Altered Liver Function Tests Research Articles

Iron(III) diacetylmonoxime‐2‐hydrazinopyridine complex: A new prospective antitumor drug

Because of the side effects and drug resistance of cisplatin, a basic clinically approved chemotherapeutic drug, a new attempt is reported to develop a novel antitumor drug based on complexation of iron metal ion with organic moiety that may be effective and safer. A newly synthesized iron(III) diacetylmonoxime‐2‐hydrazinopyridine complex was tested firstly for its cytotoxicity and superoxide dismutase (SOD)‐mimic activity in vitro then for its antitumor activity against Ehrlich ascites carcinoma (EAC) and the related biochemical alterations in vivo in comparison with cisplatin. The complex showed 80.88% SOD‐mimic activity and IC50 of 2.6 μg ml−1. In EAC‐bearing mice, in a dose‐dependent manner, Fe(III) complex treatment exhibited significant hematological profile improvements, tumor volume, viable cell count and hepatic lipid peroxidation level decreases, life span extension, hepatic glutathione and total antioxidant capacity levels enhancements, hepatic SOD and catalase activities augmentations, liver function tests alterations attenuations, and hepatocyte nucleic acids content normalization. Thus, the Fe(III) diacetylmonoxime‐2‐hydrazinopyridine complex is a novel, promising, less toxic antitumor agent. Its killing of tumor cells may be via a reactive oxygen species scavenging mechanism.

Clinicopathological case: progressive cognitive decline with gait disturbance in a steel worker

A 57-year-old male steel plant worker presented with fatigue and altered liver function tests. Over the next two years, he developed cognitive decline, parkinsonism and seizures. This paper reports the...

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

ObjectiveThis study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients.DesignData analysis from a cross-sectional survey.Setting and participants894 GP delegates of a...

Bendiocarb induced histopathological and biochemical alterations in rat liver and preventive role of vitamins C and E.

In this study, biochemical changes and histological structure of rat liver after bendiocarb administration and possible preventive effects of vitamins C and E were studied. The animals were given with bendiocarb, vitamin C and vitamin E, daily 0,8mg/kg of body weight (bw), 100mg/kg-bw and 100mg/kg-bw for 28days, respectively. Lipid peroxidation, antioxidant enzyme activities, histological alterations and antioxidant capacity assays of liver and also liver function tests and lipid profile were measured. Bendiocarb treatment decreased the antioxidant enzyme activities, FRAP and TEAC values and increased malondialdehyde levels compared to control. Also, there were statistically significant alterations in liver function tests, lipid profile parameters and histopathological changes in bendiocarb treated groups. Vitamins C and E showed protective effects against examining parameters. According to results we can say that co-treatment of vitamin C and vitamin E may be more effective than use of them alone.

Causes of altered liver function tests – the role of alpha-1 antitrypsin

Altered liver function tests are a common finding in clinical practice. Our retrospective study aimed to identify the diagnoses in a non-selected cohort of patients with altered liver tests and to investigate whether alpha-1 antitrypsin genotyping should be part of the diagnostic workup. 501 patients who were admitted to our outpatient clinic for further evaluation of altered liver function tests were included in the study. The patients underwent a standardized diagnostic program with history taking, physical examination, laboratory tests and ultrasonography. Liver biopsy was performed if appropriate. More than 50 % of the patients had nonalcoholic fatty liver disease. Alcoholic and drug-induced liver injury were found in 8.6 % and 7 % of patients, respectively. Chronic hepatitis B and C, autoimmune liver disease and inherited causes of liver disease made up for approximately 16 % of the diagnoses. The remaining patients were diagnosed with kryptogenic liver disease or had miscellaneous diagnoses. In 3.7 % of the genotyped patients, the alpha-1 antitrypsin genotype PiMZ was found. Nonalcoholic fatty liver disease is nowadays the most frequent cause of altered liver tests. Alcoholic liver disease might be underrepresented in our study since these patients less often seek medical attention or the diagnosis is already made by the primary care physician. Drug-induced liver injury was found in more patients than expected and might therefore be underdiagnosed in practice. The alpha-1 antitrypsin genotype PiMZ was found in absence of other possible causes of liver disease, indicating that the PiMZ genotype is itself a risk factor for liver disease. Genotyping for alpha-1 antitrypsin should therefore be done when other causes for altered liver function tests have been ruled out.

