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Effects of Cytokines and Nitric Oxide on Bicarbonate Secretion by Cholangiocytes
Published in Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso, The Pathophysiology of Biliary Epithelia, 2020
Carlo Spirlì, Lajos Okolicsanyi, Mario Strazzabosco
Cholangiocytes, the epithelial cells that line the intrahepatic biliary tree, play an important role in bile formation. In fact, the biliary epithelium modifies the hepatocellular bile by reabsorptive and secretive processes,1,2 that can be rapidly modulated by endocrine and paracrine stimuli according to various physiological demands.3 A number of ion carriers and channels have been identified in cholangiocyte and are reviewed in references.1,4–6 The transport function of the intrahepatic bile duct epithelium is finely regulated by a complex interplay of gastrointestinal hormones. In particular, secretin, via the cAMP/PKA pathway promotes Cl− efflux, HCO3− secretion and membrane vesicular transport resulting in increased ductular choleresis.7 Bicarbonate secretion is a major function of the biliary epithelium and is the result of the coupled action of an apical cAMP-stimulated Cl− channel (CFTR or ABCC7a) and of an apical Cl−/HCO3− exchanger (AE-2 or SLC4A2a).5,7
Biliary obstruction and leaks
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
As previously stated, the extent of assessment will be guided by the presentation. An ultrasound scan should almost always be the first investigation used to diagnose bile duct obstruction. If the obstruction is in the lower bile duct and the patient is jaundiced, then ERCP with its options for tissue sampling and therapy would be the next appropriate investigation. If a hilar stricture is present, there is a case for undertaking spiral CT or MRCP followed by PTC to avoid introducing sepsis to undrained intrahepatic segments. However, these options are largely governed by availability of local expertise and facilities. Either ERCP or PTC can be used when PSC is suspected. EUS can be a very useful alternative to CT/MRCP and as a prelude to ERCP.
Non-viral liver disease
Published in Michael JG Farthing, Anne B Ballinger, Drug Therapy for Gastrointestinal and Liver Diseases, 2019
John ML Christie, Roger WG Chapman
Broad-spectrum antibiotics such as ciprofloxacin (see p. 128) should be given for acute attacks of cholangitis but they have no proven prophylactic value. If cholangiography shows a well-defined obstruction to the extrahepatic bile ducts, mechanical relief can be seen by either inducing a prosthesis or a balloon dilatation performed at endoscopic retrograde cholangiopancreatography (ERCP).21
Distinct lipid profile in haemolytic anaemia-related gallstones compared with the general gallstone
Published in Annals of Medicine, 2023
Ziqi Wan, Xiaoyin Bai, Chengqing He, Yueyi Zhang, Ying Wang, Kaini Shen, Li Meizi, Qiang Wang, Wu Dongsheng, Yunlu Feng, Aiming Yang
We found that the time to detect gallstones was related to the age at anaemia onset and the stone location. Previous reports indicated that age was an independent risk factor for gallstone-related diseases, but did not make a distinction between cholesterol and pigment stones [1,24,26,27]. The results of our study could, to some extent, indicate that age was also a risk factor for pigment gallstones. Therefore, patients with haemolytic anaemia were recommended an abdominal US if aged older than 50 years, with more frequent follow-up visits. The other independent risk factor was the location of the stones. Stones in the bile duct caused more noticeable and obvious symptoms than those in the gallbladder and hence could be more easily detected. However, our results did not reveal a significant association between female sex, anaemic diseases, or severity of anaemia and the time of detection.
Clinical outcomes and predictors of technical failure of endoscopic transpapillary gallbladder drainage in acute cholecystitis
Published in Scandinavian Journal of Gastroenterology, 2023
Junya Sato, Kazunari Nakahara, Yosuke Michikawa, Ryo Morita, Keigo Suetani, Akihiro Sekine, Yosuke Igarashi, Shinjiro Kobayashi, Takehito Otsubo, Fumio Itoh
On the other hand, endoscopic transpapillary gallbladder drainage (ETGBD) is considered an alternative therapy in patients with acute cholecystitis [7]. Several reports have revealed the efficacy and safety of ETGBD, including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS) [8–11]. ETGBD has the following advantages over PTGBD: 1) feasibility in patients with ascites or coagulopathy, 2) internal drainage can be considered, and 3) treatment of common bile duct stones (CBDs) and acute cholangitis can be performed in the same session as endoscopic retrograde cholangiopancreatography (ERCP). However, the reported technical success rate of ETGBD was 64–100%, which is lower than that reported for PTGBD [12]. Additionally, ETGBD carries the risk of ERCP-related adverse events, such as pancreatitis. Moreover, ETGBD may result in cystic duct injury as a specific adverse event during the procedure when a device, such as a guidewire, cannula, or stent, is advanced through the cystic duct.
Heating of metallic biliary stents during magnetic hyperthermia of patients with pancreatic ductal adenocarcinoma: an in silico study
Published in International Journal of Hyperthermia, 2022
Oriano Bottauscio, Irene Rubia-Rodríguez, Alessandro Arduino, Luca Zilberti, Mario Chiampi, Daniel Ortega
The bile duct is a tube that connects the gallbladder and the duodenum in the small intestine to transport there the bile, where it performs essential tasks for food digestion [11]. This tube is part of the biliary tree, which starts in the liver. The part of this tree that comes out from the gallbladder is called cystic duct which is joined along with the common hepatic duct into the common bile duct. This goes through the pancreas and joins with the pancreatic duct, ending up in the ampulla of Vater in the duodenum. It is very common to see that the tumor blocks this path in pancreatic ductal adenocarcinoma (PDAC) patients, avoiding the bile to reach the small intestine [12]. This is clinically shown as jaundice (yellow colored skin) due to the accumulation of bilirubin in the blood, which is a component of the bile.