , Conducto Colédoco/fisiología , Conducto Hepático Común/anatomía & histología , Conducto Hepático Común/fisiología , Animales , Fenómenos Biomecánicos , Cateterismo , Técnicas In Vitro , Modelos Biológicos , Contracción Muscular/fisiología , Músculo Liso/fisiología , Presión , Estrés Mecánico , PorcinosRESUMEN
En los ultimos años y con el advenimiento de modernas técnicas y aparatos de anestesia, más los conocimientos a fondo de diversas enfermedades, el índice de la vía a aumentado a alrededor de 74 años en el hombre y 78 años en la mujer, por lo tanto existe un incremento en la supervivencia, dejando en apenas 2 por ciento las muertes debidas a accidentes anestésicos quirúrgicos. Los pacientes de la tercera edad (sobre 70 años), tienen cambios anatómicos y fisiológicos importantes, sobre todo el sistema cardiovascuar con una clara disminución en el flujo sanguineo, aumento de la rigidez miocárdica hipertrofias ventriculares, aumento de la tensión arterial, etc. el aparato respiratorio al igual que el sistema renal hepático, endócrino, sufren modificación con la senectud. el sistema nervioso es tan sensible en los ancianos que amerita un trato especial al usar las drogas anestésicas. Al llegar a esta época de la vida, se deven tener en consideración estos cambios al administrar anestésicos, es por eso que el paciente geriátrico debe tener un trato especial y un conocimiento adecuado de dosis y drogas por parte del anestesiologo.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anestesia , Sistema Cardiovascular/fisiología , Sistema Nervioso Central , Conducto Hepático Común/fisiología , Geriatría , Salud del Anciano , Sistema Respiratorio/fisiologíaRESUMEN
Hepatocyte tight junctions form the intercellular barrier between bile and blood. Cholestasis due to common bile duct ligation (CBDL) results in structural changes in the tight junction (TJ) and an overt paracellular leak, although the molecular basis for these alterations is undefined. Using the epithelial isoform of the TJ protein ZO-1 (ZO-1 alpha +) as a marker for molecular changes in hepatocyte TJs, we investigated the effects of CBDL on ZO-1 alpha + immunofluorescence (IF) localization and on ZO-1 alpha + mRNA and protein expression over 2 wk of CBDL. ZO-1 alpha + IF staining was altered after 2 days of CBDL and appeared to accumulate in pericanalicular regions after 7 and 9 days. Quantitative immunoblotting and ribonuclease protection revealed a marked increase in hepatic ZO-1 alpha + protein expression and ZO-1 alpha + mRNA levels, respectively. In contrast to changes in ZO-1 alpha + IF, which occurred throughout the lobule, and changes in mRNA and protein expression, which were maximal after 9 days of ligation, the maximal hepatocyte proliferation occurred within 2 days after CBDL and was confined to periportal regions. CBDL results in altered hepatic localization and increased expression of the TJ protein ZO-1 alpha + and appears to represent a specific response by hepatocytes to pathological junction injury independent of cell proliferation.
Asunto(s)
Conducto Hepático Común/fisiología , Uniones Intercelulares/metabolismo , Hígado/metabolismo , Proteínas de la Membrana/metabolismo , Fosfoproteínas/metabolismo , Animales , División Celular , Técnica del Anticuerpo Fluorescente , Ligadura , Hígado/citología , Masculino , Proteínas de la Membrana/genética , Fosfoproteínas/genética , ARN Mensajero/metabolismo , Ratas , Ratas Sprague-Dawley , Distribución Tisular , Proteína de la Zonula Occludens-1RESUMEN
Diseases of the bile duct system in the digestive system after surgery are common. In order to clarify the cause of these diseases, research on the diseases from a biomechanical perspective is increasing; however, the same cannot be said of biochemical research. In this paper, by using a new, well-devised testing apparatus, specimens extracted from the bile duct system of canine body are tested. The test data are analyzed using the finite deformation theory, and mechanical properties of the bile duct system outside the liver are investigated. The conclusions show that the viscoelasticity of the bile duct system is very small. In its normal physiological condition, the bile duct wall has an almost uniform distribution of circumferential and longitudinal stress. However, when the diseases of the bile duct system cause high pressure at the bile duct, the circumferential stress and longitudinal stress at the bile inside wall suddenly increase and are much larger than those stresses at the outside wall. The elastic modulus gradually becomes small from the common bile duct and the common hepatic duct to hepatic duct, and the value of elastic modulus for the cystic duct is almost equal to that of the hepatic duct.
