Chronic Bile Duct Obstruction Research Articles

A micropuncture study of renal salt and water retention in chronic bile duct obstruction.

The mechanism of sodium retention by the kidney in rats with ligation of the common bile duct was studied with micropuncture techniques. 10-14 days after bile duct ligation, rats showed positive sodium balance and ascites formation. Measurements of renal blood flow and glomerular filtration rate yielded values that were not different from those in normal control animals. Likewise, single nephron filtration rte of surface nephrons was the same in the experimental rats as in the controls. Sodium reabsorption, however, was markedly increased in the proximal convoluted tubule, as well as in segments beyond the proximal convolutions. Single nephron filtration fraction, calculated from measurements of efferent arteriolar and arterial hematocrits, was significantly elevated in the cortical nephrons, even though whole kidney filtration fraction was the same as in normal rats. The calculated protein concentration of cortical peritubular blood was higher in the bile duct-ligated rats than in the normal controls. The observations are consistent with the view that sodium retention is the result of enhanced reabsorption primarily by cortical nephrons. The enhanced reabsorption can be accounted for by relative cortical ischemia due to efferent arteriolar vasoconstriction with the consequent elevation of peritubular colloid oncotic pressure.

Effect of chronic bile duct obstruction on renal handling of calcium and magnesium.

Abstract The effect of chronic biliary tract obstruction, produced by the ligation of the common bile duct, on the renal handling of calcium and magnesium was evaluated in 7 mongrel dogs. Studies were carried out in the same animals before and 4 to 7 weeks after the ligation procedure. The increases in the excretion rates of calcium and magnesium during expansion of extracellular fluid volume were significantly lower in experiments after bile duct ligation than in control studies. The relationships between the fractional excretion of calcium and sodium and of magnesium and sodium were not affected by bile duct ligation. The results indicate that chronic bile duct ligation not only alters the renal handling of sodium, as has already been shown, but also that of calcium and magnesium.

Effect of chronic bile duct obstruction on renal handling of salt and water.

Renal sodium reabsorption and the concentrating and diluting abilities of the kidney were evaluated in the same trained mongrel dogs before and after chronic common bile duct ligation (BDL). Glomerular filtration rate (GFR) and C(PAH) were not altered by BDL. The natriuretic response to a standardized infusion of 0.45% solution of NaCl was markedly blunted by BDL (P < 0.01); calculated distal sodium delivery was significantly less in experiments after BDL than in control studies. Furthermore, the fractional reabsorption of sodium at the diluting segment for any given rate of distal delivery was enhanced by BDL. Similarly, C(H2O)/100 ml GFR for a given sodium delivery was higher after BDL than control values. Maximal urinary concentration (Uosm-max) was lower after BDL, and the mean Uosm-max for the whole group of animals was 60% of the control value (P < 0.001). Mean maximal T(H2O)/100 ml GFR after BDL was not different from control values; however, T(c) (H2O)/100 ml GFR for a given Cosm/100 ml GFR was lower after BDL in three dogs only. The sodium content of the inner part of renal medulla after BDL was significantly lower than the values obtained in control animals. The excretion of an oral water load in the conscious state was impaired after BDL; although all animals excreted hypotonic urine, urinary osmolality was usually higher after BDL than in control studies. Maximal urinary concentration and the excretion of an oral water load were not affected by sham operation. These studies demonstrate that chronic, common bile duct ligation is associated with (a) enhanced sodium reabsorption both in the proximal and diluting segments of the nephron, (b) a defect in attaining maximal urinary concentration, (c) diminished sodium content in the renal papilla, and (d) impaired excretion of a water load. The results suggest that decreased distal delivery of sodium may underlie the abnormality in the concentrating mechanism and in the inability to normally excrete a water load. In addition, antidiuretic activity despite adequate hydration, may contribute to the impaired water diuresis. Chronic, common bile duct ligation appears to provide a readily available and reproducible model for the study of liver-kidney functional interrelationship.

Prolonged Severe Obstructive Jaundice in Hodgkin's Disease

Summary A patient with Hodgkin's disease with marked elevation of both serum bilirubin and alkaline phosphatase values over a 441-day period of observation is reported. This patient was believed to have chronic hepatitis until autopsy revealed the true nature of his illness. However, even postmortem examination did not provide a completely satisfactory explanation for the exact cause of the jaundice. Although there was some enlargement of lymph nodes in the hilus of the liver, the bile ducts did not show changes usually seen in chronic bile duct obstruction. In addition, there was no demonstrable Hodgkin's infiltrate in the liver. Similar cases of Hodgkin's disease with poorly explained jaundice are reported in the literature. However, it is unusual for a patient with Hodgkin's disease to have such a marked elevation of serum bilirubin and alkaline phosphatase values over such a prolonged period of observation.