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Objective To explore the value of 99mTc-EHIDA hepatobiliary dynamic imaging at different phases for diagnosis of hepatobiliary diseases. Methods Totally 387 patients with hepatobiliary diseases confirmed by pathology or clinical data were retrospectively analyzed. All patients underwent 99mTc-EHIDA hepatobiliary dynamic imaging. According to intestinal imaging, the patients were divided into normal excretory group (n=65, without hepatobiliary disease or cured) and abnormal excretory group (n=322, including 127 cases of biliary atresia [BA], 108 cases of infant hepatitis syndrome [IHS], 62 cases of choledochal cyst and 25 cases of bile leakage). In normal excretory group, the consistency of imaging findings of excretory patency between the early phases and the delayed phases was observed. In abnormal excretory group, the detection rates of hepatobiliary diseases at different phases were calculated and compared. Results In normal excretory group, imaging findings of excretory patency between the early phases and the delayed phases were consistent in 62 cases, and normal excretion was confirmed at the delayed phase in 3 cases. In the abnormal excretory group, differences of detection rates of BA, IHS and choledochal cyst were all statistically significance between 2 h and 4 h as well as between 4 h and 6 h (all P 0.008). The detection rates of bile leakage were higher in delay phases, and there was no statistical significance between 2 h and 4 h, 4 h and 6 h nor 6 h and 24 h (all P>0.008). Conclusion 99mTc-EHIDA hepatobiliary dynamic imaging has good diagnostic value for various diseases of hepatobiliary system.
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A colângio-hepatite é considerada uma causa frequente de insuficiência hepática em gatos e é classificada em neutrofílica, linfocítica e esclerosante. Os objetivos deste estudo foram determinar a frequência de colângio-hepatite em gatos diagnosticados na Região Metropolitana de Porto Alegre, descrever seus aspectos anatomopatológicos e estabelecer uma associação com as infecções por Escherichia coli, vírus da imunodeficiência felina (FIV) e vírus da leucemia felina (FeLV). No período de janeiro de 2000 a julho de 2016 o Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul realizou 1915 necropsias de gatos, destes, 32 foram diagnosticados com colângio-hepatite, representando 1,7% dos casos. Destes, a colângio-hepatite linfocítica (CHL) foi diagnosticada em 68,7% (22/32), a neutrofílica (CHN) em 21,9% (7/32) e a esclerosante (CHE) com 9,4% (3/32). A idade variou de quatro meses a 16 anos, com a mediana de seis anos, acometendo predominantemente gatos sem raça definida. Somente na CHN observou-se predisposição por machos, verificado em 85,7% (6/7) dos casos. Enterite e pancreatite foram identificadas concomitantemente com a colângio-hepatite em 56,2% (18/32) dos casos, cada, e a formação de tríade foi identificada em 46,9% (15/32) dos gatos. Através da imuno-histoquímica, 68,2% (15/22) dos gatos com CHL, foram positivos para FIV, 40,9% (9/22) para FeLV e 31,8% (7/22) marcação para ambos os retrovírus. Na CHN, 85,7% (6/7) positivos para FIV, 57,1% (4/7) para FeLV e 42,8% (3/7) imunorreação para os dois retrovírus. Na CHE, 100% (3/3) dos casos apresentaram marcação para FeLV, 33,3% (1/3) para FIV e 33,3% (1/3) para ambos. Imunomarcação para E. coli foi observada em 27,3% (6/22) dos casos da CHL, 28,6% (2/7) da CHN e em 33,3% (1/3) da CHE. E. coli, Enterococcus sp. e Klebsiella pneumoniae foram os micro-organismos mais frequentes isolados no exame bacteriológico. A visualização da E. coli, através da IHQ no sistema hepatobiliar de gatos diagnosticados com colângio-hepatite associados à inflamação, sugere que a doença se desenvolveu secundariamente à infecção bacteriana ascendente.(AU)
