Diagnosis Of Hepatobiliary Disease Research Articles

Establishment of dry-chemistry-based reference intervals of routine liver function tests for the adult population of Gandaki Province, Nepal.

Every clinical laboratory should ideally establish its own population-specific reference intervals (RIs) to promote precision and evidence-based medicine. However, clinical laboratories in Nepal find it easier to follow external RIs than establish their own, leading to a lack of RIs specific to the local population. This study thus aimed to establish RIs of routine LFTs for the adult population of Gandaki Province, Nepal, and compare them with the current RIs used by our laboratory. We established the dry-chemistry-based reference intervals of 11 common LFT parameters for the adult population of Gandaki Province, Nepal using the direct priori-based method. The combined and sex-specific 95% double-sided RIs of total protein, albumin, globulin, A/G ratio, bilirubin, aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), AST/ALT ratio, and alkaline phosphatase (ALP) were established using non-parametric percentile method. The new RIs were also compared with the currently used RIs that were adopted from the reagent kit inserts. The newly established RIs for each LFT were: Total proteins: 68.0-69.0g/L, albumin: 39.0-52.0g/L; globulin: 27.0-42.0g/L; A/G ratio: 1.1-1.8; total bilirubin: 5.13-25.65μmol/L (0.30-1.50mg/dl); unconjugated bilirubin: 1.71-17.10μmol/L (0.10-1.00mg/dl); conjugated bilirubin: 0.00-10.26 μmol/L (0.00-0.60mg/dl); AST: 20.0-43.2U/L; ALT: 11.0-53.0 U/L; AST/ALT ratio: 0.7-2.1; ALP: 42.0-135.4U/L. The RIs of albumin, globulin, A/G ratio, AST, ALT, and AST/ALT ratio differed significantly (p < 0.05) between males and females. Moreover, calculated out-of-range values showed that up to 4-40% of apparently healthy adults were classified as having abnormal test results based on current RIs. The newly established RIs fulfil the need for population and platform-specific RIs for the adult population of Gandaki Province of Nepal and bring more conformity and accuracy in interpreting the LFT results, diagnosis of hepatobiliary diseases, clinical decision-making, monitoring the success of therapy and future liver specific biomedical researches within the Gandaki Province of Nepal.

Hepatobiliary Scintigraphy in the Diagnosis of Hepatobiliary Disease

Hepatobiliary Scintigraphy in the Diagnosis of Hepatobiliary Disease

Hepatobiliary Scintigraphy in the Diagnosis of Hepatobiliary Disease

Hepatobiliary Scintigraphy in the Diagnosis of Hepatobiliary Disease

An unusual finding of Courvoisier sign

Courvoisier sign is one of the important clinical signs used in the diagnosis of hepatobiliary disease. According to this sign, when the gallbladder is palpable in a jaundiced patient, it is unlikely due to stone. There are exceptions for Courvoisier signs such as double impacted stone, oriental cholangitis, and AIDS-associated cholangiopathy. In our case, there is a gallstone with palpable gallbladder due to concurrent occurrence of gallstone with gallbladder carcinoma compressing the adjacent biliary tree.

Doppler ultrasound evaluation of heptobiliary system in leopards (Panthera pardus)

Ultrasonography has been considered as one of the most valuable diagnostic tools in veterinary medicine. The study standardizes the Doppler ultrasonographic hepato biliary biometric features in six leopards (Panthera pardus). The hepato biliary ultrasonographic examination was performed under general anaesthesia while lateral recumbency using a 3.5 MHz convex array transducer. The hepatobiliary images obtained at area covered the periphery just behind the sternum and last ribs of thorax on left and right side of abdomen. Gall bladder was visualized at a moderate pressure below the level of sternum. The hepato biliary measurements were recorded and it can be concluded that Doppler ultrasonography as valuable technique for measuring hepato biliary biometric features and could be used as reference values for diagnosis of hepato biliary diseases and disorders in leopards.

Indirect electrochemical detection for total bile acids in human serum

Bile acids level in serum is a useful index for screening and diagnosis of hepatobiliary diseases. As bile acids concentration is closely related to the degree of hepatobiliary diseases, detecting it is a vital factor to understand the stage of the diseases. The prevalent determination for bile acids is the enzymatic cycling method which has low sensitivity while reagent-consuming. It is desirable to develop a new method with lower cost and higher sensitivity. An indirect electrochemical detection (IED) for bile acids in human serum was established using the screen printed carbon electrode (SPCE). Since bile acids do not show electrochemical signals, they were converted to 3-ketosteroids by 3-α-hydroxysteroid dehydrogenase (3α-HSD) in the presence of nicotinamide adenine dinucleotide (NAD+), which was reduced to NADH. NADH could then be oxidized on the surface of SPCE, generating a signal that was used to calculate the total bile acids (TBA) concentration. A good linear calibration for TBA was obtained at the concentration range from 5.00μM to 400μM in human serum. Both the precisions and recoveries were sufficient to be used in a clinical setting. The TBA concentrations in 35 human serum samples by our IED method didn't show significant difference with the result by enzymatic cycling method, using the paired t-test. Moreover, our IED method is reagent-saving, sensitive and cost-effective.