CGRA16: A CASE OF DEADLY SWELLING

Cytophagic histiocytic panniculitis is a rare form of panniculitis with its most detrimental phenotype thought to be related to subcutaneous panniculitis-like T cell lymphoma, itself an uncommon malignancy. Here, we describe the case of a 27 year old female of Vietnamese heritage who presented with a six week history of severe periorbital oedema and multiple nodules on her extremities. Her investigations revealed anaemia, neutropenia, mildly altered liver function tests, a weakly positive Coomb's test and a titre of ANA with negative ENA, anti-ds DNA and complements. Skin biopsy was consistent with lupus profundus. Diagnosed with a systemic lupus erythematosus and managed with steroids with partial effect, she was closely followed in the Immunology-Rheumatology clinic. She continued to have deranged liver function tests, anaemia, neutropenia, and a rising ferritin level. Further work up also showed an increased ACE level and a positive myositis specific antibody, anti PL-12. Due to her incomplete response to steroids and a worsening ferritin level, investigations to look for evidence of a macrophage activation syndrome returned with an increased soluble CD25 level. Despite the addition of hydroxycholoroquine and mycophenolate, deterioration of her liver function progressed. An emergent hospital admission for acute onset jaundice and general malaise, found her severely anaemic and coagulopathic with active melaena. A review of her initial skin biopsy was done, this time revealing subtle features consistent with a subcutaneous panniculitis-like T cell lymphoma. An emergency bone marrow biopsy confirmed evidence of haemophagocytosis. T cell gene rearrangements on both bone marrow and skin further supported a diagnosis of a peripheral lymphoma. Within her first 48 hours in hospital she required an admission into ICU, multiple endoscopies, a laparotomy and massive blood transfusions. Initially treated with dexamethasone and etoposide, she was started on cyclophosphamide, doxorubicin, etoposide, vincristine and prednisone with remarkable results.

Parenteral fish oil and liver function tests in hospitalized adult patients receiving parenteral nutrition: A propensity score-matched analysis

Intravenous fat emulsions are associated with liver disease and there is some evidence that the administration of intravenous fish oil (FO) may be useful in reversing it. The aim of our study was to assess whether there are differences in the changes of liver function tests (LFTs) in hospitalized adult patients with parenteral nutrition (PN) with FO and vegetal lipids vs patients without FO. The secondary aim was to study the relationship between impaired LFT and FO. This was a 4-year, propensity score-matched analysis including patients aged ≥18 years treated with PN for ≥10 days. The exclusion criteria were previous liver disease, biliary disorders or pancreatic cancer, and altered initial LFT values. Patients were classified into 2 groups: FO cohort (patients who received FO - in addition to vegetal oil - after the first week of PN) and the vegetal oil cohort (patients who received only vegetal oil). A propensity score matched cohort design was developed. Univariate analyses were used to study the changes in LFTs. To evaluate whether LFT alterations vary with FO administration, four stepwise multiple linear regression models were conducted. 52 patients were included, 52% men, median 66 (55-75) years and 69kg (61.7-78.8), with 18.5 (14-31.8) days of PN treatment. Maximum FO supplementation was 23%. During the first week with PN (none of the groups receiving FO), gammaglutamyl transferase (GGT), alkaline phosphatase (AP) and total bilirubin (BIL) increased significantly. Comparing LFT values at seven days of PN with at the end of PN treatment, the univariate analysis showed a better response for the FO group. The group without FO showed a significant increase for GGT and AP. In multivariate models, the percentage of FO administered was associated with a decrease in GGT, B=-0.33 [CI 95%=-0.54/-0.12], in AP, B=-0.12 [CI 95%=-0.20/-0.03] and ALT, B=-0.12 [CI 95%=-0.21/-0.024]. Lipid composition plays a significant role in LFT alteration associated with PN, and FO intravenous lipid emulsions (ILEs) minimize disturbance of LFTs in hospitalized adult patients.

