Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal...Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. The key event in the pathophysiology of obstructive jaundice-associated complications is endotoxemia of gut origin because of intestinal barrier failure. This breakage of the gut barrier in obstructive jaundice is multi-factorial, involving disruption of the immunologic, biological and mechanical barrier. Experimental and clinical studies have shown that obstructive jaundice results in increased intestinal permeability. The mechanisms implicated in this phenomenon remain unresolved, but growing research interest during the last decade has shed light in our knowledge in the field. This review summarizes the current concepts in the pathophysiology of obstructive jaundice-induced gut barrier dysfunction, analyzing pivotal factors, such as altered intestinal tight junctions expression, oxidative stress and imbalance of enterocyte proliferation and apoptosis. Clinicians handling patients with obstructive jaundice should not neglect protecting the intestinal barrier function before, during and after intervention for the relief of this condition, which may improve their patients’ outcome.展开更多
AIM:To evaluate the effects of honey on bacterial translocation and intestinal villus histopathology in experimental obstructive jaundice.METHODS:Thirty Wistar-Albino rats were randomly divided into three groups each ...AIM:To evaluate the effects of honey on bacterial translocation and intestinal villus histopathology in experimental obstructive jaundice.METHODS:Thirty Wistar-Albino rats were randomly divided into three groups each including 10 animals:group Ⅰ,sham-operated;group Ⅱ,ligation and section of the common bile duct(BDL);group Ⅲ,bile duct ligation followed by oral supplementation of honey(BDL+honey) 10 g/kg per day.Liver,blood,spleen,mesenteric lymph nodes,and ileal samples were taken for microbiological,light and transmission electrone microscopic examination.RESULTS:Although the number of villi per centimeter and the height of the mucosa were higher in sham group,there was no statistically significant difference between sham and BDL + honey groups(P>0.05).On the other hand,there was a statistically significant difference between BDL group and other groups(P<0.05).The electron microscopic changes werealso different between these groups.Sham and honey groups had similar incidence of bacterial translocation(P>0.05).BDL group had significantly higher rates of bacterial translocation as compared with sham and honey groups.Bacterial translocation was predominantly detected in mesenteric lymph nodes.CONCLUSION:Supplementation of honey in presence of obstructive jaundice ameliorates bacterial translocation and improves ileal morphology.展开更多
AIM： To investigate the effects of propolis on bacterial translocation and ultrastructure of intestinal morphology in experimental obstructive jaundice. METHODS： Thirty Wistar-Albino male rats were randomly divided ...AIM： To investigate the effects of propolis on bacterial translocation and ultrastructure of intestinal morphology in experimental obstructive jaundice. METHODS： Thirty Wistar-Albino male rats were randomly divided into three groups, each including 10 animals： group Ⅰ, sham-operated; group Ⅱ, ligation and division of the common bile duct （BDL）; group Ⅲ, BDL followed by oral supplementation of propolis 100 mg/kg per day. Liver, blood, spleen, mesenteric lymph nodes, and ileal samples were taken for microbiological, light and transmission electron microscopic examination on postoperative 7^th d after sacrification. RESULTS： The mean number of villi per centimeter and mean mucosal height of the propolis group were significantly different in the BDL group （P = 0.001 and 0.012, respectively）. The electron microscopic changes were also different between these groups. Sham and BDL＋propolis groups had similar incidence of bacterial translocation （BT）. The BDL group had significantly higher rates of BT as compared with sham and BDL ＋ propolis groups. BT was predominantly detected in MLNs and the most commonly isolated bacteria was Escherichia coil CONCLUSION： Propolis showed a significant protective effect on ileal mucosa and reduced bacterial translocation in the experimental obstructive jaundice model. Further studies should be carried out to explain the mechanisms of these effects,展开更多
The two most widely used experimental models of advanced liver disease are the administration of carbon tetrachloride, and common bile duct ligation (BDL), however, neither has been systematically evaluated as a model...The two most widely used experimental models of advanced liver disease are the administration of carbon tetrachloride, and common bile duct ligation (BDL), however, neither has been systematically evaluated as a model of hepatorenal syndrome (HRS). The BDL model in rats, studied at diverse time points, induced a progressive renal dysfunction without structural changes in the kidney. The authors concluded that BDL is a good model for further studies of HRS and its treatment. However, the renal impairment observed at the acute phase of the BDL model is based on a different pathophysiology than that of HRS. Specifi cally, in acute obstructive jaundice, cholemia predominates over parenchymal liver disease (reversible at this stage without portal hypertension or cirrhosis) and independently induces negative inotropic and chronotropic effects on the heart, impaired sympathetic vasoconstriction response and profound natriuresis and diuresis that might lead to volume depletion. In addition, systemic endotoxemia contributes to the prerenal etiology of renal impairment and promotes direct nephrotoxicity and acute tubular necrosis. On the other hand, the renal failure observed in the chronic BDL model (with development of biliary cirrhosis, portal hypertension and ascites) shares pathophysiological similarities with HRS, but the accordance of the chronic BDL model to the diagnostic criteria of HRS (e.g. absence of spontaneous bacterial peritonitis, no renal function improvement after plasma volume expansion) should have been confirmed. In conclusion, we think that the BDL model is not suitable for the study of the natural history of HRS, but the chronic BDL model might be valid for the study of established HRS and its potential therapies.展开更多
