• 한국임상수의학회지
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• 제8권1호
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• pp.71-80
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• 1991

Clinical signs, serum chemical values and histological findings of hepatic tissue after partial and complete obstruction of common bile duct in Korean goats were investigated. Abnormal clinical signs were not observed in partial obstruction of common bile duct, but in complete obstruction clinical signs such as jaundice, urine color change, were observed. Serum total bilirubin, total cholesterol, aspartate aminotransferase, sorbitol dehydrogenase, gamma glutamyltranspeptidase, and total protein values increased on the 1-4th day and then gradually decreased to normal level in partial obstruction. However, they tend to increase persistently by the 24th day in complete obstruction of common bileduct. Histologic features of hepatic tissue in partial obstruction were not changed as compared with normal hepatic tissue. On the other hand, in complete obstruction of common bite duct there were moderate bile duct proliferation in a portal area, rupture of bile canaliculi, phagocytosis of bile pigment by Kupffer cells, periportal fibrosis, intrahepatic bile stasis and hepatic cell necrosis.

• 대한핵의학회지
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• 제24권2호
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• pp.254-259
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• 1990

We examined patients with suspected acute or intermittent biliary obstruction using hepatobiliary scintigraphy, ultrasonography and contrast cholangiography. Of 16 patients with confirmed common bile duct obstruction, sonography and scintigraphy disagreed in 8(50%). Scintigraphy revealed partial or complete common bile duct obstruction in 13 patients (81.3%) and 6 of them had no evidence of dilated biliary trees. It is concluded that disagreement between sonography and scintigraphy is not rare in patients with acute or intermittent biliary obstruction and hepatobiliary scintigraphy is useful in diagnosing obstruction prior to ductal dilatation.

• Journal of Yeungnam Medical Science
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• 제39권2호
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• pp.161-167
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• 2022

Congenital web formations are extremely rare anomalies of the extrahepatic biliary tree. We herein report a case of common bile duct septum combined with multiple intrahepatic bile duct strictures in a 74-year-old female patient who was successfully treated with radiological intervention. The patient initially visited the hospital because of upper abdominal pain. Imaging studies revealed multifocal strictures with dilatation in both intra- and extrahepatic ducts; the final clinical diagnosis was congenital common bile duct web combined with multiple intrahepatic duct strictures. Surgical treatment was not indicated because multiple biliary strictures were untreatable, and the disease was clinically diagnosed as benign. The multiple strictures were extensively dilated twice through bilateral percutaneous transhepatic biliary drainage (PTBD) for 2 months. After 1 month of observation, PTBD catheters were successfully removed. The patient is doing well at 6 months after completion of the radiological intervention, with the maintenance of normal liver function. Congenital web of the bile duct is very rare, and its treatment may vary depending on the patterns of biliary stenosis. In cases where surgical intervention is not indicated for congenital web and its associated disease, radiological intervention with balloon dilatation can be a viable therapeutic option.

• 대한핵의학회지
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• 제32권2호
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• pp.161-167
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• 1998

목적: Tc-99m DISIDA 신티그라피에서 간 실질에 분절형으로 배설지연을 보이는 소견은 분절형 간내담관폐쇄의 소견으로 보고되고 있으나, 이러한 소견의 분절형 간내 담관폐쇄에서의 진단적 가치는 알려져 있지 않다. 본 연구에서는 간 실질 분절형 배설지연 소견의 분절형 간내 담관폐쇄 진단에서의 양성예측도와, 방사선학적 검사와 비교한 진단적 가치를 알고자하였다. 대상 및 방법: Tc-99m DISIDA 신티그라피에서 간 실질에 분절형 배설지연 소견을 보인 43명의 환자(48개 영상)를 대상으로하여 그 원인을 분석하고, 1개월 이내에 시행된 CT와 US와 비교하였다. 결과: 31예는 ERC나 PTC에 의해, 13예는 임상적 경과 관찰에 의해 분절형 담도 폐쇄가 확진되었고, 4예는 원인이 규명되지 않았다. 분절형 담관폐쇄에 대한 Tc-99m DISIDA 간담도 신티그라피의 양성예측도는 92% (44/48)이었다. US의 28%(5/ 18), CT의 13% (5/38)는 정상 소견이고, US의 17% (3/18), CT의 18% (7/38)에서는 담관 확장 소견만이 있었고, 원인이 되는 병변을 알 수 없었다. 결론: Tc-99m DISIDA 신티그라피에서 간 실질에 분절형 배설지연을 보이는 소견은 분절형 간내 담관폐쇄 진단에 높은 양성 예측도를 가진다. Tc-99m DISIDA 신티그라피는 특히 US나 CT가 정상인 경우에 분절형 담관폐쇄 진단에 선별검사로서 이용되어질 수 있을 것으로 생각된다. Tc-99m DISIDA 신티그라피의 분절형 담도관쇄 진단에서의 진단적 가치에 대한 전향적인 연구가 요구된다.