Idiopathic noncirrhotic portal hypertension: current perspectives.

The term idiopathic noncirrhotic portal hypertension (INCPH) has been recently proposed to replace terms, such as hepatoportal sclerosis, idiopathic portal hypertension, incomplete septal cirrhosis, and nodular regenerative hyperplasia, used to describe patients with a hepatic presinusoidal cause of portal hypertension of unknown etiology, characterized by features of portal hypertension (esophageal varices, nonmalignant ascites, porto-venous collaterals), splenomegaly, patent portal, and hepatic veins and no clinical and histological signs of cirrhosis. Physicians should learn to look for this condition in a number of clinical settings, including cryptogenic cirrhosis, a disease known to be associated with INCPH, drug administration, and even chronic alterations in liver function tests. Once INCPH is clinically suspected, liver histology becomes mandatory for the correct diagnosis. However, pathologists should be familiar with the histological features of INCPH, especially in cases in which histology is not only requested to exclude liver cirrhosis.

Acute Right Upper Abdominal Pain With No Trauma History

Question: An 82-year-old woman arrived in our emergency department for acute right upper abdominal pain with no trauma history. She had a medical history of cardiac arrhythmia (atrial fibrillation) with pacemaker insertion and anticoagulant therapy (warfarin 2.5 mg/d). At the time of her presentation Prothrombin time was 36.8 s, prothrombin activity was 21%, international normalized ratio was 3.32, and platelet count was normal (247 × 103/μL). There was no alteration in liver function tests. She underwent abdominal multiphasic contrast-enhanced multidetector computed tomography. The unenhanced phase demonstrated a distended gallbladder with slightly hyperdense heterogeneous material occupying all its lumen (Figure A). On the arterial phase (Figure B, arrowhead) it appeared inside the lumen of the gallbladder at the middle third of the inferior wall, a focal contrast media area, which become more evident on venous phase (Figure C, D, arrowhead). After multidisciplinary discussion and correction of coagulation parameters, the patient underwent laparoscopic cholecystectomy. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. This radiologic sign on multiphasic contrast-enhanced multidetector computed tomography with axial images (Figure A–C), coronal multiplanar reconstruction (Figure D) and coronal volume rendering technique were indicative for active hemorrhage of gallbladder wall. During the urgent surgical treatment there was confirmation of that distended gallbladder. Postoperatively opening of the gallbladder revealed in its lumen the presence of bile mixed with dishomogeneous blood clots. Pathologic evaluation demonstrated arteriosclerosis of cystic artery, with a pseudoaneurysmatic tear of one of its collateral branches with focal surround inflammatory tissue of gallbladder wall. The postoperative course was uneventful, and the patient was discharged on day 8. Hemorrhage from the gallbladder is not a frequent event.1Hudson P.B. Johnson P.P. Hemorrhage from the gall bladder.N Engl J Med. 1946; 234: 438-441Crossref PubMed Scopus (12) Google Scholar The etiologies for hemorrhage of the gallbladder are trauma, neoplasms, inflammation wall with gallstones, aneurysms, varicose veins with portal hypertension, arteriosclerosis, and coagulopathy. However, isolated gallbladder arterial hemorrhage owing to anticoagulation therapy has been reported rarely. This pathologic state can be detected by contrast-enhanced ultrasound, contrast-enhanced computed tomography, and digital subtraction angiography.2Krudy A.G. Doppman J.L. Bissonette M.B. et al.Hemobilia: computed tomographic diagnosis.Radiology. 1983; 148: 785-789Crossref PubMed Scopus (35) Google Scholar, 3Pandya R. O'Malley C. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis.Abdom Imaging. 2008; 33: 652-653Crossref PubMed Scopus (39) Google Scholar

