Correlation among pressure, diameter, and jaundice in acute obstruction of common bile duct

Abstract

Objective To investigate the relationship between the pressure,diameter,and jaundice in acute obstruction of the common bile duct (CBD).Methods An automatic pressure measurement device was placed through a small tube (D =3.5 mm) into the CBD on the upper entrance of the duodenum.The pressure and diameter of the CBD were detected.The switch was then turned on and methylene blue (MB) in saline (NS 100 ml+ MB 60 mg,20 drops/min) was infused into the CBD to create CBD congestion.The pressure and diameter were detected according to the time set,and the reflux of MB to the liver was observed.Results Before the MB was injected,the pressure of the CBD was hower than 8 mm Hg ( 1 mm Hg =0.133 kPa),the diameter was 4.0 mm,and the color of the liver was normal.Seven min after the MB was introduced,the pressure was increased to 15.42 mm Hgand the diameter widened to 5.50 mm.Fifteen min after introduction the pressure was increased to 20 mm Hg and the diameter widened to 6.00 mm,the liver surface began to turn blue,indicating that the bile had begun to reflux into the liver.After 30 min,the pressure was increased to 33 mm Hg,the diameter widened to 6.7 mm,and the blue liver color enhanced.After 45 min,the pressure was increased to 21 mm Hg,the diameter widened to 7.5 mm,and the color of the liver was dark blue.After 60 min,the pressure was increased to 18 mm Hg and the diameter widened to 7.5 mm.Conclusion After the pressure rises,increase in the diameter is observed,followed by jaundice.Within a certain range,bile duct dilatation is positively correlated with the biliary pressure.The degree of jaundice and biliary duct dilatation pressure are also positively correlated.However,when the biliary pressure rises to 33 mmHg,it no longer increases,while the expansion of the width to 7.5 mm also no longer continues,indicating that duct dilatation and pressure are both self-limiting. Key words: Acute obstruction of the common bile duct; Bihary pressure ; Biliary expansion; Jaundice