Cholangiohepatitis is considered a frequent cause of liver failure in cats, and are classified as neutrophilic, lymphocytic and sclerosing. The aims of this study was to determine the frequency of cholangiohepatitis in cats diagnosed in the metropolitan region of Porto Alegre, to describe the anatomopathological aspects and to establish an association with Escherichia coli, feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV). From January 2000 to July 2016, the Department of Veterinary Pathology of the Universidade Federal do Rio Grande do Sul performed 1915 cat necropsies, of which 32 were diagnosed with cholangiohepatitis, representing 1.7% of the cases. Of these, lymphocytic cholangiohepatitis (LCH) was diagnosed in 68.7% (22/32), neutrophilic (NCH) in 21.9% (7/v) and sclerosing cholangiohepatitis (SCH) with 9.4% (3/32) of the cases. In general, age ranged from four months to 16 years, with the median age of six years, and predominantly affected cats with mixed breed. Only in NCH demonstrated male predisposition, verified in 85.7% (6/7) of this cases. Enteritis and pancreatitis were identified concomitantly with cholangiohepatitis in 56.2% (18/32) cases, each, and triad formation was identified in 46.9% (15/32) of cats. In the immunohistochemistry, we observed that 68.2% (15/22) of the cats with LCH were positive for FIV, 40.9% (9/22) for FeLV, and 31.8% (7/22) positive for both retroviruses. In NCH, 85.7% (6/7) was positive for FIV, 57.1% (4/7) for FeLV, and 42.8% (3/7) immunoreactions for the two retroviruses. In SCH, 100% (3/3) of the cases presented FeLV marking, 33.3% (1/3) for FIV and 33.3% (1/3) for both. Immunostaining for E. coli was observed in 27.3% (6/22) of LCH, 28.6% (2/7) of NCH, and 33.3% (1/3) of SCH. E. coli, Enterococcus sp. and Klebsiella pneumoniae were the most frequently microorganisms isolated in the bacteriological examination. The visualization of E. coli by the immunohistochemistry in the hepatobiliary system of cats diagnosed with cholangiohepatitis suggests that the disease developed secondary to ascending bacterial infection.(AU)
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Animals , Cats , Cats/abnormalities , Cholangitis/diagnosis , NoxaeABSTRACT
Currently, there is no randomized controlled clinical trial of immunoglobulin (Ig) G4-related diseases in the world. Therefore, the best-known evidence-based medical treatment plan for this disorder is unavailable. The goal of IgG4-related hepatobiliary diseases treatment is to alleviate symptoms, prevent disease-related complications and fibrosis progression. A definite diagnosis is warranted before treatment. Hormonal therapy has become the basis of induction of remission in IgG4-related hepatobiliary disease. An initial prednisone dose is 30 ~ 40mg/d or 0.6 mg.kg-1.d-1 for 2 to 4 weeks, thereafter, gradually the dose is reduced within 2-3 months. Maintenance therapy with low-dose glucocorticoids hormone (prednisone 2.5 to 5.0 mg/d) is recommended for 1 to 3 years to prevent disease recurrence. In addition, immunosuppressive agents are equally effective, and in most cases, hormone combined immunosuppressive therapy may respond. Rituximab, a monoclonal antibody is a promising drug for treatment of this kind of diseases.
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Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated disease that share common pathologic, serologic and clinical features. IgG4- RD may include inflammatory pseudotumor, IgG4-related autoimmune hepatitis, and type 1 autoimmune pancreatitis mainly involving liver and clinically classified into three types. IgG4-related sclerosing cholangitis is a rare disease. It is frequently present in association with type 1 autoimmune pancreatitis, so it needs to be distinguishing from primary sclerosing cholangitis.
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IgG4-related diseases (IgG4-RD) can affect multiple organs, including liver and bile ducts, and manifested as IgG4-related sclerosing cholangitis, IgG4-related liver disease, and IgG4-related autoimmune hepatitis. IgG4-RD has common pathogenesis and histopathological features. A histopathological examination is very important for the diagnosis of IgG4-RD. This article reviews the histopathological features and pathological diagnosis of IgG4-RD and IgG4- related hepatobiliary diseases.