Afectación hepática en enfermedades sistémicas de patogenia inmunológica

IntroductionLiver involvement in patients with autoimmune disease is not unusual. Clinical manifestationsSubclinical alterations in liver function tests (mild hypertransaminasemia and cholestasis), are the most frequent forms of presentation. Cirrhosis and fulminant hepatitis are infrequent in this group of diseases. The presence of Budd-Chiari syndrome and nodular regenerative hyperplasia are remarkable, and related to hepatic vein and small intrahepatic arteries thrombosis, respectively. HistopathologyLiver biopsy is not specific and may reveal a variety of subclinical diseases, such as viral hepatitis, steatosis and drug toxicity. TreatmentThere is no specific treatment for these alterations and the management should be directed toward the underlying disease.

Protocolo diagnóstico de la alteración aguda de las pruebas de función hepática en el paciente inmunodeprimido

IntroductionThe diagnosis of acute alteration of liver function tests in the immunocompromised patients requires an independent issue, because its causes, clinical manifestations and evolution has peculiarities which must be discussed. EtiologyThe state of immunosuppression may be secondary to a congenital or acquired condition. In this protocol, we will focus on acquired defects induced by drugs (hematology/oncology treatments, immunosuppressive therapy in the context of inflammatory/autoimmune disease or within the prevention of rejection in post-transplant of solid organs and bone that is). PathogenyAcute alterations in liver function tests may be secondary to infections, drugs, or hemodynamic changes.

A study on drug induced Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and SJS-TEN overlap in a tertiary care hospital of Northeast India

Background : Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS-TEN overlap are rare, but potentially life-threatening, reactions to medications. From Northeast India, limited epidemiological data is available on these cutaneous drug reactions. Aims : The purpose of this study was to assess the drug-induced SJS/TEN cases of a tertiary care hospital of Northeast India. Methods : This cross sectional study was conducted in Gauhati Medical College & Hospital of Guwahati city, Northeast India. WHO–UMC probability assessment system and ALDEN were used for causality assessment of reported SJS/TEN cases. Results are presented in percentage; mean (standard deviation), and median (interquartile range difference). Results : Forty five cases of drug induced SJS (42.22%), TEN (55.55%) & SJS-TEN (2.22%) overlap were reported. Out of these, 25 patients were males and 20 patients were females. The mean age of the patients was 29.69 (17.57) year. The median time duration between drug intake and onset of symptoms for SJS/TEN was 25(4) and the median duration of hospital stay by patients was 13(8). The most offending groups of drugs were antimicrobials (35.55%), followed by anticonvulsants (28.89%), antipyretics (17.78%), and nonsteroidal anti-inflammatory drugs (6.67%). In individual drug category, paracetamol (17.77%) & phenytoin (15.55%) were among the commonly reported offending drugs. Altered liver function test was commonly reported complication in SJS/TEN patients. As per ALDEN, drug causality was very probable in 16 cases whereas by WHO-UMC assessment system, 1 case was certain while 29 cases were probable. Limitations : Statistical significance among the variables has not shown and large study sample may be required for interpretation of results to arrive at a definite conclusion. Conclusions : Antimicrobials, anticonvulsants, and antipyretics were commonly reported group of offending drugs to cause SJS/TEN in patients. Paracetamol & phenytoin were commonly reported individual offending drugs. Key words: SJS, TEN, Northeast India, Paracetamol, Anticonvulsants, Offending drugs

