Diagnosis Of Jaundice Research Articles

Diagnostic laparoscopy in prolonged jaundice

Background: The early diagnosis of surgical jaundice in a neonate is an important step for the surgical success in extrahepatic biliary atresia. Diagnostic laparoscopy, as in many areas in surgery, is included in the conventional diagnostic methods of extrahepatic biliary atresia. Methods: Since 1992, 24 infants with prolonged jaundice, in whom extrahepatic biliary atresia and neonatal hepatitis could not be differentiated with conventional diagnostic interventions, have been evaluated laparoscopically. Results: A coarse, irregular, greenish-brown liver with some degree of fine angiomatous development and an atretic gallbladder are the findings of laparoscopic evaluation in an infant with extrahepatic biliary atresia. However, in neonatal hepatitis, the liver is smooth, sharp-edged, and chocolate brown in color, and simultaneously performed cholangiography should show the passage of the contrast material both into the proximal biliary tracts and the intestinal system. In this series, 10 of 24 cases were proved to be neonatal hepatitis diagnosed by laparoscopy, so unnecessary laparotomy was avoided in 42% of the cases. Conclusion: When the diagnostic laparoscopy, in which the liver and the gallbladder are directly visualized, is combined with the cholangiographic examination, the most accurate and earlier diagnosis in an infant with prolonged jaundice can be achieved, and the important period of time for the surgical success in extrahepatic biliary atresia will be minimally wasted. J Pediatr Surg 36:463-465. Copyright © 2001 by W.B. Saunders Company.

Endoscopic treatment of obstructive jaundice at a second level national health system hospital

The difficulty of performing endoscopic retrograde cholangiopancreatography (ERCP) in our patients in the reference hospitals within a few days of diagnosis of obstructive jaundice led us to perform this technique in our center. We expected to perform a small number of ERCP annually. We analyzed the success rate of initial biliary drainage and the complications of this procedure. We performed a retrospective study. From 1997-1999 we carried out 240 ERCP. In 128 patients, 140 ERCP were performed for obstructive jaundice (58,3%). The final diagnosis was choledocholithiasis in 69 patients (54%), tumors in 35 (27%), dilatation of the biliary tract without obstruction at cholangiography in 21 (17%) and benign stenosis of the biliary tract in 3 (2%). The mean procedure time for ERCP was 5.26 ( 2.8) days. Cholangiography was successfully performed in 117 patients (91.4%). Effective therapeutic endoscopy was performed in 111 patients (86.7%). Jaundice was resolved in 62 patients (90%) with choledocholithiasis, 55 (80%) by stone removal and in 7 (10%) by prosthesis. Resolution was also achieved in 25 (71.5%) tumors, mainly by prosthesis, and in 100% of patients with benign stenosis. In all patients with dilatation of the biliary tract without obstruction, biliary sphincterotomy was performed. Complications were found in 15 patients (11.7%) and two (1.56%) died. The majority of patients with obstructive jaundice can be satisfactorily treated in a center with our characteristics. However, in tumors, the figures for drainage were slightly lower than those reported in the medical literature.

Obstructive jaundice in advanced gastric cancer (AGC): Clinical characteristics and therapeutic approaches

