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The Nigerian Postgraduate Medical... 2020This study aimed at evaluating the endoscopic management and clinical outcomes in patients with obstructive jaundice undergoing Endoscopic Retrograde...
BACKGROUND
This study aimed at evaluating the endoscopic management and clinical outcomes in patients with obstructive jaundice undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) within a newly established apprenticeship teaching model at an academic centre in a resource-limited setting.
MATERIALS AND METHODS
We employed an apprenticeship-style model of ERCP training with graded responsibility, multidisciplinary group feedback and short-interval repetition. We collected sociodemographic and clinicopathologic data on consecutive patients who underwent ERCP from March 2018 to February 2020.
RESULTS
A total of 177 patients were referred, of which 146 patients had an ERCP performed for obstructive jaundice and 31 excluded during the study period. The median age was 55 years, age range from 8 to 83 years. The most common referral diagnosis was pancreatic head cancer 56/146 (38.1%), followed by choledocholithiasis 29/146 (19.7%), cholangiocarcinoma 22/146 (15.0%) and gall bladder cancer 11/146 (7.5%). In all, 102 patients had a malignant indication for ERCP. The cannulation rate was 92%. The most common site for malignant biliary obstruction was proximal bile stricture in 31/102 (30.4%), followed by distal bile strictures in 30/102 (28.4%), periampullary cancer 20/102 (19.6%) and mid bile duct stricture in 9/102 (8.8%). The common benign obstructive etiology includes choledocholithiasis in 33/44 (75%) and mid duct obstruction from post-cholecystectomy bile duct injury in 3/44 (2.9%) while 2/44 (2.0%) patients had choledochal cyst. Overall complications were post-ERCP pancreatitis (8/146 patients), cholangitis (3/146 patients), stent migration and post-sphincterotomy bleeding (one patient each). Peri-procedural mortality was 5/146 (3.4%).
CONCLUSION
ERCP is an effective and safe method of treatment of patients with benign and malignant biliary obstruction. The low morbidity and mortality and its immediate therapeutic benefits, together with the short duration of hospitalization, indicate that this procedure is an important asset in the management of such patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cholangiopancreatography, Endoscopic Retrograde; Choledocholithiasis; Humans; Jaundice, Obstructive; Middle Aged; Nigeria; Pancreatic Neoplasms; Young Adult
PubMed: 33154282
DOI: 10.4103/npmj.npmj_242_20 -
BMJ Case Reports Feb 2024A woman in her fifth month of pregnancy presented to the outpatient department with vomiting, generalised itching and yellowish discolouration of the skin for 1 week....
A woman in her fifth month of pregnancy presented to the outpatient department with vomiting, generalised itching and yellowish discolouration of the skin for 1 week. No history of rashes, fever, pain abdomen or altered stools. In view of four pregnancy losses previously, she was evaluated to have antiphospholipid antibody syndrome and was advised low molecular weight heparin. She was a known type-II diabetic on insulin. Prophylactic oral dydrogesterone and natural micronised progesterone were started at a local hospital 2 months prior, in view of threatened abortion. Investigations revealed grossly elevated serum bilirubin and liver enzymes. Other blood investigations were unremarkable and abdominal ultrasonography was normal. The most likely diagnosis in this case, is drug-induced liver injury due to oral progestin consumption. Causality assessment by Roussel Uclaf Causality Assessment Model was used to establish the diagnosis. High doses of progestin over a prolonged period resulted in acute hepatic toxicity causing itching, jaundice and transaminitis. Cautious use of progestins in appropriate dosage is recommended during pregnancy.
Topics: Pregnancy; Female; Humans; Progestins; Liver; Progesterone; Jaundice; Pruritus
PubMed: 38383125
DOI: 10.1136/bcr-2023-257138 -
Liver International : Official Journal... Aug 2017Increased serum bilirubin level is a widely used diagnostic marker for hepatic illnesses. Nevertheless, mild elevation of unconjugated serum bilirubin (such as in... (Review)
Review
Increased serum bilirubin level is a widely used diagnostic marker for hepatic illnesses. Nevertheless, mild elevation of unconjugated serum bilirubin (such as in Gilbert syndrome) has been recently demonstrated to correlate with low risk of chronic inflammatory and/or oxidative stress-mediated diseases. In accord, a low serum bilirubin level has emerged as an important predisposing factor or a biomarker of these pathologic conditions including cardiovascular, tumour, and possibly neurodegenerative diseases. Bilirubin possesses multiple biological actions with interaction in a complex network of enzymatic and signalling pathways. The fact that the liver is the main organ controlling the bioavailability of bilirubin emphasizes the central role of this organ in human health.