TOXICOLOGY OF BILE SALTS IN ANIMALS

In Asia, ingestion of animal bile is believed to improve health, but poisoning cases often occur. The composition of the bile varies with animal species, and is important in the diagnosis of hepatobiliary diseases. Bile acids are major components in terrestrial animal bile, but bile alcohols are major components in several freshwater fish. Both bile acids and alcohols cause liver and renal dysfunctions, and bile alcohols are more toxic than bile acids. Except for the bear bile component ursodeoxycholic acid, the medicinal use of animal bile components needs further study because of their toxicity.

Postprandial Venous Ammonia Concentrations in the Diagnosis of Hepatobiliary Disease in Dogs

A postprandial ammonia tolerance test (PPATT) was performed on normal dogs and dogs with signs that suggested they may have liver disease. All dogs underwent transcolonic scintigraphy, liver biopsy, or both and were assigned to extrahepatic disease, primary hepatocellular, and congenital portosystemic vascular anomalies (PSVA) groups. Each dog was fed a chicken and rice diet providing 25% of its estimated daily metabolizable energy requirement (MER) as an ammonia challenge. This is practical in patients with liver disease because ammonium chloride administration often causes vomiting or ammonia toxicity. Venous ammonia concentrations were measured before feeding and every 2 hours after feeding for 8 hours. No difference in mean ammonia concentrations between dogs with extrahepatic disease and control dogs was found. Therefore, the specificity of the PPATT was 100%. Dogs with hepatocellular disease showed no change in mean ammonia concentration at any time point, before or after feeding, but sensitivity was greatest when venous ammonia was measured 6 hours after feeding (sensitivity before feeding, 28%, and after feeding, 36%). Among dogs with congenital PSVA, mean ammonia concentrations were higher than the reference range at all time points before and after feeding, and peak mean ammonia concentration occurred 6 hours after feeding. In this group, the sensitivity of the PPATT was 81% before feeding and 91% 6 hours after feeding. This study demonstrates that the measurement of venous ammonia concentration is a useful test to detect congenital PSVA, and the sensitivity of the test may be improved by sampling 6 hours after feeding. The PPATT has poor sensitivity in detecting primary hepatocellular disease.

Blood chemistry reference values for use in columbine hepatology

Reference values of nine plasma chemical variables considered to be of potential use for the (differential) diagnosis of hepatobiliary disease in racing pigeons (Columba livia domestica) were determined. Enzymes included creatine kinase, lactate dehydrogenase, aspartate amino-transferase, alanine aminotransferase, alkaline phosphatase, glutamate dehydrogenase, gamma glutamyl transferase and cholinesterase. Plasma bile acid concentrations were also measured.

Application of a rapid and efficient h.p.l.c. method to measure bilirubin and its conjugates from native bile and in model bile systems. Potential use as a tool for kinetic reactions and as an aid in diagnosis of hepatobiliary disease.

We have developed an extremely rapid and efficient reverse-phase h.p.l.c. method for the measurement of bilirubin and its conjugates in human bile and in model bile systems. Our method involves the use of a Perkin-Elmer 3 mu C18 column and a methanol/sodium acetate/aq. ammonium acetate buffer system. Three isomers of bilirubin diglucuronide (BDG), two isomers of bilirubin monoglucuronide (BMG), three isomers of unconjugated bilirubin (UCB) and minor conjugates containing glucose and xylose were separated in 12 min. Initial quantification of BDG and BMG was based on the use of the ethyl anthranilate azo derivative of bilirubin (AZO UCB); however, the standard curves for BDG, BMG and UCB were similar enough to permit quantification to be later based on the UCB standard curve only, thereby simplifying the quantification process. Routine direct injection of 6 or 10 microliter of crude undiluted or diluted (1:1) bile sample was sufficient for analysis. The method was helpful in diagnosing biliary-tract obstruction in a newborn and a partial deficiency state of bilirubin conjugation (Crigler-Najjar syndrome) in a 10-year-old male. When the method was applied to biles of patients both with and without gallstones, levels of UCB were less than 2% of total pigment, consistent with previous reports. Because of its speed and efficiency, this method has the potential for a broad range of applications including enzymic, kinetic and bile sample analyses.

Predictive value of the concentration in serum of total 3 alpha-hydroxy bile acids in the diagnosis of hepatobiliary disease.

