Diagnosis Of Hepatobiliary Disease Research Articles

The Acute Abdomen

This book is compiled from two issues of<i>Seminars in Roentgenology</i>on the subject of the acute abdomen. Eighteen authors have collaborated in 13 chapters that present different aspects of the radiological approach to this subject. The first chapter deals with the technical aspects of the examination, a systematic review of the ways and means available to the radiologist, and contains an excellent description of the details of technique. It is followed by a series of chapters that discuss intestinal obstruction, the special problems in pediatric cases, and inflammatory diseases. Acute extraperitoneal infection is described in an extremely informative chapter, with superb anatomical descriptions. Toxic megacolon is decribed concisely and to the point, and the roentgenological findings of diverticulitis are well analyzed and correlated with their pathological base. The radiologically difficult subject of acute pancreatitis is thoroughly reviewed and there is an excellent discussion about the diagnosis of hepatobiliary disease.

Diagnosis of Hepatobiliary Disease by Combination of 131I-BSP Blood Retention Ratio with Serial Hepatobiliary Scintigraphy

131I-BSP連続肝胆道シンチグラフィに, 131I-BSP静注後の血中5分値に対する20分値の停滞率比を求め, 両所見による核医学的肝胆道疾患診断法確立へのアプローチを試みた。血中停滞比85%以上の群では, シンチ所見で腸管RI排泄の有無にかかわらず内科的黄疸例であり, 70～85%の群では腸管へのRI排泄を示さない完全閉塞所見は外科的肝外完全閉塞性黄疸例であった。40～70%の群では内科的か外科的かを判定するのは困難であったが, 4時間以後の排泄遅延所見をまた40%以下の群では2時間以後の排泄遅延所見を示した例は, いずれも外科的肝外胆道疾患例であった。

Normal Ranges and Diagnostic Value of Serum 5'Nucleotidase and Alkaline Phosphatase Activities in Infancy

Determinations of serum alkaline phosphatase (APase) and 5′nucleotidase (5Nase) activities have been carried out in 159 children investigated for possible disease of liver or bones, and in 147 children in whom these possibilities never arose. The latter group, which served as a control population, showed 5Nase levels very much lower than those encountered in a normal adult population. APase values in this group rose after birth, fell after the first year, and remained stable until puberty when the range increased slightly. APase was raised in 73% of children with hepatobiliary disease, 65% of children with bone disease, and 28% of children in whom there was no evidence of disease of either type. The corresponding figures for 5Nase activity were 87%, 6%, and 3%, and the degree of increase encountered in hepatobiliary disease was proportionately higher than the increase of APase seen in the same subjects. It is concluded that 5Nase is superior to APase in the diagnosis of hepatobiliary disease in infancy.

The diagnosis of hepatobiliary diseases by serum enzyme analyses.

Abstract. Serum guanase has been observed to rise sensitively in hepatitis but was a quite insensitive indicator of extrahepatic jaundice and liver cirrhosis. Thus serum guanase determination, despite its relative specificity for liver damage, appears not to be sensitive enough for an indicator test of liver disease. In respect to sensitivity the serum γ‐glutamyl transpeptidase (γ‐GT) test was observed to fulfil best the expectations also in anicteric patients, and was elevated particularly in extrahepatic biliary obstruction. Serum ornithine carbamoyl transferase (OCT) activity was observed to rise in hepatitis and in extrahepatic jaundice. Because of its specificity for liver tissue, OCT is the most certain test for detection of liver damage. The differentiation of hepatocellular jaundice from extrahepatic obstruction was noted to be best achieved by means of the serum guanase and alkaline phosphatase ratio. This still leads in about 10% to a misleading diagnosis in the differentiation of these clinical states.

Radioiodinated Rose Bengal and Colloidal Radiogold in the Diagnosis of Hepatobiliary Disease.

The radio-active pharmaceuticals discussed in this volume have been used for testing liver function for more than 15 years; more recently they have found popularity as scanning agents. In the former role they met with only partial success, probably because they provide limited help in difficult clinical problems and were overshadowed by more sensitive, specific, and easily obtained chemical tests. Rosenthall reviews their history in this monograph and reports his experience with them in the differential diagnosis of jaundice. His method combines measurement of blood levels of 131 I rose bengal (rose bengal sodium I 131) with sequential imaging of the liver, gallbladder, and small bowel for evidence of biliary obstruction. Twenty-minute rose bengal sodium I 131 blood retention of more than 86% invariably means parenchymal disease; 80% to 86% retention with no excretion into the small intestine indicates complete extrahepatic obstruction; but lesser degrees of retention with biliary excretion

The Zinc Sulfate Turbidity Test

Summary 1.Results of ZST tests were compared with electrophoretic protein patterns in 174 cases. It was concluded that (1) the ZST is a useful, rapid, qualitative test for the determination of serum gamma globulin, (2) ZST is not affected by the levels of serum albumin, or of the alpha or beta globulins, (3) ZST is affected by the albumin-gamma globulin and total albumin-globulin ratios. 2.The results of 1,187 ZST tests were compared with clinical diagnoses to evaluate the ZST as an aid in the diagnosis of hepatobiliary disease. It was concluded that (1) the ZST is a valuable aid in the diagnosis of hepatobiliary disease, (2) the ZST is of most value in the diagnosis of cirrhosis, (3) the ZST is elevated in some cases of hepatitis, is higher in chronic than in acute hepatitis, (4) the ZST is of value in the differential diagnosis of long-standing jaundice-when normal, it indicates biliary obstruction, when elevated it indicates hepatocellular disease, (5) the mean value of the ZST is no lower in persons having obstructive jaundice than in normal people, (6) the ZST is not specific for hepatic disease alone, as any disease producing changes in the serum gamma globulin level can produce abnormal ZST. 3.The significance of low ZST values is discussed and 14 cases are reviewed. Low ZST values were most frequently seen in severe renal disease with proteinuria, malignant hypertension, metastatic carcinoma.

Serum iron in the diagnosis of hepatobiliary disease.

Serum iron in the diagnosis of hepatobiliary disease.

Serum complement in hepatobiliary diseases.

SummaryThe serum complement titer was determined in 20 patients with acute hepatitis, 20 with hepatic cirrhosis, and 25 with (benign and malignant) biliary obstruction. The only distinctly subnormal values were encountered in 2 moribund patients suffering from cirrhosis. The data speak against formation of complement in or through the liver and fail to indicate usefulness of complement titration in diagnosis of hepatobiliary diseases.