Liver function tests as a measure of hepatotoxicity in areca nut chewers

Background: Areca nut has been listed as a carcinogenic agent in humans and is linked to cancers of oral cavity, gastrointestinal tract, and hepatobiliary system. Liver function tests (LFTs), the estimation of enzymes specific to the hepatic system, give an assessment of its cellular integrity, and functionality. Aim and Objectives: This study aimed to evaluate the state of the liver in patients consuming areca nut and its products over a period. Materials and Methods: LFTs were carried out on 10 nonareca nut chewers and thirty patients with a history of areca nut, quid or a combination of tobacco and areca nut chewing, extending from 6 months to 30 years. The LFTs included estimation of aspartate transaminase (AST), alanine transaminase, alkaline phosphatase (ALP), direct bilirubin, albumin, and total protein content. A comparative analysis was done for each biochemical marker with duration, form (betel nut alone, quid, and betel nut with tobacco), and frequency of chewing areca nut. Results: A mild increment in AST was seen in 33.3% cases. Statistically significant association (P < 0.05) was observed between the control and cases for AST, ALP, and total protein content. A significant positive Pearson's correlation (+0.417) was obtained for a form of areca nut chewing (areca nut and tobacco) and AST. A significant negative Pearson's correlation (−0.05) was observed between total protein content and form of chewing (areca nut and tobacco). Conclusion: The results of the study seem to indicate that even long-term chewing of areca nut is not hepatotoxic. Minor alterations in LFTs were well within limits.

Oral Lichen Planus in Relation to Transaminase Levels and Hepatitis C Viral Antibodies Detection: A Clinical Study

ABSTRACTBackgroundLichen planus (LP) is a common long term inflammatory disorder that affects skin and mucous membranes. Though mostly asymptomatic in oral mucosa it may cause severe morbidity in erosive cases. The relation between LP and liver diseases especially hepatitis C have been proposed by many authors with varied results. Alteration in liver function tests reflected by increased levels of transaminase levels, i.e., serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) with or without the presence of antibodies against hepatitis C virus (HCV) has been observed in oral lichen planus (OLP) patients in many studies. So this study was undertaken with the intent to further evaluate any alliance between OLP and liver disease principally hepatitis C.Materials and methodsThe study consisted of 30 histopathologically confirmed patients of OLP and 30 age and sex matched healthy volunteers visiting the outpatient department of a dental hospital over a period of 1 year. All subjects in both groups were subjected to SGOT, SGPT and HCV antibodies detection.ResultsThe percentage of patients with elevated SGOT and SGPT values was higher among the OLP patients in the study group (40%) in comparison to subjects in the control group (7%). The mean values of SGOT and SGPT were also higher in the study group in comparison to the control group. No HCV antibodies were found in the serum of subjects in both the study group and control group.ConclusionLiver disease or hepatitis C can be considered a risk factor for LP and may lead to diagnosis, early treatment and possibly a better prognosis in asymptomatic OLP patients. Further studies with large samples are recommended to prove the current hypothesis regarding the association between LP and chronic liver disease and/or HCV infection.How to cite this articleSobti G, Manjunath M, Deepak TA, Krishna S, Annaji AG. Oral Lichen Planus in Relation to Transaminase Levels and Hepatitis C Viral Antibodies Detection: A Clinical Study. World J Dent 2016;7(2):64-68.

What is the real-life maintenance mesalazine dose in ulcerative colitis?

To describe how mesalazine (MSZ) is used in our practice in ulcerative colitis (UC), at what dose, and the success rate (regarding adherence to therapy). Observational, transversal study, including all patients with UC and with MSZ maintenance therapy seen from September 2014 to February 2015 at two IBD units in Spain. Treatment adherence was measured by the Morisky-Green scale. We included 203 patients (mean MSZ dose: 2.6 ± 1.0 g/d; median of treatment: 19.5 months [IQR: 8-48]). Doses < 2 g/d were used in 15.3% of cases, 2-2.9 g/d doses in 35.0%, 3-3.9 doses in 29.5%, and ≥ 4 g/d doses in the remaining 20.2%. A single daily dose was preferred in 51.2% of cases, two doses in 33.0% and three doses in 15.8%. A different MSZ brand had been previously used in 36.6% of patients. In 134 cases (66%), the maintenance dose had been increased during a flare-up, and in 49 (36.6% of cases) this higher dose had been kept for maintenance (dose ≥ 4 g/d in 36 patients). During the MSZ therapy, 14 patients (6.9%) suffered mild side effects (21.4% altered liver function tests). Therapy adherence was good in 81.8% of cases. Half of our UC patients take high MSZ doses (≥ 3 g/d) as maintenance therapy, with acceptable safety and good adherence. Half of all patients take a single daily dose, and one third needed a different commercial brand during therapy. Opting for a higher MSZ maintenance dose is a possible strategy for a satisfactory maintenance therapy.