Fasting serum levels of total 3 alpha-hydroxy bile acids were measured in 163 consecutive patients, who clinically were suspected of having a hepatobiliary disorder. By means of routine biochemical liver tests and paraclinical investigations the clinical suspicion was confirmed in 95 patients and disproved in the other 68 patients. A comparison between this diagnostic grouping and the serum bile acids levels showed that the predictive value of serum concentrations above a discrimination value of 10 mumol/l--that is, the predictive value of a positive test--was 1.0 (0.94-1.0), whereas the corresponding predictive value of a negative test was 0.66 (0.56-0.75). Thus, fasting serum levels of total 3 alpha-hydroxy bile acids may be used as a highly specific and moderately sensitive diagnostic test for hepatobiliary disorders. Furthermore, the study showed that the nosographic sensitivity of total 3 alpha-hydroxy bile acids in patients with verified cirrhosis was significantly greater than that of serum bilirubins and not significantly different from those of the other routine biochemical liver tests.

Sclerosing cholangitis in ulcerative colitis. A follow-up study.

In the 5-year period 1974-78, 48 (14%) of 336 patients with ulcerative colitis were found to have hepatobiliary disease. Endoscopic retrograde cholangiography (ERC) was successfully performed in 39 of these 48 patients, and sclerosing cholangitis was demonstrated in 19. One is excluded from this series because Crohn's disease was diagnosed at reclassification of the bowel disease. Two of the 18 patients with ulcerative colitis and sclerosing cholangitis have died, one of cholangiocarcinoma and one of an unrelated cause. The remaining 16 patients have been observed for a median period of 6 years (3-13 years) since the diagnosis of hepatobiliary disease. Ten have remained symptom-free, four have had intermittent or non-progressive symptoms, and two have developed symptoms of advanced chronic liver disease. The bilirubin level, which was initially raised in one of the patients, was elevated in four at the follow-up examination. Otherwise the laboratory values have remained stationary. Evidence of a progression of the hepatobiliary disease was found in most patients by repeated liver biopsy and particularly ERC. It is concluded that sclerosing cholangitis may remain asymptomatic for several years. Since progressive cholangiographic changes were often seen without concomitant worsening of symptoms, laboratory data, and liver biopsy findings, it is concluded that these criteria are of limited use in evaluating the progression of this disease.

Diagnosis of hepatobiliary disease in infants and children with Tc-99m-diethyl-IDA imaging.

Thirteen infants and children from 42 days to 14 years old with hepatobiliary disease underwent Tc-99m-diethyl-IDA hepatobiliary imaging. Five patients had biliary atresia, four had biliary hypoplasia, two had neonatal hepatitis, and there were single examples of alpha-1-antitrypsin deficiency and congenital hepatic fibrosis. Tc-99m-diethyl-IDA imaging accurately differentiated biliary atresia (complete bile duct obstruction) from other forms of childhood hepatobiliary disease by demonstrating no intestinal radioactivity in the former and the presence of intestinal radioactivity in the latter. In addition, two of four patients with biliary hypoplasia had nonhomogeneous parenchymal transit, and the one patient with congenital hepatic fibrosis showed possible intrahepatic cysts. In conclusion, these preliminary data indicate that Tc-99m-diethyl-IDA provides information not previously available with I-131-rose bengal; this information is likely to be useful in the noninvasive evaluation of childhood hepatobiliary disease.

Peritoneoscopy examination following abdominal operations

In a prospective study about peritoneoscopy in patients previously laparotomized and its difficulties and risks in the diagnosis of hepatobiliary disease, we have reviewed 3000 laparoscopic procedures finding 836 patients with laparotomy scars in the abdominal wall, reaching the diagnostic target in %,4% with only 3.6% of failures with no mortality or fatal accidents. Therefore, we can state that laparotomy scars are not a formal contraindication for laparoscopic procedures. In a prospective study about peritoneoscopy in patients previously laparotomized and its difficulties and risks in the diagnosis of hepatobiliary disease, we have reviewed 3000 laparoscopic procedures finding 836 patients with laparotomy scars in the abdominal wall, reaching the diagnostic target in %,4% with only 3.6% of failures with no mortality or fatal accidents. Therefore, we can state that laparotomy scars are not a formal contraindication for laparoscopic procedures.