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IgG4-associated hepatobiliary diseases are group of autoimmune diseases characterized by lymphoplasmacytic infiltrates with an elevated serum IgG4 levels, affecting pancreas and biliary tract. In addition, it mainly includes IgG4-related sclerosing cholangitis, IgG4-related autoimmune pancreatitis and IgG4-related autoimmune hepatitis. An accurate diagnosis helps to avoid unnecessary surgery. Notably, an early diagnosis and treatment can improve the prognosis and enhance the quality of life. This review will focus on research advances and difficulties encountered in the study of IgG4 related hepatobiliary diseases.
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Ductular reaction is a kind of repair response to biliary and hepatocellular injury, and the pathological changes include lobular bile duct hyperplasia, matrix change and inflammatory cell infiltrations. In human liver, a ductular reaction originates from the activation and proliferation of hepatic progenitor cells. The activated hepatic progenitor cells, the intermediate hepatocytes and the reactive small bile duct cells together form the cell complex of ductular reaction, which has the dual characteristics of hepatobiliary system and co-expresses the hepatocyte and cholangiocyte antigen. Ductular reaction appears in all kinds of acute and chronic hepatobiliary injury, and plays an important role in liver regeneration and repair, fibrogenesis, cirrhosis formation, and hepatobiliary cancer occurrence and development. Understanding the pathological features and pathophysiological mechanisms of ductular reaction in various clinical hepatobiliary diseases and their role in liver regeneration can provide important suggestion for further exploring new-targeted treatment approach.
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The role and potential function of oral vancomycin in regulating intestinal microflora and prospect of alleviating function of vancomycin in primary sclerosing cholangitis were reviewed,based on domestic and abroad clinical researches and experiments.Through this review,it can provide new ideas for clinical treatment of primary sclerosing cholangitis and to fill vacancies in oral administration of vancomycin in domestic:oral vancomycin play a consi-derable role in the improvement of clinical indicators and clinical manifestations of the primary sclerosing cholangitis patients,affecting the immune response and the release of related cytokines.Based on this,it has the potential to play a role in alleviating the disease in children with primary sclerosing cholangitis.In addition,through the problems remain resolved in this review,we provides a new research direction for future clinical research.
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Objective To investigate the value of serum IgG4 level for the diagnosis of IgG4-related hepatobiliary diseases and the differentiation from other hepatobiliary diseases.Methods A total of 270 patients with hepatobiliary diseases in the People's Hospital of Hunan Province from August 2015 to April 2017 were enrolled in this study,and 20 healthy subjects were selected as controls.The 270patients were divided into eight groups:liver cirrhosis group (n =17),acute pancreatitis group (n =52),chronic pancreatitis group (n =33),cholecystitis and gallstone group (n =27),bile duct carcinoma group (n =30),cholangitis and biliary calculi group (n =41),pancreatic cancer group (n =47),IgG4-related hepatobiliary disease group (n =23).The levels of serum IgG4 were measured by rate nephelometery assay.The sensitivity and specificity of IgG4 levels for distinguishing IgG4-associated hepatobiliary diseases were evaluated by receiver operating characteristic curve.Results The levels of IgG4 of the cirrhosis group and the IgG4 related hepatobiliary disease group were significantly higher than those of the control group (P ＜ 0.05).The IgG4 level in the hepatobiliary disease group was significantly higher than those of the other seven groups (Z =-5.267,-6.802,-5.921,-6.005,-6.173,-6.513,-6.014,P all ＜ 0.01).The area under curve (AUC) for IgG4 level in distinguishing IgG4 associated hepatobiliary diseases and other hepatobiliary diseases was 0.982.When 4.13 g/L was used as the cut off value of diagnosis,the sensitivity and specificity of IgG4for diagnosis were 95.7％ and 96.0％ respectively.The IgG4 levels in twelve patients with IgG-associated hepatobiliary diseases after 2 months of glucocorticoid therapy were significantly lower than those before glucocorticoid therapy (Z =-2.021,P =0.043).Conclusion The elevated serum IgG4 level may not be specific just for IgG4-related hepatobiliary diseases.The cut off value of 4.13 g/L should be very useful for diagnosing IgG4-related hepatobiliary diseases,differentiating from other hepatobiliary diseases and evaluating the therapeutic effect of glucocorticoid therapy.The further detailed verification for these findings should be necessary in clinical practice by increasing the sample size.