Background; AGC is frequently associated with obstructive jaundice and is a more common cause of secondary malignant biliary obstruction in Asia. However, the clinical characteristics and therapeutic approach of biliary obstruction secondary to AGC has not been fully elucidated. Patients and Methods; Between January 1989 and February 1999, 27 patients with obstructive jaundice in histologically confirmed gastric cancer were reviewed retrospectively. The diagnostic work-up of obstructive jaundice was performed with abdominal ultrasound, CT, ERCP or PTC. The percutaneous transhepatic biliary drainage(PTBD) and endoscopic retrograde biliary drainage(ERBD) were performed for palliative management of obstructive jaundice. Results; I) Obstruction sites were distal extrahepatic duct(EHD) in 20 patients(74%), proximal EHD in 5(19%), ampulla in 1(3%), and undetermined in 1(3%). 2) The causes of biliary obstruction were metastatic lymphadenopathy in 13 patients(48%), direct invasion to bile duct in 4(15%), pancreatic invasion in 4(15%), liver metastasis in 2(7%), and undetermined in 1(3%). Three cases showed combined duodenal obstruction. 3) Stages of AGC were III in 8(30%) and IV in 15(56%). In II patients whose histologic type could be reviewed, histologic types of AGC were signet ring cell carcinoma in 2, poorly differentiated adenocarcinoma in 7 and moderately differentiated in 2. 4) In 21 patients who underwent gastrectomy, obstructive jaundice was initially managed by ERBD in 3 and PTBD in 18. Initial ERBD was converted into PTBD in I due to stent clogging, and initial PTBD into ERBD in 12 by conventional ERBD method or percutaneous endoscopic biliary stenting(PEBS) method. 5) In 6 patients who did not undergo gastrectomy, obstructive jaundice was initially managed by ERBD in 4 and PTBD in 2 debilitating patients. Initial ERBD was kept without conversion into PTBD, and initial PTBD was converted into ERBD in I by PEBS method. 6) The mean time between onset of jaundice and initial diagnosis of gastric cancer was 15.1:'::20.2 months. The mean survival time after onset of obstructive jaundice was 4.6:'::5.3 months and 6 month survival rate was 19%. Conclusions; Obstructive jaundice in AGC is associated with relatively short life expactency(mean 4.6 months), preferential site of obstuction is distal EHD, and ERBD is recommendable as initial therapeutic approach, especially in patients who did not undergo gastrectomy.

Jaundice: An unusual presentation of a brunneroma

We describe obstructive jaundice as the presenting feature in a 55‐year‐old male with a peri‐ampullary Brunner’s gland hamartoma. Duodenal obstruction and bleeding from such lesions have been noted previously, but obstructive jaundice has not yet been reported. This case is being described for its unconventional presentation and for consideration in the differential diagnosis of obstructive jaundice.

A CASE OF PAPILLARY CARCINOMA WITH COMPLETE TYPE OF UNFUSED PANCREATIC DUCT SYSTEM

A case of papillary carcinoma with complete type of unfused pancreatic duct system is reported. A 58-year-old man was admitted to the hospital because he was pointed out having jaundice at another hospital. With a diagnosis of obstructive jaundice and papillary carcinoma of the pancreas, the patient was operated on. An exploration of the excised material revealed that the main pancreatic duct did not unite with the common bile duct and opened at 2cm oral side from the papilla. The definite diagnosis of papillary carcinoma with complete type of unfused pancreatic duct system was made. In a review of the Japanese literature, only two such cases including our case have been reported so far.

Objective Assessment of the Contribution of Each Diagnostic Test and of the Ordering Sequence in Jaundice Caused by Pancreatobiliary Carcinoma

Background: Computer-assisted diagnostic systems are not substantially more accurate than the clinician in the differential diagnosis of jaundice but may help in optimal selection and sequencing of tests. The present study aimed to assess with an electronic diagnostic tool the pattern of ordering tests and the diagnostic contribution and related financial cost of each test in jaundiced patients with pancreatobiliary carcinoma, in an effort to make the clinician's diagnostic behaviour more efficient and economical. Methods: Clinical and diagnostic test data were prospectively gathered from 356 jaundiced patients with pancreatobiliary carcinoma and entered in a Bayesian diagnostic programme. The test results were added to the existing diagnostic evidence, and the programme calculated the diagnostic contribution of each test. Results: A total of 1804 diagnostic tests were ordered. Quantitative assessment of the diagnostic contribution of each test showed that percutaneous transhepatic cholangiography and computed tomography were associated with the highest provision of information. The most cost-effective tests were ultrasonography and liver function tests. Conclusions: It is possible to determine objectively the diagnostic contribution of each test in establishing the diagnosis of pancreatobiliary carcinoma. The observed physician behaviour in ordering the various diagnostic tests might be improved with regard to its efficacy and its cost-effectiveness profile.

Validation of ICTERUS, a Knowledge-based Expert System for Jaundice Diagnosis

The study aimed to describe an example of the assessment and validation of knowledge-based clinical expert systems. The paper focuses on ICTERUS, an expert system for jaundice diagnosis. It describes system design, the methodology applied for upgrading and validating the program, and the most important outcomes of the validation procedure. The clinical validation of the system on a very large European database (Euricterus Project) shows that diagnostic conclusions are reliable in about 70% of eligible cases. This figure appears acceptable for a system which provides decision support only on the basis of clinical data, assuming that the final decision is achieved under user responsibility. Expected biases, limitations and inconsistencies in the practical application of the system are discussed.