The study of clinical, biochemical and hematological profile in malaria patients

Background: Malaria is a major health problem in India. Malaria is the most important parasitic infection which causes major health challenges. Malaria pathogenesis is based on extensive changes in hematological and biochemical parameters. The objective of this study was to study the clinical features, hematological and biochemical parameters in malaria patients and correlate them. Methods: The present study was done in the department of medicine, M.G.M.M.C & M.Y.H. Indore (M.P.). In this study various signs and symptoms and frequency of changes in hematological and biochemical parameters caused by Plasmodium species were determined. Mean, standard deviation, minimum, maximum values of laboratory alterations were noted and associations were calculated. Results: 104 patients who had peripheral smear positive for malaria parasite were included in this study. Out of these 104 patients 53 (50.96%) patients of P. falciparum , 48 (46.15%) patients of P. vivax and 3 (2.88%) patients of mixed infection. In the present study most common system involved was haematological (69%) followed by hepatic (42.3%), renal (29.04%), neurological (28.84%), cardiovascular (16.34%) and pulmonary (2.88%). Conclusions: Malaria though potentially treatable, still kills many patients every year in India. The most common presentation of malaria is fever, so in endemic region malaria may be considered as a leading differential diagnosis in all patients presenting as acute febrile illness, especially patients who also have organomegaly, fall in hemoglobin level, thrombocytopenia and altered liver function tests. Therefore, it is vital to know and perform hematological and biochemical investigations to detect early complications and to treat them effectively.

Characteristics of Patients with Crimean-Congo Haemorrhagic Fever in an Outbreak in Saurashtra region of Gujarat, India in 2013

Background:CCHF (Crimean Congo Hemorrhagic Fever) is a severe fatal viral hemorrhagic fever similar to dengue fever but having potential to cause Nosocomial spread. CCHF virus belongs to RNA virus of Bunyaviridae family and its get transmitted by Hyalomma tick. Viral Illness presents as fever, severe body ache and bleeding manifestations along with thrombocytopenia, altered coagulation profiles and Liver Function Test. Ribavirin, antiviraldrug, if given in early stage may increases survival significantly. Aims: 1) To Study Clinical, Pathological & Biochemical parameters in patients of CCHF 2) To Study the efficacy of Oral Ribavirin in CCHF. Materials and Methods:This retrospective study included 10(ten) patients of RT-PCR confirmed CCHF admitted in Tertiary care teaching hospital of Gujarat, India. Their Clinical Parameters and laboratory finding studied on day to day basis. Oral Ribavirin given to 8 patients as 2 patients died before diagnosis of CCHF established. Results: Almost all patients have had fever of short duration with most having bleeding manifestation with marked thrombocytopenia, altered PT &aPTT, decreased plasma fibrinogen and elevated FDP with mild to modest elevation in liver enzymes .Out of 8 patients who received ribavirin, only one died. Conclusion: Oral ribavirin is to be started empirically in any patients involved in animal husbandry activity and develops acute hemorrhagic febrile illness in which tests for malaria and dengue are negative.

