RESUMO
Hepatocyte growth factor (HGF) has been proved to protect the liver against α-naphthylisothiocyanate (ANIT)-induced cholestasis by acting as an antioxidant agent and redirecting toxic biliary solutes towards blood for urinary excretion. However, this may represent an additional potential risk for kidney integrity, which is already compromised by the cholestatic process itself (cholemic nephropathy). Therefore, in the present work, we studied the renal damage caused by ANIT-induced cholestasis and whether it is aggravated or, on the contrary, counteracted by HGF; if the latter holds, the involvement of its antioxidant properties will be ascertained. ANIT-induced cholestatic deleterious renal effects were corroborated by the presence of urine bile salts, impairment of renal function, and the alterations of renal damage markers, such as HSP72, creatinine clearance, and albuminuria. HGF fully reverted all these, and the cast formation in the tubules was significantly decreased. These findings were associated with the control of renal oxidative stress. In summary, despite HGF enhancing the overload of potentially harmful biliary constituents that the kidney should remove from the bloodstream as an alternative depuration organ in cholestasis, it simultaneously protects the kidney from this damage by counteracting the prooxidant effects resulting from this harmful exposure.
Assuntos
Colestase/tratamento farmacológico , Fator de Crescimento de Hepatócito/farmacologia , Nefropatias/fisiopatologia , 1-Naftilisotiocianato/efeitos adversos , 1-Naftilisotiocianato/farmacologia , Animais , Antioxidantes/farmacologia , Ácidos e Sais Biliares/metabolismo , Ductos Biliares/fisiopatologia , Colestase/sangue , Colestase/metabolismo , Modelos Animais de Doenças , Fator de Crescimento de Hepatócito/metabolismo , Rim/metabolismo , Nefropatias/metabolismo , Fígado/metabolismo , Masculino , Camundongos , Estresse Oxidativo/efeitos dos fármacos , Espécies Reativas de Oxigênio/metabolismoRESUMO
AIMS: Lipopolysaccharide (LPS) induces inflammatory cholestasis by impairing expression, localization, and function of carriers involved in bile formation, e.g. bile salt export pump (Bsep) and multidrug resistance-associated protein 2 (Mrp2). A specific therapy against this disease is still lacking. Therefore, we evaluated the anticholestatic effects of spironolactone (SL), a PXR ligand that regulates bile salt homeostasis, up-regulates Mrp2, and bears anti-inflammatory properties. MAIN METHODS: Male Wistar rats were divided into four groups: Control, SL (83.3 mg/kg/day of SL, i.p., for 3 days), LPS (2.5 mg/kg/day, i.p., at 8 am of the last 2 days, and 1.5 mg/kg/day at 8 pm of the last day), and SL + LPS. Biliary and plasma parameters and the expression, function, and localization of Mrp2 and Bsep were evaluated. KEY FINDINGS: SL partially prevented LPS-induced drop of basal bile flow by normalizing the bile salt-independent fraction of bile flow (BSIBF), via improvement of glutathione output. This was due to a recovery in Mrp2 transport function, the major canalicular glutathione transporter, estimated by monitoring the output of its exogenously administered substrate dibromosulfophthalein. SL counteracted the LPS-induced downregulation of Mrp2, but not that of Bsep, at both mRNA and protein levels. LPS induced endocytic internalization of both transporters, visualized by immunofluorescence followed by confocal microscopy, and SL partially prevented this relocalization. SL did not prevent the increase in IL-1ß, IL-6, and TNF-α plasma levels. SIGNIFICANCE: SL prevents the impairment in Mrp2 expression and localization, and the resulting recovery of Mrp2 function normalizes the BSIBF by improving glutathione excretion.