Differentiation and diagnosis of jaundice.

Bilirubin metabolism is a complex and fascinating example of the body's ability to discard, renew, and recycle vital elements. Jaundice is the warning sign for derangements in this system. As is true of pain, jaundice is a powerful impetus for visiting a healthcare provider. Usually associated with hepatitis by a nonclinician, the origins of jaundice can range from benign to fatally malignant. Patients may have any number of idiopathic or nosocomial conditions that can contribute to an icteric state. This review delineates the steps of bilirubin metabolism, enumerates the sources of bilirubin derangement, and examines elements of patient condition and therapeutics that can contribute to hyperbilirubinemia and jaundice.

SEPSIS AND CHOLESTASIS

Sepsis-associated cholestasis should always be considered as part of the differential diagnosis of jaundice in the hospitalized or critically ill patient. The development of a disproportionate elevation of serum bilirubin in comparison with serum alkaline phosphatase and serum aminotransferases should be considered an early warning sign of an underlying infection, even in the absence of fever, leukocytosis, or other signs or symptoms. Prompt recognition and appropriate medical and surgical intervention may reduce morbidity and mortality.

Jaundice in the Breastfed Infant

Maternal perception of insufficient milk is a widespread phenomenon in modern breastfeeding. This article addresses underlying physiology, feeding patterns, growth patterns, and medical complications as they impact milk supply and infant growth. The complexity of mother-infant factors leads to a broad differential diagnosis. Problem-oriented management is discussed with the goal of preventing low milk supply, intervening promptly for feeding problems, promoting infant growth, and preserving the breastfeeding relationship.

Azathioprine-Induced Lymphoma Manifesting as Fulminant Hepatic Failure

Azathioprine-Induced Lymphoma Manifesting as Fulminant Hepatic Failure

Clinical medicine for icterus - Progress in diagnosis and treatment. III. Approach to diagnosis of obstructive jaundice. 1. Progress in obstructive jaundice diagnosing equipment. (2) Intraoral ultrasonography.

Clinical medicine for icterus - Progress in diagnosis and treatment. III. Approach to diagnosis of obstructive jaundice. 1. Progress in obstructive jaundice diagnosing equipment. (2) Intraoral ultrasonography.

Clinical medicine for icterus - Progress in diagnosis and treatment. III.Approach to diagnosis of obstructive jaundice. 6. Surgical treatment for obstructive jaundice.

閉塞性黄疸は,胆道の機械的閉塞に起因する胆汁流出障害で,それに続く病態は非常に重篤であり,腹部救急疾患として認識する必要がある.治療上の重要なポイントは早期に胆汁流出障害を取り除くことである.胆道閉塞の原因,部位により病態が異なりそれに適切な治療法を選択することが大事で,最初の選択を誤るとその後の治療に難渋する.また,悪性腫瘍の治療成績は乳頭部癌以外では不良で外科的切除以外に集学的治療が必要となる.

Clinical medicine for icterus - Progress in diagnosis and treatment. III.Approach to diagnosis of obstructive jaundice. 3. Biliary tract malignant diseases and icterus.

Clinical medicine for icterus - Progress in diagnosis and treatment. III.Approach to diagnosis of obstructive jaundice. 3. Biliary tract malignant diseases and icterus.

Evaluation of Pancreatic Injury After Blunt Abdominal Trauma

Pancreatic injury after blunt abdominal trauma can be subtle and delayed in its onset. We present a 24-year-old man who became jaundiced 16 days after he experienced blunt trauma. He was found to have an isolated pancreatic contusion. We discuss the initial evaluation for blunt pancreatic injury, the differential diagnosis of jaundice resulting from the trauma, and, finally, three methods of treating pancreatic contusions that cause jaundice. [Emmick RH Jr, Petersen SR: Evaluation of pancreatic injury after blunt abdominal trauma. Ann Emerg Med May 1996;27:658-661.]