Coexistence of Salmonella Typhi Associated Hepatitis and Pancreatitis in a South Indian Male-A Case Report

Enteric fever is predominantly a tropical disease caused by Salmonella typhi and paratyphi. Enteric fever commonly presents with altered liver function tests, but Salmonella is a rare cause for acute hepatitis presentation. Also Salmonella lead to acute pancreatitis with rhabdomyolysis leading to renal failure. We report an otherwise immunocompetent adult male who presented with acute hepatitis with coagulopathy, acute pancreatitis along with rhabdomyolysis, renal failure and delirium which finally turned out to be a case of Salmonella typhi causing enteric fever.

Routine endoscopic ultrasound in moderate and indeterminate risk patients of suspected choledocholithiasis to avoid unwarranted ERCP: A prospective randomized blinded study.

Endoscopic ultrasound (EUS) is the most sensitive test for diagnosis of common bile duct stones and it may avoid unnecessary endoscopic retrograde cholangiopancreatography (ERCP). The purpose of this study was to evaluate whether EUS done initially would avoid unnecessary ERCP in patients with moderate or indeterminate risk for occurrence of choledocholithiasis. Patients with biliary colic or acute biliary pancreatitis, who were referred for suspected choledocholithiasis on the basis of alterations in liver function tests were prospectively included over 12months period in blinded randomized fashion. Endoscopic ultrasonography was performed for all patients. Patients were randomized to two groups. ERCP was done in all patients in group A irrespective of the EUS findings, while in the group B, ERCP was done only in those patients in whom EUS was suggested the presence of common bile duct stone or sludge. A total of 50 patients were randomized into each group. EUS diagnosed common bile duct stones in 24 out of 50 patients (48%) in group A, and ERCP identified common bile duct stones in 23 of those 24 patients. Twenty-eight out of 50 patients had common bile duct stones/sludge in group B, which were removed by subsequent ERCP. However, ERCP could be avoided in 22 cases (44%) of group B and none of these patients had biliary symptoms up to 6months of follow up. In patients with moderate or indeterminate risk for choledocholithiasis, prior EUS done for confirmation of choledocholithiasis avoids unnecessary ERCP in almost half of the cases.

Correlation of Histopathologic Findings of Non-Graft Threatening Preservation/Reperfusion Injury in Time-Zero Liver Needle Biopsies With Short-Term Post-transplantation Laboratory Alterations.

Background:Early post-transplantation alterations in liver tests are caused by a variety of etiologies including rejection, biliary or vascular complications, and preservation/reperfusion injury (PRI).Objectives:The aim of this study was to show the correlation between histopathologic changes of PRI and the alterations in liver tests in the early post-transplantation period.Materials and Methods:Between April 2013 and August 2014, histopathologic findings of protocol, time-zero, Tru-Cut, liver needle biopsies were evaluated in 94 cases of cadaveric liver transplantation. The histopathologic changes included ballooning degeneration, micro- and macro-vesicular steatosis, bilirubinostasis, apoptotic cells, bile plugs and neutrophilic infiltration. These histopathologic changes were compared with the early (15 days) post-transplantation liver laboratory findings.Results:Clinico-pathologic evaluation of all 94 cases was done by assessment of PRI findings in time-zero biopsies and possible causes of allograft injury were appraised. In 21 patients, a specific cause for allograft injury was found including rejection and/or surgical complications. In the remaining 73 cases, there was no specific cause for allograft injury and histopathologic findings of time-zero liver needle biopsies supported PRI. We classified liver laboratory tests alterations as: hepatocellular damage (elevation of transaminases and lactate dehydrogenase), cholestatic damage (elevation of alkaline phosphatase and total bilirubin) and mixed. Hepatocellular and cholestatic alterations in liver function tests were associated with the presence of marked apoptotic bodies and neutrophilic aggregates in time zero biopsies, respectively. On the other hand, macrovesicular steatosis was dominantly associated with mixed (hepatocellular and cholestatic) laboratory alterations of liver tests.Conclusions:Any discrepancy between histopathologic changes in time-zero biopsies and pattern of early liver laboratory alterations may be considered as a warning for causes other than PRI.