Assuntos
Transportadores de Cassetes de Ligação de ATP/metabolismo , Colestase/tratamento farmacológico , Espironolactona/uso terapêutico , Membro 11 da Subfamília B de Transportadores de Cassetes de Ligação de ATP/metabolismo , Animais , Bile/metabolismo , Colestase/sangue , Colestase/metabolismo , Citocinas/sangue , Regulação da Expressão Gênica/efeitos dos fármacos , Lipopolissacarídeos/efeitos adversos , Masculino , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase em Tempo RealAssuntos
Corticosteroides/uso terapêutico , Colestase/tratamento farmacológico , Hepatite B/tratamento farmacológico , Doença Aguda , Colestase/sangue , Colestase/diagnóstico , Colestase/etiologia , Feminino , Hepatite B/sangue , Hepatite B/complicações , Hepatite B/diagnóstico , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. AIM: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. METHODS: : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. RESULTS: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. CONCLUSION: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.
Assuntos
Perda Sanguínea Cirúrgica , Colestase/cirurgia , Drenagem/efeitos adversos , Hemostasia , Complicações Intraoperatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Catéteres , Colestase/sangue , Estudos Transversais , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções , Fatores de Risco , Adulto JovemRESUMO
RESUMEN El médico asistencial debe evaluar a diario las pruebas hepáticas en personas con afecciones del hígado, o en los llamados controles a personas supuestamente normales. El objetivo fue facilitar la reflexión práctica en la interpretación de las pruebas hepáticas. Se realizó una revisión de las publicaciones más importantes en base de datos como MEDLINE, EMBASE y Scielo en los últimos años para facilitar la interpretación de las pruebas de laboratorio en el estudio de las lesiones del hígado. En la práctica diaria la elevación de las aminotransferasas, ha sido asociada con un incremento en la mortalidad total y está relacionada con disfunción hepática. Los estudios imagenológicos al igual que la biopsia hepática pueden ser considerados cuando las pruebas hepáticas no definen el diagnóstico, para estudiar al enfermo o cuando los posibles diagnósticos sean múltiples, por lo que definir el valor de la elevación de los niveles de alanino aminotransferasas, aspartato aminotransferasas, junto a la los niveles de fosfatasa alcalina y bilirrubina en la lesión colestática, unidas al uso de pruebas que miden el metabolismo celular en la enfermedad hepatocelular o la colestasis son de vital importancia la práctica médica diaria (AU).
SUMMARY The physician providing health care should daily evaluate hepatic testes in persons with liver diseases, or in the so-called controls to persons supposedly healthy. The aim of this work was facilitating practical reflection in the interpretation of hepatic testes. The most important works published in MEDLINE, EMBASE and Scielo during the last years were reviewed for understanding laboratory tests in the study of hepatic lesions. In the regular practice the increase of aminotransferases has been associated to a growth of total mortality, and this one related to hepatic dysfunction. The imaging studies and also hepatic biopsy should be taking into consideration when hepatic testes do not define the diagnosis, to study the patient, or when there are many possible diagnoses; therefore defining the growth of the alaninotransferase and aspartate aminotransferase levels together with the levels of alkaline phosphatase and bilirubin in the cholestasis lesion and the use of testes measuring the cell metabolism in the hepatocellular disease or cholestasis are very important in the day-to-day medical practice (AU).
Assuntos
Humanos , Hepatopatias/sangue , Metabolismo , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Albumina Sérica/análise , Colestase/sangue , Fosfatase Alcalina/sangue , Hepatopatias/metabolismoRESUMO
ABSTRACT Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.