• Journal of Yeungnam Medical Science
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• 제28권2호
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• pp.180-186
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• 2011

Obstruction of the bile duct owing to the direct extension of a tumor is occasionally found in patients with a hepatic neoplasm, but bile duct tumor thrombus caused by the intrabiliary transplantation of a free-floating tumor is a rare complication of hepatocellular carcinoma A 50-year-old woman was diagnosed with HCC with bile duct tumor thrombi. She received transarterial chemoembolization (TACE) because her liver function was not suitable for surgery at the time of diagnosis. After TACE, infected biloma occurred recurrently. Thus, resection of the HCC, including the bile duct tumor thrombi, was performed. Six months after the surgery, recurred HCC in the distal common bile duct as drop metastasis was noted. The patient was treated with tomotherapy and has been alive for three years as of this writing, without recurrence. The prognosis of HCC with bile duct tumor thrombi is considered dismal, but if appropriate procedures are selected and are actively carried out, long-term survival can occasionally be achieved.

• Toxicological Research
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• 제19권1호
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• pp.67-72
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• 2003

Cholestatic liver injury results from the accumulation of toxic bile salts within the liver. The aim of the present study is to elucidate the changes in expression and cellular localization of apoptosis related proteins in the liver of bile duct-ligated (BDL) rat. Extrahepatic cholestasis was induced by double ligation of the common bile duct and cut between the ligatures. Animals were sacrificed at day 3 and at week 1, 2, 4, 6, and 8 after BDL. The number of TUNEL positive cells was increased significantly after 3 days of BDL, decreased over 2 weeks and remained constant thereafter. Fas expression was not changed and activation of caspase 8 did not occur. Fas immunoreactivity was exclusively observed in the cytoplasm of hepatocytes, indicating that Fas expressed in rat hepatocytes is a soluble form. Hepatocyte apoptosis was associated with Bax expression, which showed a peak at day 3 and decreased over time gradually. Immnunostaining of Bax was observed in hepatocytes and bile duct epithelial cells (BEC) of control and BDL rats. Bcl-2 was increased over time in BDL rats. These results suggest that apoptosis of hepatocytes in BDL rats is independent of Fas and controlled by Bax expression.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권2호
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• pp.262-266
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• 1999

Obstruction of the extrahepatic bile ducts is the most common cause of conjugated hyperbilirubinemia in early infancy. More than 90% of such obstructive lesions are accounted for by extrahepatic biliary atresia. A rare lesion is obstruction of the common duct by impacted, thickened secretions and bile. Bile plug syndrome is defined as extrahepatic obstruction of the bile ducts by bile sludge in term infants without anatomic abnormalities, congenital chemical defects of bile, or hepatocellular lesions. Obstruction of extrahepatic ducts by plugs of biliary material apperas to be due to the inspissation and precipitation of bile and mucus within the lumen of the ducts. Cholestasis and precipitation of bile develop in association with abnormal composition of bile in cystic fibrosis, hepatocellular damage, prolonged erythroblastic jaundice, altered biliary dynamics with total parenteral nutrition, gut dysfunction, diuretic therapy, exchange transfusions and perinatal hemolysis. In those cases, the term inspissated bile syndrome is used. The clinical and laboratory findings in bile plug syndrome are identical to those observed in biliary atresia and choledochal cyst. The diagnosis can be suspected based on the findings of clinical and laboratory examinations together with hepatobiliary imaging, ultrasonography, radionuclide scan and liver biopsy. We experienced a case of spontaneous resolution of bile plug syndrome in a 4-year-old girl. We report this case with brief review related literatures.