Topics: Bilirubin; Humans; Jaundice; Sex Factors
PubMed: 28004508
DOI: 10.1111/liv.13351 -
PLoS Neglected Tropical Diseases 2015Leptospirosis occurs worldwide, but the global incidence of human disease and its mortality are not well understood. Many patients are undiagnosed and untreated due to... (Review)
Review
BACKGROUND
Leptospirosis occurs worldwide, but the global incidence of human disease and its mortality are not well understood. Many patients are undiagnosed and untreated due to its non-specific symptoms and a lack of access to diagnostics. This study systematically reviews the literature to clarify the mortality from untreated leptospirosis. Results will help quantify the global burden of disease and guide health policies.
METHODOLOGY/PRINCIPAL FINDINGS
A comprehensive literature search was performed to identify untreated patient series. Included patients were symptomatic, but asymptomatic patients and those who had received antibiotics, dialysis or who were treated on Intensive Care Units were excluded. Included patients had a confirmed laboratory diagnosis by culture, PCR, or serological tests. Data was extracted and individual patient series were assessed for bias. Thirty-five studies, comprising 41 patient series and 3,390 patients, were included in the study. A high degree of bias within studies was shown due to limitations in study design, diagnostic tests and missing data. Median series mortality was 2.2% (Range 0.0-39.7%), but mortality was high in jaundiced patients (19.1%) (Range 0.0-39.7%), those with renal failure 12.1% (Range 0-25.0%) and in patients aged over 60 (60%) (Range 33.3-60%), but low in anicteric patients (0%) (Range 0-1.7%).
CONCLUSIONS
This systematic review contributes to our understanding of the mortality of untreated leptospirosis and provides data for the estimation of DALYs attributable to this disease. We show that mortality is significantly higher in older patients with icteric disease or renal failure but is lower in younger, anicteric patients. Increased surveillance and accurate point-of-care diagnostics are required to better understand the incidence and improve diagnosis of disease. Empirical treatment strategies should prioritize early treatment to improve outcomes from leptospirosis.
Topics: Age Factors; Bias; Humans; Jaundice; Leptospirosis; Meningitis; Renal Insufficiency
PubMed: 26110270
DOI: 10.1371/journal.pntd.0003866 -
Transfusion and Apheresis Science :... Aug 2023Undiagnosed and untreated hyperbilirubinemia in infants may result in Kernicterus Spectrum Disorder and poor prognoses. Rhesus incompatibility and glucose-6-phosphate...
INTRODUCTION
Undiagnosed and untreated hyperbilirubinemia in infants may result in Kernicterus Spectrum Disorder and poor prognoses. Rhesus incompatibility and glucose-6-phosphate dehydrogenase (G6PD) deficiency are among the known causes of infantile jaundice. This study was designed to define the severity and prognosis in jaundiced infants with Rh incompatibility or G6PD deficiency.
METHODS
A total of 144 term, 2- 14 days old jaundiced infants (bilirubin > 20 mg/dl) with Rh incompatibility(85 infant) or G6PD deficiency(59 infant) were included in this cohort study with 24-month follow-up through available sampling at Ghaem hospital between 2015 and 2022. Denver II test was used at 6, 12, 18, and 24-month ages after discharge. Infants with Rh incompatibility or G6PD deficiency were assigned into two groups of favorable and poor prognosis. Following that, the bilirubin levels of these infants were compared at the time of admission.
RESULTS
The bilirubin level in G6PD deficient infants with poor prognoses (37.96 ± 9.25 mg/dl) and neonates with Rh incompatibility (36.23 ± 5.08 mg/dl) almost was the same (P = 0.232). 40 babies (47%) caused by Rh incompatibility and 33 (56%) babies caused by G6PD deficiency had a poor prognosis (P = 0.465). Average bilirubin in babies with RH incompatibility with favorable prognosis is 21.8 and poor prognosis is 36.2 mg/dl. In infants with G6PD deficiency, it was 24 mg/dl with favorable prognosis and 38 mg/dl with poor prognosis (P < 0.0001). The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups (P < 0.0001).
CONCLUSION
The two-year prognoses of hyperbilirubinemia caused by G6PD deficiency are as poor as that of Rh incompatibility. The severity of hyperbilirubinemia had a significant role in the prognosis of infants in both groups.Exchange transfusion in cases with bilirubin < 25 mg/dl can improve the prognosis in both groups, especially in infants with Rh incompatibility.
Topics: Humans; Infant, Newborn; Glucosephosphate Dehydrogenase Deficiency; Cohort Studies; Jaundice, Neonatal; Hyperbilirubinemia; Prognosis; Bilirubin; Jaundice; Blood Group Incompatibility
PubMed: 37164807
DOI: 10.1016/j.transci.2023.103714 -
Khirurgiia 2023Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or...