RESUMO Racional: A drenagem biliar percutânea é procedimento seguro. O risco de complicações hemorrágicas é aceitável. Frequentemente, os pacientes com obstruções biliares apresentam distúrbios de coagulação, aumentando o risco de sangramento. Por esse motivo, eles devem sempre ser adequados aos parâmetros da hemostasia. Objetivo: Determinar se a porcentagem de complicações hemorrágicas na drenagem biliar percutânea é maior em adultos com hemostasia corrigida antes do procedimento em relação àqueles que necessitaram nenhuma. Métodos: Estudo prospectivo, observacional, transversal, comparativo por amostras independentes (comparação não pareada). Oitenta e dois pacientes foram submetidos à drenagem biliar percutânea. A idade média foi de 64±16 anos (20-92), 38 eram homens e 44 mulheres. Os pacientes que apresentaram hemostasia alterada foram corrigidos, e a presença de complicações hemorrágicas foi avaliada com exames laboratoriais e ultrassonográficos. Resultados: Dos 82 pacientes, 23 necessitaram de correção da hemostasia. O acesso à direita foi em 41 casos, 30 à esquerda e 11 bilaterais. A quantidade de punções em média foi de 3±2. Houve 13 (15,8%) complicações hemorrágicas, 12 (20%) no grupo não corrigido e apenas uma (4,34%) no corrigido sem diferença estatística. Não houve diferenças no lado, no número de perfurações e no tipo de drenagem, mas o número de passagens e o tamanho da drenagem no lado direito foram diferentes. Não houve mortalidade. Conclusão: As complicações hemorrágicas em pacientes que necessitam de correção da hemostasia antes da drenagem biliar percutânea não são maiores do que naqueles que não a requerem.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Drenagem/efeitos adversos , Colestase/cirurgia , Perda Sanguínea Cirúrgica , Hemostasia , Complicações Intraoperatórias/etiologia , Punções , Drenagem/métodos , Colestase/sangue , Estudos Transversais , Estudos Prospectivos , Fatores de Risco , CatéteresRESUMO
INTRODUCTION AND AIM: Neonatal cholestasis constitutes for 19 to 33% of all chronic liver disease in India. Cholestasis leads to fibrosis of liver and ultimately cirrhosis. There are various methods of diagnosis of fibrosis of liver like fibroscan, APRI index, FIB-4, fibro index, forns index, heap score, magnetic elastography. Here we are comparing APRI index with METAVIR index in patients with neonatal cholestasis without biliary atresia and determining whether APRI index can be used as a tool to determine fibrosis in these patients. MATERIAL AND METHODS: Patients with neonatal cholestasis without biliary atresia were included in the study. This retrospective analysis was done between 2009 and 2015. All patients underwent a liver biopsy and METAVIR index was calculated. APRI at the time of liver biopsy was determined. RESULTS: Forty-eight patients were included in this study with mean age of 3.5 ± 2.8 months with a male: female ratio of 35:13. Metavir Index F0 was seen in was 32 (66.67%) patients, F1 in 6(12.5%), F2 in 4(8.33%), F3 in 0 and F4 in 6(12.5%) patients respectively. Mean APRI for F0-F3 was 1.38 and for F4 was 3.74 respectively. With an APRI of 1.38, the sensitivity and specificity to detect fibrosis/cirrhosis was 100% and 21.43% respectively. CONCLUSION: APRI is not an effective tool to measure fibrosis or cirrhosis in patients with non-BA neonatal cholestasis in Indian children.
Assuntos
Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Plaquetas , Colestase/diagnóstico , Técnicas de Apoio para a Decisão , Doenças do Recém-Nascido/diagnóstico , Cirrose Hepática/diagnóstico , Bilirrubina/sangue , Biomarcadores/sangue , Biópsia , Colestase/sangue , Colestase/diagnóstico por imagem , Colestase/patologia , Ensaios Enzimáticos Clínicos , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Recém-Nascido/diagnóstico por imagem , Doenças do Recém-Nascido/patologia , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Imageamento por Ressonância Magnética , Masculino , Contagem de Plaquetas , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Cholestasis results from defective bile flow through the biliary ducts leading to the accumulation of bile acids (BAs) in hepatocytes and serum. It has been seen that cholestasis is associated with hypercholesterolemia, which is a prerequisite for gallstone formation and primary biliary cirrhosis, being some of the most common gastrointestinal disorders in Western societies. Cytotoxic BAs induce proinflammatory mediators, oxidative stress, and apoptosis in hepatocytes, whereas cytoprotective BAs prevent them; they can also modify the plasmatic membrane structure of cells or mitochondrial outer membrane properties as well as the distribution of cholesterol, altering various proteins involved in BAs homeostasis.