• Advances in pediatric surgery
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• 제9권2호
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• pp.81-88
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• 2003

Congenital dilatation of the common bile duct (choledochal cyst) is an uncommon disease. Although the etiology is unknown yet, various theories such as distal obstruction of the common bile duct, congenital weakness of the duct and anomalous union of the pancreaticobiliary duct have been offered to explain the occurrence of choledochal cyst. Thirty - six cases of choledochal cyst over 22 years were analyzed clinically and classified according to Todani's classification and Kimura's anomalous union of pancreaticobiliary duct type. Todani type 1 consisted with 22 cases which were subdivided into 19 cases of type Ia, 1 case of type Ib and 2 of type Ic. Type IVa consisted with 14 cases including one case of Caroli's disease. There were 25 type BP cases and 10 type PB cases and 1 normal pancreatobiliary junction. Serum alkaline phosphatase was increased significantly in almost all cases. Seven patients (19.4%) had associated congenital anomalies such as double gallbladder, left - sided gallbladder, common bile duct web, biliary atresia, accessory hepatic duct, heterotopic pancreas, cleft lip and 2 cases of intestinal malrotation. All patients underwent cyst excision and Roux - en - Y hepaticojejunostomy and cholecystectomy. There was one death due to methicillin resistant Staphylococcus aureus sepsis.

• 한국임상수의학회지
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• 제22권4호
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• pp.412-416
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• 2005

Three cases of extrahepatic bile duct disorder were presented. Two cases, a dog and a cat, were related to the obstruction of the extrhepatic bile duct, the other dog was affected with the gall bladder rupture. The clinical signs included anorexia, abdominal distension and vomiting. The laboratory test represented increased hepatic enzymes. On the radiography, hepatomegaly was seen in the obstructive cases, and ascites could be seen in the ruptured case. On the Ultrasonography, dilated gall bladder and extrahepatic bile duct were found in the obstructive cases, and there were ascites, indistinct gall bladder wall, dilation of gall bladder and extrabiliary tract, increased mesenteric echogenicity in the ruptured case. All presented were taken medication, surgical foreign material removal, or cholecystectomy showed complete recovery.

• Toxicological Research
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• 제17권3호
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• pp.187-194
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• 2001

The oxidative stress causes the cell damage and death and thereby, stimulates membrane lipid peroxidation. In this study, the correlation between the lipid peroxidation product and the parameter of liver fibrosis (cirrhosis) was investigated in cholestasis induced rats. The Sprague-Dawley rats were divided into 3 groups (sham: sham operation, BDL/S-I and BDL/S-II : bile duct ligation/scission) and were observed for 2 or 4 weeks. After observation period, the organs were weighed and the ratio of organ weight/body weight was calculated. Sera and liver tissue were used for the measurement of malondealdehyde (MDA), parameter of clinical biochemistry, total collagen content and the staining. The ratio of organ weight/body weight in BDL/S-I and BDL/S-II was significantly increased compared to sham operated group. Serological parameters (Alanine transaminase, Aspartate transaminase, Alkaline phosphatase and Total bilirubin) in BDL/S-I and BDL/S-II group were significantly higher than those in sham operated group. Concentration of MDA in BDL/S-I (261%) and BDL/S-II(790%) was significantly increased compared to MDA in sham operated group. And the content of hydroxyproline (hyp) in BDL/S-I and BDL/S-II group was significantly increased 2~4 times than in sham operated group. The good correlations between hyp in liver tissue and MDA in sera of sham operated group and all operated group were found (r=0.825). The significantly higher value of MDA, hyp and serological parameters in BDL/S-I and BDL/S-II group suggests the stimulation of lipid peroxidation and chronic liver damage. Especially the activation of lipid peroxidation and the stimulation of liver fibrosis was stronger in BDL/S-II group than in BDL/S-I group. The stronger fibrosis, portal-portal septum formation, the more massive bile duct proliferation in portal triads and stroma, and hepatocytes swelling were observed in liver tissue of and BDL/S-II group compared to BDL/S-I group. Conclusively, a good correlation between MDA as a lipid peroxidation marker and hyp as a liver fibrotic parameter could be connected with the process of liver fibrosis. Moreover, cholestasis condition may cause jaundice, activation of lipid peroxidation, and collagen accumulation in liver. Additionally, optimal observation period of bile duct obstruction for the screening of antioxidant and antifibrotic effect in rats would be four weeks.