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Objective To investigate practical effects of task based learning (TBL), case based learning (CBL) and problem based learning (PBL) integrated teaching method in clinical novitiate of hepatobiliary disease and pancreatopathy. Methods Total of 64 students majored in seven-year clinical practice were divided into TBL+CBL, TBL+PBL, PBL+CBL and TBL+CBL+PBL groups, using a cluster stratified random sampling method, with 16 students in each group. The students were taught with the same basic theoretical knowledge, followed by different course of the combination of TBL, CBL and PBL. In the TBL + CBL + PBL group, the typical patient data were sent to the students before the class, and at the same time, the catalogues of the reference materials and the preview questions were also provided for them. In the course of teaching, the results of the students' information and the answers to the preview questions were first carried out, and then the task test was carried out in the form of collective consultation, and then the students focused on the answers and tests . The theoretical difficulties and blind spots of the theory and the correction of mistakes, deficiency, the breakdown of the case after the end of the expla-nation, and the mistakes and shortcomings of the students' knowledge were discussed in class. The practical effects were evaluated by theory test, teaching and self-acceptance assessment. The data were analyzed by variance analysis, t test and Chi square test. Results Average scores of students in the TBL+PBL , TBL+PBL, PBL+CBL and TBL+PBL+CBL group were (75.313±8.260), (74.875±9.818), (77.125±9.667) and (82.000±6.491), respectively. Average scores of students in the TBL+PBL+CBL group are signifi-cantly higher than the TBL+PBL (t=0.217, P=0.016) and TBL+PBL (t=0.059, P=0.022) groups, while there was no difference with those of PBL+CBL groups (t=0.049, P=0.106). However, Tests grades of 4 students which were poor performance in TBL+CBL+PBL group were significantly higher than those of 4 students with poor performance in PBL+CBL groups (t=0.356, P=0.000). In addition, students in TBL+CBL+PBL group more greatly enhanced learning interest and initiative, and improved their comprehensive analysis ability than students in TBL+CBL ( x2 and P value: 5.565, 0.018; 5.109, 0.024; 4.167, 0.041), TBL+PBL ( x2 and P value:7.127, 0.008;5.367, 0.021;5.565, 0.018) and PBL+CBL ( x2 and p value:4.167, 0.041;5.000, 0.025; 8.866, 0.003). Conclusion TBL, CBL and PBL integrated teaching method can improve students' mastery of theoretical knowledge, and especially can help poor students to improve their academic perfor-mance and interest.
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Objective To investigate isolation of pathogens from bile and clinical characteristics of patients with hepatobiliary diseases.Methods Bacterial culture result of bile and related clinical data of patients with hepatobiliary diseases in a hospital were collected and analyzed by retrospective survey.Results A total of 406 bile specimens from patients with hepatobiliary diseases were collected,the positive rate of culture was 64.53％.Of 262 positive specimens,62.21％ (n =163),32.83％ (n =86),and 4.96％ (n =13) were isolated single pathogen,2 kinds of pathogens,and 3 kinds of pathogens respectively.374 pathogenic strains were isolated,242 (64.71％),131 (35.02 ％),and 1 (0.27 ％) were gram-negative bacteria,gram-positive bacteria,and fungus respectively.Patients with cirrhosis of liver,history of hepatobiliary surgery,and cholelithiasis had higher isolation rates of pathogens from bile than control group(all P＜0.05),isolation rates of pathogens from bile in patients with cholelithiasis of different sites were varied;but there was no significant differences among patients of different age,gender,and whether or not with hepatobiliary tumors(all P＞0.05).There were no statistical difference in constitute of pathogenic species from bile between patients with and without gallstones,as well as with and without history of hepatobiliary surgery(both P＞0.05);while constitute of pathogenic species from bile between patients with and without cirrhosis of liver was statistically different(x2 =14.058,P =0.001).Conclusion Pathogens from bile in patients with hepatobiliary diseases are mainly Enterobacteriaceae and Enterococcus spp.which caused single infection.Positive culture rate of pathogens from bile is higher in patients with cholelithiasis,history of hepatobiliary surgery,and liver cirrhosis.