Assuntos
Colestase/sangue , Colesterol/sangue , Hipercolesterolemia/sangue , Apoptose , Ácidos e Sais Biliares/sangue , Membrana Celular/metabolismo , Membrana Celular/patologia , Colestase/diagnóstico , Colestase/etiologia , Colestase/patologia , Hepatócitos/metabolismo , Hepatócitos/patologia , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/diagnóstico , Hipercolesterolemia/patologia , Mediadores da Inflamação/sangue , Mitocôndrias Hepáticas/metabolismo , Mitocôndrias Hepáticas/patologia , Membranas Mitocondriais/metabolismo , Membranas Mitocondriais/patologia , Estresse Oxidativo , PrognósticoRESUMO
Lipoprotein X (LpX) is an abnormal lipoprotein associated with cholestasis. It is a significant cause of severe hypercholesterolemia and should always be considered in patients with cholestatic liver disease. This case highlights the significance of LpX as a cause of severe hypercholesterolemia in a patient with cholestasis secondary to a granulomatous hepatitis attributed to tuberculosis. Lipoprotein agarose gel electrophoresis and gradient gel electrophoresis were performed for the detection of LpX. The liver function tests, electrolytes, lipid profile and bile acids were also determined. Anti-tuberculous therapy was initiated and the liver functions improved with normalisation of the lipid profile.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Colestase/etiologia , Hepatite/etiologia , Hipercolesterolemia/etiologia , Lipoproteína-X/sangue , Tuberculose Gastrointestinal/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Biomarcadores/sangue , Biópsia , Colestase/sangue , Colestase/diagnóstico , Eletroforese em Gel de Ágar , Feminino , Hepatite/sangue , Hepatite/diagnóstico , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/diagnóstico , Testes de Função Hepática , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Gastrointestinal/tratamento farmacológico , Tuberculose Gastrointestinal/microbiologiaRESUMO
In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular and cholestatic) after ingestion of various "over the counter" products to increase muscle mass and physical performance (NO Xplode®, creatine, L-carnitine, and Growth Factor ATN®). The diagnosis was based on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins industry is one with the highest growth rates in the market, with annual revenues amounting to billions and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered products. Furthermore, and contrary to popular belief, different forms of injury associated with these natural substances have been documented particularly in the liver, supporting the need of a more strict regulation.
Assuntos
Atletas , Desempenho Atlético , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase/induzido quimicamente , Suplementos Nutricionais/efeitos adversos , Fígado/efeitos dos fármacos , Medicamentos sem Prescrição/efeitos adversos , Substâncias para Melhoria do Desempenho/efeitos adversos , Doença Aguda , Adolescente , Biomarcadores/sangue , Biópsia , Carnitina/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/sangue , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/tratamento farmacológico , Colestase/sangue , Colestase/diagnóstico , Colestase/tratamento farmacológico , Creatina/efeitos adversos , Humanos , Fígado/diagnóstico por imagem , Fígado/metabolismo , Fígado/patologia , Testes de Função Hepática , Imageamento por Ressonância Magnética , Masculino , UltrassonografiaRESUMO
OBJECTIVES: To compare the incidence of cholestasis in very low birth weight infants receiving cycled versus continuous parenteral nutrition, and to determine factors that predispose to parenteral nutrition-associated cholestasis (PNAC). STUDY DESIGN: Preterm infants weighing ≤ 1250 g (n = 70) at birth were randomly assigned within the first 5 postnatal days to either cycle (n = 34) or continuous (n = 36) parenteral nutrition. Liver function tests were obtained at baseline, and sequentially thereafter. Cholestasis was defined as direct bilirubin >2 mg/dL. Infants with major congenital anomalies, congenital hepatic disease, clinically apparent congenital viral infection, and those who required major abdominal surgery were excluded. RESULTS: The incidence of PNAC was similar in the 2 groups (cycle 32% vs continuous 31%; P = 1.0). Bilirubin and transaminases were similar in both groups by repeated measures of ANOVA. Gestational age, birth weight, and Apgar scores were significantly lower, and Clinical Risk Index for Babies II scores were significantly higher in infants who developed PNAC. Using backward selection logistic regression, bronchopulmonary dysplasia, duration of parenteral nutrition, and days to full enteral nutrition emerged as factors independently associated with PNAC. CONCLUSIONS: Early prophylactic parenteral nutrition cycling in very low birth weight infants in this study did not reduce cholestasis. Time to full feedings is a significant predictor for PNAC in very low birth weight infants. Preterm infants with bronchopulmonary dysplasia are more likely to have PNAC as a comorbidity. The Clinical Risk Index for Babies II score may help identify those preterm infants who might benefit from future prospective prevention trials.