Asunto(s)
Conductos Biliares Extrahepáticos/fisiología , Algoritmos , Animales , Enfermedades de los Conductos Biliares/patología , Enfermedades de los Conductos Biliares/fisiopatología , Conductos Biliares Extrahepáticos/anatomía & histología , Fenómenos Biomecánicos , Conducto Colédoco/anatomía & histología , Conducto Colédoco/fisiología , Conducto Cístico/anatomía & histología , Conducto Cístico/fisiología , Perros , Elasticidad , Conducto Hepático Común/anatomía & histología , Conducto Hepático Común/fisiología , Modelos Biológicos , Presión , Estrés Mecánico , ViscosidadRESUMEN
The initial results of biliary reconstruction in 72 liver transplants realized in 62 patients, 50 adults and 12 children, are presented. Three reconstruction techniques were used: end-to-end choledocho-choledochostomy on a Kehr tube in 44 transplants (61.1%); choledocho-jejunostomy on a Roux-en-Y loop in 24 transplants (33.3%); double derivation cholecysto-choledocho-jejunostomy in 2 transplants (2.7%). The number of early complications related to biliary reconstruction was 5 (7.14%): 3 fistulas in the choledocho-choledochostomy series (6.8%) and 2 fistulas among the choledocho-jejunostomies (8.3%). All complications required reoperation and mortality was nil. Thirty-two months after the onset of the program, no late complications of the biliary anastomosis have been registered.
Asunto(s)
Vesícula Biliar/cirugía , Conducto Hepático Común/cirugía , Yeyuno/cirugía , Adolescente , Adulto , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Niño , Preescolar , Femenino , Conducto Hepático Común/fisiología , Humanos , Lactante , Trasplante de Hígado , Masculino , Persona de Mediana EdadRESUMEN
The mechanical properties of the longitudinally cut preparations of the guinea-pig hepatic duct were studied. About 42% of the preparations (18 of 43 preparations) showed spontaneous phasic contractions which were unaffected by either tetrodotoxin, guanethidine or atropine. About 60% of them exhibited phasic contractions which appeared at irregular frequencies in the same tissue and varied in size. This sort of contractions usually accompanied small contractions. In about 20%, contractions occurred constantly in frequency (about 6-14 every 10 min) and in size. The remaining 20% showed twitch-like contractions which occurred sporadically. These contractions were classified into two types depending upon the susceptibility to the Ca2+ entry blocker, D-600. D-600 (1-100 microM) strongly suppressed both regularly occurring contractions and twitch-like ones. On the other hand, the drug was ineffective on irregularly occurring contractions. The Ca2+ sources underlying these contractions were discussed.
Asunto(s)
Bloqueadores de los Canales de Calcio/farmacología , Galopamilo/farmacología , Conducto Hepático Común/fisiología , Contracción Muscular/efectos de los fármacos , Músculo Liso/fisiología , Animales , Cobayas , Conducto Hepático Común/efectos de los fármacos , Masculino , Músculo Liso/efectos de los fármacosRESUMEN
Using ERC-manometry diameters of the common bile duct (CBD) the common hepatic duct (CHD) as well as CBD pressure before and after opacification were determined in 35 non-cholecystectomized patients without extrahepatic cholestasis. We found a significant rise of both CBD and CHD diameters as well as CBD pressure recorded before the injection of contrast medium with increasing age. (p less than 0.005, less than 0.001 and less than 0.05 respectively). Following the opacification CBD pressure became elevated. Again this increase tended to be more pronounced in older patients although this association was lacking statistical significance. In the presence of comparable age female patients (n = 16) exhibited higher CBD and CHD diameters (n.s.) as well as CBD pressure values (p less than 0.05) than male patients (n = 19). We conclude that in the absence of extrahepatic cholestasis bile duct diameter as well as bile duct pressure rise significantly with increasing age. Furthermore women tend to have higher diameters and pressure values than men.