Hepatic artery aneurysms (HAA) are rare (20% of all visceral arteries). Most often, HAAs are asymptomatic and detected at autopsy. However, their ruptures and/or bleeding following pressure ulcers in visceral gastrointestinal organs are a significant clinical and diagnostic problem. We present 2 patients with obstructive jaundice and hemobilia. Diagnostics revealed aneurysm of the right hepatic artery with arterio-biliary fistula. Life-threatening hemobilia is a consequence of HAA rupture into biliary system. Endovascular approach is preferable for HAA without clinical manifestations. Awareness of this disease is important for early detection and active surgical intervention before possible complications.
Topics: Humans; Biliary Fistula; Hemobilia; Aneurysm; Hepatic Artery; Jaundice, Obstructive
PubMed: 37850899
DOI: 10.17116/hirurgia202304177 -
Contrast Media & Molecular Imaging 2022This study aims to investigate the mechanism by which biliary drainage reduces intestinal barrier damage in obstructive jaundice (OJ). A biliary drainage model was...
This study aims to investigate the mechanism by which biliary drainage reduces intestinal barrier damage in obstructive jaundice (OJ). A biliary drainage model was established in rats with OJ to detect changes in inflammatory factors and diamine oxidase (DAO), a marker of intestinal mucosal damage. The expression of autophagy-related genes in the intestinal mucosa after biliary drainage was detected using a reverse transcription-polymerase chain reaction. The rats were separated into two groups that received the autophagy activator rapamycin (RAPA) or the autophagy inhibitor 3-methyladenine (3-MA) to further investigate whether biliary drainage could alleviate the inflammatory response, oxidative stress, mitochondrial complex IV damage, and thus barrier damage in rats with OJ. The expression levels of inflammatory factors and the serum DAO content were increased in rats with OJ ( < 0.05). Biliary drainage further induced autophagy, reduced the expression levels of inflammatory factors, decreased the serum DAO content ( < 0.05), and improved intestinal mucosal damage. Administration of RAPA to OJ rats with biliary drainage increased autophagy ( < 0.05); decreased inflammatory factor secretion ( < 0.05), the serum DAO content ( < 0.05), oxidative stress ( < 0.05), and mitochondrial respiratory chain complex IV damage ( < 0.05); and ameliorated intestinal mucosal injury in OJ rats. When OJ rats were treated with 3-MA, intestinal mucosal injury, intestinal mitochondrial injury, and oxidative stress were all aggravated ( < 0.05). Biliary drainage can reduce the expression of inflammatory factors, oxidative stress, and mitochondrial injury by inducing intestinal mucosal autophagy in OJ rats, thus suggesting its role in the alleviation of intestinal mucosal injury.
Topics: Animals; Autophagy; Drainage; Intestinal Mucosa; Jaundice, Obstructive; Oxidative Stress; Rats
PubMed: 35909583
DOI: 10.1155/2022/3301330 -
Annali Italiani Di Chirurgia 2023Pancreatic surgery e pancreatic fistula (POPF) is a potentially fatal sequela with substantial morbidity and mortality. POPF incidence and risk factors vary. This study... (Observational Study)
Observational Study
UNLABELLED
Pancreatic surgery e pancreatic fistula (POPF) is a potentially fatal sequela with substantial morbidity and mortality. POPF incidence and risk factors vary. This study aimed to evaluate the incidence and risk factors of patients with pancreatic fistula (PF) from patients undergoing various pancreatic surgeries for different pancreatic diseases.
MATERIAL AND METHODS
A retrospective observational study was conducted in the surgical unit of our university hospitals from July 2014 to July 2019. Three hundred forty-seven patients were admitted with a clinical diagnosis of pancreatic fistula following both open and laparoscopic approaches for pancreatic benign and malignant tumors.