Assuntos
Colestase/prevenção & controle , Doenças do Prematuro/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Nutrição Parenteral/métodos , Índice de Apgar , Bilirrubina/sangue , Peso ao Nascer , Colestase/sangue , Colestase/etiologia , Nutrição Enteral , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/etiologia , Masculino , Nutrição Parenteral/efeitos adversosRESUMO
OBJECTIVE: To test the hypothesis that implementation of a marked reduction in intravenous fat will result in reversal of parenteral nutrition-associated liver disease (PNALD) in infants. STUDY DESIGN: Prospective study of intravenous fat emulsion reduction in parenteral nutrition to 1 g/kg/d 2 times per week in neonates diagnosed with PNALD. Primary outcome measure was total bilirubin levels compared with gestational age, birth weight, and diagnosis-matched historical controls receiving 3 g/kg/d of intravenous lipids. RESULTS: Intravenous fat emulsion reduction resulted in a significant decline in total bilirubin levels compared with controls. Comparison of growth in the 2 groups was similar. Mild essential fatty acid deficiency was detected in 8 of 31 infants and was reversed with additional days of lipid infusion. No significant adverse events were noted. CONCLUSIONS: An association between intravenous lipid emulsion administration and the development of PNALD seems probable. Use of intravenous fat emulsion reduction is a potential approach to reverse PNALD in young infants. Frequent monitoring of essential fatty acid deficiency is needed with the use of this regimen.
Assuntos
Emulsões Gordurosas Intravenosas/administração & dosagem , Hepatopatias/terapia , Nutrição Parenteral/efeitos adversos , Bilirrubina/sangue , Colestase/sangue , Colestase/etiologia , Colestase/terapia , Emulsões Gordurosas Intravenosas/efeitos adversos , Ácidos Graxos Essenciais/deficiência , Feminino , Humanos , Recém-Nascido , Hepatopatias/sangue , Hepatopatias/etiologia , MasculinoRESUMO
Background: During cholecystectomy, the bile duct may be injured. When this complication occurs, Kupffer cells are activated and produce tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL6) to phagocyte toxic products Aim: To measure serum levels of TNF-α and IL-6 among patients that suffered a bile duct injury after a cholecystectomy. Patients and Methods: Serum levels of TNF-α and IL-6 were measured prior to the bile-enteric derivation and after one year of follow up, in 31 patients that had a complete bile duct obstruction after open or laparoscopic cholecystectomy and in 5 healthy controls. Results: At baseline TNF-α levels in healthy subjects and patients with bile duct injury were 0 and 43.9 ± 2.9 ng/mL, respectively (p < 0.01). At one year of follow up, TNF-á became undetectable among patients. At baseline, the values for IL-6 among healthy controls and patients were 3.0 ± 2.0 and 72.0 ± 94.7 pg/mL respectively, (p < 0,004). After one year of follow up, IL-6 levels decreased to 6.4 ± 0.3 pg/mL among patients. Conclusions: TNF-α and IL-6 levels were elevated before bile-enteric derivation among patients with bile duct injury and became normal one year later.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colestase/etiologia , /sangue , Células de Kupffer/metabolismo , Fator de Necrose Tumoral alfa/sangue , Biomarcadores/sangue , Colestase/sangue , Estudos TransversaisRESUMO
Substance P (SP) is an excitatory neuropeptide that acts via the neurokinin-1 receptor (NK-1) in the nervous system. Pruritus, a complication of cholestasis, is a nociceptive stimulus; thus, we hypothesized that cholestasis would be associated with increased neurotransmission via SP as evidenced, in part, by increased serum concentrations of this neuropeptide. Accordingly, the aim of this study was to determine the serum concentration of SP in patients with pruritus secondary to cholestasis and in the serum of rats with cholestasis secondary to bile duct resection (BDR). The mean serum SP concentration of patients with chronic liver disease (CLD) and pruritus was 9.09 pg/mL SD +/- 6.5, significantly higher than 0.74 pg/mL SD +/- 0.77, the mean serum concentration of SP from patients with CLD without pruritus (p = 0.0001), and from that of the control group, which was 0.65 pg/mL SD +/- 0.37 (p = 0.0001). The mean serum SP concentration from six rats with cholestasis secondary to BDR six and fourteen days after surgery was 57.9 pg/mL, SD +/- 17.3, and 56.3 pg/mL, SD +/- 21.4, respectively, as compared to the concentration from the sham resected control group, which was 3.5 pg/mL SD +/- 0.59 (p = 0.002) at six days post surgery. In conclusion, in cholestasis, there is increased availability of SP. These data provide a rationale for the study of SP release and metabolism in cholestasis, and in the mediation of the pruritus.