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Opisthorchis viverrini infection induces chronic inflammation, and a minor proportion of infected individuals develop advanced periductal fibrosis (APF) and cholangiocarcinoma (CCA). Inflammatory cytokines and/or their gene polymorphisms may link to these biliary pathologies. We therefore investigated associations among cytokine gene polymorphisms and cytokine production in 510 Thai cases infected with O. viverrini who presented with APF+ or APF−, as established by abdominal ultrasonography as well as in patients diagnosed with CCA. Levels of pro-inflammatory and anti-inflammatory cytokines were determined in culture supernatants after stimulation of peripheral blood mononuclear cells (PBMCs) with O. viverrini excretory-secretory (ES) products. Pro-inflammatory cytokines, IL-1β, IL-6, IFN-γ, LT-α, and TNF-α were significantly increased in CCA patients compared with non-CCA (APF− and APF+) cases. Polymorphisms in genes encoding IL-1β-511C/T, IL-6-174G/C, IFN-γ +874T/A, LT-α +252A/G, and TNF-α−308G/A were then investigated by using PCR-RFLP or allele specific-PCR (AS-PCR) analyses. In the CCA cases, LT-α +252A/G and TNF-α−308G/A heterozygous and homozygous variants showed significantly higher levels of these cytokines than the wild type. By contrast, levels of cytokines in wild type of IFN-γ +874T/A were significantly higher than the variants in CCA cases. IFN-γ +874T/A polymorphisms were associated with advanced periductal fibrosis, whereas IL-6 −174G/C polymorphisms were associated with CCA. To our knowledge, these findings provide the first demonstration that O. viverrini infected individuals carrying several specific cytokine gene polymorphisms are susceptible to develop fibrosis and CCA.
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Humans , Alleles , Asian People , Cholangiocarcinoma , Cytokines , Fasciola hepatica , Fibrosis , Inflammation , Interleukin-6 , Liver , Opisthorchis , Pathology , UltrasonographyABSTRACT
Objective To analyze the hepatitis B virus infected patients'B-ultrasound hepatobiliary imaging and provide a refer-ence for infection prevention and diagnosis of hepatobiliary disease in the region of Shijiazhuang.Methods In three hospitals of Shi-jiazhuang,500 cases of hepatitis B virus infected patients were enrolled in the study.All patients had intact liver function test data and hepatobiliary B-ultrasound information,and their liver function test results and hepatobiliary B-ultrasound imaging test results were analyzed.Results Among 500 cases of patients with hepatitis B virus infection,22.4% patients were with alanine aminotrans-ferase (ALT)increasing,diagnosed by using B-mold ultrasonography 5.4% patients with a liver cyst,2.2% with liver abscess,8. 4% with fatty liver,1.4% with primary liver cancer percent,1.2% with secondary liver cancer,1.0% with cirrhosis.Conclusion The liver function test of patients suffering from fatty liver,cirrhosis,liver abscess shows higher proportion of ALT increasing, which suggests that in patients with hepatitis B virus infection whose liver function tests display ALT elevations should underwent B ultrasonic examination and doctors should focuse on if the patient with cirrhosis,fatty liver or liver abscess.