RESULTS
The most prevalent age was >60 years (67%), with a male predominance (83%). The most common diagnosis before surgery was pancreatic head adenocarcinoma (32%), followed by duodenal neoplasm (19%) and true epithelial pancreatic cystic neoplasms (18%), ampullary neoplasms (15%), bile duct neoplasms (12%), neuroendocrine neoplasms (2%), and chronic pancreatitis (2%). The most prevalent site of the pancreatic tumor was the head (87%), while accompanied Jaundice (47%) and epigastric discomfort (37%) were the commonest presentations before surgery. Pancreatic duct diameter greater than 3 mm was present in 208 patients (60%), tumor size greater than 3 cm in 63%, hard pancreatic texture in 67%, and preoperative ERCP with a stent in 37% of cases. Tumor in the tail of the pancreas was found in 5% (17 patients) of cases. The commonest operations performed were open pylorus-preserving pancreaticoduodenectomy, open pancreaticoduodenectomy without pylorus-preserving, and open distal pancreatectomy with splenic preservation. Postoperative pancreatic fistula occurred in 8% of cases (27), with ISPGF grade A (biochemical leak) occurring in 17 patients (17/27) and clinically significant POPF occurring in 10 patients (10/27). POPF occurred in 13 patients after distal pancreatectomy, 11 patients after pancreaticoduodenectomy, two cases followed central pancreatectomy, and one. Grade B after pancreaticoduodenectomy and two after distal pancreatectomy. Grade C POPF occurred in four patients after pancreaticoduodenectomy but not after distal pancreatectomy. Age >55 (p=0.00), male (p=0.03), presence of symptom (p=0.0008), location at Head of the pancreas (p=0.0004), elevated CA19-9 (p=0.0004), jaundice (p=0.0001) and pancreatic texture (p=0.00**).
CONCLUSION
Pancreatic fistula occurred in 27 patients (8%), a comparatively low incidence. POPF was linked to age, Jaundice, gender, pancreatic head cancer, symptoms, high CA 19-9, jaundice, and a soft pancreas. POPF incidence was higher after distal pancreatectomy, whereas POPF severity was higher after pancreaticoduodenectomy KEY WORDS: Pancreaticoduodenectomy, Pancreatic Fistula, Pancreatic Resection, Postoperative Complications.
Topics: Humans; Male; Middle Aged; Female; Pancreatic Fistula; Pancreas; Pancreatectomy; Pancreaticoduodenectomy; Pancreatic Neoplasms; Postoperative Complications; Risk Factors; Jaundice; Retrospective Studies
PubMed: 38051507
DOI: No ID Found -
Journal of Surgical Oncology Sep 2018Preoperative jaundice is considered a relative contraindication to radical gallbladder cancer (GBC) resection due to poor prognosis and high postoperative morbidity.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Preoperative jaundice is considered a relative contraindication to radical gallbladder cancer (GBC) resection due to poor prognosis and high postoperative morbidity. Recent reports have indicated that aggressive surgery may improve long-term survival for patients with advanced GBC who present with obstructive jaundice. The current systematic review and meta-analysis aimed to compare postoperative outcomes among jaundiced and non-jaundiced patients with resectable GBC.
METHODS
An electronic search was performed using several Medical Subject Headings terms: cholecyst, gallbladder, tumor, cancer, carcinoma, adenocarcinoma, neoplasia, neoplasm, jaundice, and icterus. Overall survival after surgery was the primary outcome; resectability and postoperative morbidity were the secondary outcomes.
RESULTS
Overall survival was shorter among patients who presented with jaundice (Hazard ratio [HR]: 2.21, 95% confidence interval [CI], 1.64-2.97; P < 0.001). Patients with jaundice were less likely to have resectable disease (odds ratio: 0.27, 95% CI, 0.17-0.43; P < 0.001). The jaundice group had higher odds of postoperative morbidity, bile-leak, and posthepatectomy failure versus the non-jaundiced control group.
CONCLUSIONS
Radical surgery for GBC resection for patients presenting with obstructive jaundice was associated with reduced overall survival and increased postoperative morbidity. Jaundiced patients with advanced GBC should be considered for surgical resection but need careful evaluation and counseling before undertaking extensive surgical resection.
Topics: Bile Duct Neoplasms; Gallbladder Neoplasms; Hepatectomy; Humans; Jaundice; Prognosis; Survival Rate
PubMed: 30259519
DOI: 10.1002/jso.25186 -
Pediatric Clinics of North America Dec 2021"Biliary atresia (BA) is a common cause of jaundice in infancy. There is increasing evidence that newborn screening with direct or conjugated bilirubin leads to earlier... (Review)
Review
"Biliary atresia (BA) is a common cause of jaundice in infancy. There is increasing evidence that newborn screening with direct or conjugated bilirubin leads to earlier diagnosis. Although the Kasai portoenterostomy is the primary treatment, there are scientific advances in adjuvant therapies. As pediatric patients transition to adult care, multidisciplinary care is essential, given the complexity of this patient population."
Topics: Acetylcysteine; Biliary Atresia; Bilirubin; Cholestasis; Early Diagnosis; Humans; Infant; Infant, Newborn; Jaundice; Liver Transplantation; Neonatal Screening; Portoenterostomy, Hepatic; Young Adult
PubMed: 34736593
DOI: 10.1016/j.pcl.2021.08.002