Computer-Aided Diagnosis in Jaundice: Comparison of Knowledge-based and Probabilistic Approaches

The study reported in this paper is aimed at evaluating the effectiveness of a knowledge-based expert system (ICTERUS) in diagnosing jaundiced patients, compared with a statistical system based on probabilistic concepts (TRIAL). The performances of both systems have been evaluated using the same set of data in the same number of patients. Both systems are spin-off products of the European project Euricterus, an EC-COMAC-BME Project designed to document the occurrence and diagnostic value of clinical findings in the clinical presentation of jaundice in Europe, and have been developed as decision-making tools for the identification of the cause of jaundice based only on clinical information and routine investigations. Two groups of jaundiced patients were studied, including 500 (retrospective sample) and 100 (prospective sample) subjects, respectively. All patients were independently submitted to both decision-support tools. The input of both systems was the data set agreed within the Euricterus Project. The performances of both systems were evaluated with respect to the reference diagnoses provided by experts on the basis of the full clinical documentation. Results indicate that both systems are clinically reliable, although the diagnostic prediction provided by the knowledge-based approach is slightly better.

Advances in the Diagnosis and Treatment of Neonatal Hyperbilirubinemia

Many controversies remain regarding the role of bilirubin in the developing human. Although kernicterus and cognitive impairment have been linked to hyperbilirubinemia, more recent studies have suggested that there might actually be beneficial effects of bilirubin at a cellular level; thus, the need to better understand the molecular and cellular physiology of this molecule is important. The attempted management of serum or tissue levels of bilirubin may either have implications for long-term neurologic development or interfere with normal body stress responses. Production of CO via heme catabolism also warrants further investigation regarding its role in cell to cell communication or in other important cellular reactions. New methods are being developed to better detect CO under a variety of experimental conditions, as well as to estimate total bilirubin production by measuring the COHb level of pulmonary excretion of CO. The development of new drugs to modulate bilirubin production is the subject of ongoing research. Although some metalloporphyrins already have been used clinically, the advantages and disadvantages of each drug still require further study. These new drugs are not only raising fascinating research questions about heme and bilirubin metabolism, but they may soon revolutionize the way we approach the diagnosis and management of neonatal jaundice, and provide new pharmacologic tools for exploring other aspects of metabolism.

Baseline for assessment of the technologies used in the diagnosis of jaundice

Baseline for assessment of the technologies used in the diagnosis of jaundice

SUCCESFULLY RESECTED HEPATOCELLULAR CARCINOMA PRESENTING WITH OBSTRUCTIVE JAUNDICE DUE TO BILE DUCT INVASION-REPORT OF CASE-

A 66-year-old male was admitted to the hospital because of jaundice and abdominal pain. Ultrasonography, abdominal CT, and PTCD revealed tumors in the bile duct at the porta hepatis and liver S-5, and a diagnosis of cholangiocarcinoma wasmade. Right hepatectomy and left hepatico-jejunostomy were performed. Postoperative pathological study revealed that the hepato cellular carcinoma (HCC) in the S-5 infiltrated into the bile duct. Jaundice usually occurs due to the bile duct invasion of HCC in the terminal stage, but less commonly the tumor can invade and rupture into the bile duct early before it develops to be of palpable size. It is named icteric type hepatoma and this case is one of this. Preoperative differentation of icteric type hepatoma from carcinoma of the biliary tract is difficult, but the former is often less invasive than predicted by imaging diagnosis unlike the latter. Accordingly, more curative resection can be expective with good selection of operative candidates. In the diagnosis of obstructive jaundice, it is important to entertain a possible presence of icteric type hepatoma as well as biliary carcinoma.

New Recommendations Not Very Different from Current Practice

To the Editor.— In the "Evaluation and Treatment of Jaundice in the Term Newborn: A Kinder, Gentler Approach," Newman and Maisels1 focus on "unnecessary testing and treatment of many jaundiced term infants."1,p809 Although "routine screening with a more specific test" was suggested for galactosemia, none was mentioned in any of the five tables. In the follow-up commentaries only one other author mentioned galactosemia in the differential diagnosis of neonatal jaundice.2 After reading these several interesting papers it is still unclear to me whether reducing the frequency of tests for neonatal jaundice or excluding individual specific tests (ie, direct bilirubin) will benefit cost-effective analysis or be "a kinder, gentler approach" for babies.