Lack of value of serum γ-glutamyl transferase in the diagnosis of hepatobiliary disease

Serum gamma-glutamyl transferase (GGT, EC. 2.3.2.2. was measured in 173 patients with diseases of the hepatobiliary system (including metastatic cancer) and in 90 patients who were subsequently shown to have primary diseases of other etiology. All patients had been selected because they had abnormal alkaline phosphatase, aspartate aminotransferase or bilirubin on SMA 12/60 screening. Serum GGT was elevated in 97% of patients with primary hepatobiliary disease. The magnitude of the increase in GGT was variable in all groups and was unhelpful in differential diagnosis, even between medical and surgical cases. Moreover, GGT was abnormal in 69 patients who did not have primary hepatobiliary disease (77%), an incidence higher than that for other enzyme tests performed. We conclude that because GGT was more susceptible than other tests to spurious elevation in the absence of hepatobiliary disease and was unhelpful in differential diagnosis, it has little value apart from monitoring alcohol abuse and enzyme induction.

Serum glycylproline dipeptidyl aminopeptidase activity in human hepatic cancer

A method for the assay of glycylproline dipeptidyl aminopeptidase activity in the serum is described. The enzyme activity determination in sera from patients with hepatic cancer opens a possibility in the differential diagnosis of hepatobiliary diseases, because of the significantly higher values found in some cases of hepatic cancer. No correlation with alpha-fetoprotein was found.

A computer-aided system for the diagnosis of hepato-biliary diseases. A comparison with the performance of physicians

A computer-aided system has been developed for the diagnosis of disease of the liver and biliary system. The program is based on the use of 30 indicants, all of which are available within six hours after patient's admission: 18 of them are clinical signs, 12 are laboratory parameters including routine liver-function tests. To date, the program concerns 52 hepato-biliary diseases. From the analysis of the 30 items collected in any patient, the diagnoses are computed according to Bayes' theorem and printed by decreasing order of probability. The performance of the program was tested using records of patients with fully proven diagnosis. The first diagnosis given by the computer was correct in 57 per cent of the cases. In 80 per cent, the right diagnosis was among the first four proposed. When the performance of the model was compared to that of physicians, the number of correct answers was roughly the same for the computer and for the specialists in hepatology; in contrast, the computer's responses were far better than those of general practitioners. These results demonstrate the efficiency of the program for the diagnosis of hepato-bilitary diseases and its potential interest for helping clinicians in decision-making.

Role of γ-Glutamyl Transpeptidase Activity in the Diagnosis of Hepatobiliary Disease

The enzyme gamma-glutamyl transpeptidase is widely distributed throughout the body, notably kidney, seminal vesicles, pancreas, liver, spleen and brain. Being one of the enzymes of the gamma-glutamyl cycle, it is involved in aminoacid transport, catalysing a transpeptidation reaction between gamma-glutamyl peptides and most common amino acids. Methods of assay of the enzyme are based on its ability also to act on synthetic amides of glutamic acid; kinetic methods monitoring the release of p-nitroaniline from the substrate L-gamma-glutamyl p-nitroanilide are the most satisfactory. In diseases of the liver, the highest levels occur in association with cirrhosis, alcoholism, hepatic secondaries and cholestasis. As the enzyme is present in the endoplasmic reticulum of the hepatocyte, its activity is increased in situations leading to microsomal enzyme induction. Raised levels can also occur in pancreatitis, diabetes, myocardial infarction, congestive cardiac failure, chronic renal failure, cerebrovascular accidents, cerebral tumours and chronic obstructive pulmonary disease. Although the lack of specificity must be recognised, the estimation can be useful in the elucidation of some clearly defined problems arising during investigation of patients with suspected hepatic disease, especially where performed as part of a biochemical profile.

Diagnostic Value of Routine Liver Tests

In 131 patients on a medical service and 97 patients on a surgical service, in whom a diagnosis of hepatobiliary disease was verified in the hospital, the diagnostic value of routine liver tests performed soon after admission was evaluated by stepwise discriminant analysis. By measurements of alanine aminotransferase, alkaline phosphatases, gamma globulin, prothrombin time, bilirubin, and albumin, half of the medical patients were correctly classified into one of seven diagnostic categories. Aminotransferase contributed most to the classification, being twice as effective as random allocation. Decreasing the number of diagnostic categories to three (hepatitis, fatty liver, and chronic liver disease) increased the frequency of correct allocation to 80%. The allocation of all the patients to seven medical and four surgical diagnostic categories by means of four tests (aminotransferase, alkaline phosphatases, prothrombin time, and bilirubin) was significantly improved by each step with a misclassification rate of 55% when all tests were used. A reduction of the diagnostic groups to five (hepatitis, fatty liver, chronic liver disease, duct obstruction and tumor) increased the frequency of correct allocation to 63%. The analysis demonstrates the limited diagnostic effectiveness of routine liver tests when used alone. The absolute discrimination values depend on the a priori frequencies of the diagnostic groups investigated, and therefore may vary from time to time and from place to place.

血清Glutamate Dehydrogenase活性測定による肝胆道疾患の診断

血清Glutamate Dehydrogenase活性測定による肝胆道疾患の診断