Assuntos
Colestase/sangue , Prurido/sangue , Substância P/sangue , Animais , Ductos Biliares/cirurgia , Biomarcadores/sangue , Estudos de Casos e Controles , Colestase/etiologia , Modelos Animais de Doenças , Humanos , New York , Prurido/etiologia , Ratos , Transmissão Sináptica , Fatores de Tempo , Regulação para CimaRESUMO
La colestasis, tiene incidencia de 1:60-375 ictéricos a las 2 semanas de edad, es potencialmente grave, presentan riesgos inmediatos como coagulopatías por hemorragia severa ante el déficit de la absorción de la vitamina K, y con su diagnóstico precoz, se identifican patologías que tienen tratamiento, incluso, trasplante hepático. Como consecuencia de la colestasis, hay retención de sales biliares, daño celular hepático, y descenso de la bilis a nivel intestinal, que ocasionan mala digestión de grasas y proteínas, con defectos en las vitaminas liposolubles. Existen hepatopatías primariassecundarias a una serie de entidades genéticas y metabólicas, y colestasis secundarias a otros problemas, que en el adulto generan enfermedad hepática. Es necesario establecer protocolos deidentificación del niño con ictericia.
Cholestasis has 1:60-375 incidence of jaundice at 2 weeks of age, are potentially serious, immediateand present risk of severe bleeding coagulopathy to the shortfall in the absorption of vitamin K, andearly diagnosis, identify diseases that are treatable, even liver transplantation.As a result of cholestasis, there is retention of bile salts, liver cell damage and decrease of bile in the intestine, causing poor digestion of fats and protein, with defects in soluble vitamins. There are primaryliver disease secondary to a variety of metabolic and genetic entities, and cholestasis secondary toother problems, generated in the adult liver disease. It is necessary to establish protocols for the identification of children with jaundice.
Assuntos
Criança , Colestase/classificação , Colestase/complicações , Colestase/diagnóstico , Colestase/epidemiologia , Colestase/fisiopatologia , Colestase/patologia , Colestase/sangue , Ductos Biliares/lesões , Ductos Biliares/metabolismo , Ductos Biliares/patologia , Bile , Síndrome de Alagille/classificação , Síndrome de Alagille/genética , Síndrome de Alagille/patologia , Vitamina KRESUMO
BACKGROUND: During cholecystectomy, the bile duct may be injured. When this complication occurs, Kupffer cells are activated and produce tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL6) to phagocyte toxic products AIM: To measure serum levels of TNF-α and IL-6 among patients that suffered a bile duct injury after a cholecystectomy. PATIENTS AND METHODS: Serum levels of TNF-α and IL-6 were measured prior to the bile-enteric derivation and after one year of follow up, in 31 patients that had a complete bile duct obstruction after open or laparoscopic cholecystectomy and in 5 healthy controls. RESULTS: At baseline TNF-α levels in healthy subjects and patients with bile duct injury were 0 and 43.9 ± 2.9 ng/mL, respectively (p < 0.01). At one year of follow up, TNF-á became undetectable among patients. At baseline, the values for IL-6 among healthy controls and patients were 3.0 ± 2.0 and 72.0 ± 94.7 pg/mL respectively, (p < 0,004). After one year of follow up, IL-6 levels decreased to 6.4 ± 0.3 pg/mL among patients. CONCLUSIONS: TNF-α and IL-6 levels were elevated before bile-enteric derivation among patients with bile duct injury and became normal one year later.
Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colestase/etiologia , Interleucina-6/sangue , Células de Kupffer/metabolismo , Fator de Necrose Tumoral alfa/sangue , Biomarcadores/sangue , Colestase/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To observe the histological alterations in the liver and biochemistry in the blood that can happen in Wistar rat, after the ligature of right hepatic duct. METHODS: In this study were used rats (n=46) of Wistar pedigree. The animal groups (n=46) were distributed in 6 experimented sub-groups (n=6). It was held a ligature surgery of the right hepatic duct and euthanasia in 7, 14, 21, 28, 60 and 90 days and the biochemistry control group (n=10), that animals had 2ml of their blood taken by cardiac puncture for biochemistry study with value analyses of bilirubins, transaminasis, lactic desidrogenasis, alkaline phophatase and gamma-glutamil-transferase. Given the expected time of each group, the animals were submitted to anesthesia procedure and cavity re-opening, being held intra-cardiac puncture and with 2ml blood collected for biochemistry analyses. It was proceeded the liver resection, being the liver put in formol solution to 10% for a period of 24 hours and taken to the histology. RESULTS: It was not possible to identify results that express significant differences as the existence of alterations histological and biochemical between the different groups. CONCLUSION: At the end of the study, it was not possible to identify histological and biochemical alterations that express significant differences between livers of the animals from the right linked hepatic duct and the animals of the control group.
Assuntos
Ductos Biliares/cirurgia , Colestase/sangue , Fígado/patologia , Fosfatase Alcalina/sangue , Animais , Bilirrubina/sangue , Colestase/etiologia , Modelos Animais de Doenças , Fibrose , Ligadura , Masculino , Punções , Ratos , Ratos Wistar , Estatísticas não Paramétricas , Aderências Teciduais , Transaminases/sangueRESUMO
PURPOSE: To observe the histological alterations in the liver and biochemistry in the blood that can happen in Wistar rat, after the ligature of right hepatic duct. METHODS: In this study were used rats (n=46) of Wistar pedigree. The animal groups (n=46) were distributed in 6 experimented sub-groups (n=6). It was held a ligature surgery of the right hepatic duct and euthanasia in 7, 14, 21, 28, 60 and 90 days and the biochemistry control group (n=10), that animals had 2ml of their blood taken by cardiac puncture for biochemistry study with value analyses of bilirubins, transaminasis, lactic desidrogenasis, alkaline phophatase and gamma-glutamil-transferase. Given the expected time of each group, the animals were submitted to anesthesia procedure and cavity re-opening, being held intra-cardiac puncture and with 2ml blood collected for biochemistry analyses. It was proceeded the liver resection, being the liver putted in formol solution to 10 percent for a period of 24 hours and taken to the histology. RESULTS: It was not possible to identify results that express significant differences as the existence of alterations histological and biochemistrily between the different groups. CONCLUSION: At the end of the study, it was not possible to identify histological and biochemistrily alterations that express significant differences between livers of the animals from the right linked hepatic duct and the animals of the control group.
INTRODUÇÃO: a colestase é uma situação grave e geralmente letal. Habitualmente a obstrução do fluxo da secreção biliar ocorre por lesão iatrogênica. Cerca de 80 por cento das lesões das vias OBJETIVO: Observar as alterações histológicas que possam ocorrer no fígado e bioquímicas no sangue de ratos Wistar, após ligadura do ducto hepático direito. MÉTODOS: Neste estudo foram utilizados ratos (n=46) da linhagem Wistar. O grupo de animais (n=46) foi dividido em 2 grupos: A experimento (n=36) e B controle bioquímico (n=10), sendo o grupo A subdividido em 6 subgrupos experimento (n=6). Foi realizada cirurgia para a ligadura do ducto hepático direito e eutanásia em 7, 14, 21, 28, 60 e 90 dias. No grupo B controle bioquímico (n=10), os animais tiveram 2ml de seu sangue retirado por punção cardíaca para estudo bioquímico com análise dos valores de bilirrubinas, transaminases, desidrogenase láctica, fosfatase alcalina e gama-glutamil-transferase. Dado o prazo de espera de cada grupo, os animais foram submetidos a procedimento anestésico e reabertura da cavidade, sendo realizada punção intracardíaca, com coleta de 2ml de sangue para análise bioquímica. Foi realizada a retirada do fígado, sendo o fígado fixado em solução de formol a 10 por cento por um período de 24 horas e encaminhado ao laboratório de histologia. RESULTADOS: Não foram encontrados resultados estatisticamente significantes quanto a existência de alterações histológicas e bioquímicas entre os diversos grupos. CONCLUSÃO: Ao final do estudo não se conseguiu identificar histológica e bioquimicamente, alterações que expressassem diferenças significativas entre os animais do grupo com o ducto hepático direito ligado e os animais do grupo controle.