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Objective: To analyze the risk factors of emergence agitation in patients with hepatobiliary diseases. Methods: A total of 110 patients with hepatobiliary disease were enrolled in the present study. The level of emergence agitation was scored by sedation-agitation scale (SAS) 30 min after the surgery. Patients with SAS < 4, were excluded. Related medical data of the rest 90 patients were subjected to univariate and multivariate Logistic regression for analysis of risk factors of emergence agitation. Results: Univariate analysis revealed that the airway management method, anesthesia maintenance method, operation time and the use of anesthetic gas absorber were significantly correlated with the incidence of agitation (P values being 0.014, 0.011, 0.042 and 0.019, respectively). Multivariate analysis revealed that induction with midazolam, urinary catheterization after anesthesia and total inhalational anesthesia were significantly correlated with the incidence of agitation (P values being 0.026, 0.049 and 0.004, and the OR values being 5.481, 10.867, and 11.604, respectively). Conclusion: In patients with hepatobiliary diseases, induction with midazolam, total inhalational anaesthesia and urinary catheterization after anesthesia are associated with high incidence of emergence agitation following general anaesthesia.
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Objective To investigate the practical value of ultrasound-guided percutaneous transhepatic gallbladder drainage (PTGD) and percutaneous transhepatic bile duct drainage (PTBD)in the treatment of hepatobiliary diseases. Methods A total of 68 times of ultrasound-guided PTGD/PTBD were performed in 60 patients from December 2000 to December 2003, including 15 cases of acute pyogenic cholecystitis, 8 cases of acute severe cholangitis and 37 cases of malignant obstructive jaundice. Results Out of the 15 cases of acute pyogenic cholecystitis, PTGD was completed successfully in 14 cases and failed in 1 case which then required a conversion to open operation. The 37 cases of malignant obstructive jaundice had undergone 45 times of PTBD, which consisted of 42 times of successful drainage tube placement and 3 times of failure (2 cases of conversions to open operation and 1 case of quitting treatment). Out of the 37 cases, resection of bile duct carcinoma or palliative cholangiojejunostomy was conducted in 14 cases, stents were inserted into the bile ducts under radioscopy in 8 cases, and the drainage tubes were left in place permanently in 15 cases (the maximum survival time was over 2 years and the mean survival time was 9 months). Of the 8 cases of acute severe cholangitis, successful drainage was achieved in 6 cases, a conversion to open surgery was required in 1 case because of blocked drainage, and 1 patient died of the multiple organ failure (MOF). Complications included 2 cases of bile leakage, 3 cases of hemorrhage, 1 case of portal vein-bile duct fistula, and 7 cases of drainage tube dislocation or blockage. Conclusions Ultrasound-guided PTGD/PTBD is an effective alternative for bile duct drainage, with advantages of minimal invasion, simplicity and accurateness of performance, safety and fewer complications. It presents much clinical value for hepatobiliary diseases, especially acute cholecystitis.
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Ulcerative colitis is a diffuse inflammatory disease which is characterized by the vascular congestion and superficial ulcerations in the mucosal and the submucosal layers of the rectum and colon. Extraintestinal manifestations such as arthritis, skin lesion, hepatobiliary and ocular diseases occur in a large number of patients with ulcerative colitis, though gastrointestinal symptoms of mucous and bloody stool, diarrhea and abdominal pain are frequently presented. The association of ulcerative colitis and hepatobiliary disease has been frequently reported in the western countries since the first description by Thomas C.H. in 1874. Fatty degeneration, chronic active hepatitis, cirrhosis, primary sclerosing cholangitis and hepatobiliary carcinoma are included in this list of complications. In the case of hepatobiliary carcinoma, however, the histological diagnosis has almost invariably been cholangiocarcinoma. We report a case of clinical ulcerative colitis with coneurrent hepatocellular carcinoma confirmed by the histologic examination of biopsy specimen in a 49 year old man with the relevant literatures.