Assuntos
Animais , Masculino , Ratos , Ductos Biliares/cirurgia , Colestase/sangue , Fígado/patologia , Fosfatase Alcalina/sangue , Bilirrubina/sangue , Colestase/etiologia , Modelos Animais de Doenças , Fibrose , Ligadura , Punções , Ratos Wistar , Estatísticas não Paramétricas , Aderências Teciduais , Transaminases/sangueRESUMO
PURPOSE: To observe the histological alterations in the liver and biochemistry in the blood that can happen in Wistar rat, after the ligature of right hepatic duct. METHODS: In this study were used rats (n=46) of Wistar pedigree. The animal groups (n=46) were distributed in 6 experimented sub-groups (n=6). It was held a ligature surgery of the right hepatic duct and euthanasia in 7, 14, 21, 28, 60 and 90 days and the biochemistry control group (n=10), that animals had 2ml of their blood taken by cardiac puncture for biochemistry study with value analyses of bilirubins, transaminasis, lactic desidrogenasis, alkaline phophatase and gamma-glutamil-transferase. Given the expected time of each group, the animals were submitted to anesthesia procedure and cavity re-opening, being held intra-cardiac puncture and with 2ml blood collected for biochemistry analyses. It was proceeded the liver resection, being the liver putted in formol solution to 10 percent for a period of 24 hours and taken to the histology. RESULTS: It was not possible to identify results that express significant differences as the existence of alterations histological and biochemistrily between the different groups. CONCLUSION: At the end of the study, it was not possible to identify histological and biochemistrily alterations that express significant differences between livers of the animals from the right linked hepatic duct and the animals of the control group.(AU)
INTRODUÇÃO: a colestase é uma situação grave e geralmente letal. Habitualmente a obstrução do fluxo da secreção biliar ocorre por lesão iatrogênica. Cerca de 80 por cento das lesões das vias OBJETIVO: Observar as alterações histológicas que possam ocorrer no fígado e bioquímicas no sangue de ratos Wistar, após ligadura do ducto hepático direito. MÉTODOS: Neste estudo foram utilizados ratos (n=46) da linhagem Wistar. O grupo de animais (n=46) foi dividido em 2 grupos: A experimento (n=36) e B controle bioquímico (n=10), sendo o grupo A subdividido em 6 subgrupos experimento (n=6). Foi realizada cirurgia para a ligadura do ducto hepático direito e eutanásia em 7, 14, 21, 28, 60 e 90 dias. No grupo B controle bioquímico (n=10), os animais tiveram 2ml de seu sangue retirado por punção cardíaca para estudo bioquímico com análise dos valores de bilirrubinas, transaminases, desidrogenase láctica, fosfatase alcalina e gama-glutamil-transferase. Dado o prazo de espera de cada grupo, os animais foram submetidos a procedimento anestésico e reabertura da cavidade, sendo realizada punção intracardíaca, com coleta de 2ml de sangue para análise bioquímica. Foi realizada a retirada do fígado, sendo o fígado fixado em solução de formol a 10 por cento por um período de 24 horas e encaminhado ao laboratório de histologia. RESULTADOS: Não foram encontrados resultados estatisticamente significantes quanto a existência de alterações histológicas e bioquímicas entre os diversos grupos. CONCLUSÃO: Ao final do estudo não se conseguiu identificar histológica e bioquimicamente, alterações que expressassem diferenças significativas entre os animais do grupo com o ducto hepático direito ligado e os animais do grupo controle.(AU)