文摘Despite advances in preoperative evaluation and postoperative care, intervention, especially surgery, for relief of obstructive jaundice still carries high morbidity and mortality rates, mainly due to sepsis and renal dysfunction. The key event in the pathophysiology of obstructive jaundice-associated complications is endotoxemia of gut origin because of intestinal barrier failure. This breakage of the gut barrier in obstructive jaundice is multi-factorial, involving disruption of the immunologic, biological and mechanical barrier. Experimental and clinical studies have shown that obstructive jaundice results in increased intestinal permeability. The mechanisms implicated in this phenomenon remain unresolved, but growing research interest during the last decade has shed light in our knowledge in the field. This review summarizes the current concepts in the pathophysiology of obstructive jaundice-induced gut barrier dysfunction, analyzing pivotal factors, such as altered intestinal tight junctions expression, oxidative stress and imbalance of enterocyte proliferation and apoptosis. Clinicians handling patients with obstructive jaundice should not neglect protecting the intestinal barrier function before, during and after intervention for the relief of this condition, which may improve their patients’ outcome.
文摘AIM:To evaluate the effects of honey on bacterial translocation and intestinal villus histopathology in experimental obstructive jaundice.METHODS:Thirty Wistar-Albino rats were randomly divided into three groups each including 10 animals:group Ⅰ,sham-operated;group Ⅱ,ligation and section of the common bile duct(BDL);group Ⅲ,bile duct ligation followed by oral supplementation of honey(BDL+honey) 10 g/kg per day.Liver,blood,spleen,mesenteric lymph nodes,and ileal samples were taken for microbiological,light and transmission electrone microscopic examination.RESULTS:Although the number of villi per centimeter and the height of the mucosa were higher in sham group,there was no statistically significant difference between sham and BDL + honey groups(P>0.05).On the other hand,there was a statistically significant difference between BDL group and other groups(P<0.05).The electron microscopic changes werealso different between these groups.Sham and honey groups had similar incidence of bacterial translocation(P>0.05).BDL group had significantly higher rates of bacterial translocation as compared with sham and honey groups.Bacterial translocation was predominantly detected in mesenteric lymph nodes.CONCLUSION:Supplementation of honey in presence of obstructive jaundice ameliorates bacterial translocation and improves ileal morphology.
文摘AIM： To investigate the effects of propolis on bacterial translocation and ultrastructure of intestinal morphology in experimental obstructive jaundice. METHODS： Thirty Wistar-Albino male rats were randomly divided into three groups, each including 10 animals： group Ⅰ, sham-operated; group Ⅱ, ligation and division of the common bile duct （BDL）; group Ⅲ, BDL followed by oral supplementation of propolis 100 mg/kg per day. Liver, blood, spleen, mesenteric lymph nodes, and ileal samples were taken for microbiological, light and transmission electron microscopic examination on postoperative 7^th d after sacrification. RESULTS： The mean number of villi per centimeter and mean mucosal height of the propolis group were significantly different in the BDL group （P = 0.001 and 0.012, respectively）. The electron microscopic changes were also different between these groups. Sham and BDL＋propolis groups had similar incidence of bacterial translocation （BT）. The BDL group had significantly higher rates of BT as compared with sham and BDL ＋ propolis groups. BT was predominantly detected in MLNs and the most commonly isolated bacteria was Escherichia coil CONCLUSION： Propolis showed a significant protective effect on ileal mucosa and reduced bacterial translocation in the experimental obstructive jaundice model. Further studies should be carried out to explain the mechanisms of these effects,
文摘The two most widely used experimental models of advanced liver disease are the administration of carbon tetrachloride, and common bile duct ligation (BDL), however, neither has been systematically evaluated as a model of hepatorenal syndrome (HRS). The BDL model in rats, studied at diverse time points, induced a progressive renal dysfunction without structural changes in the kidney. The authors concluded that BDL is a good model for further studies of HRS and its treatment. However, the renal impairment observed at the acute phase of the BDL model is based on a different pathophysiology than that of HRS. Specifi cally, in acute obstructive jaundice, cholemia predominates over parenchymal liver disease (reversible at this stage without portal hypertension or cirrhosis) and independently induces negative inotropic and chronotropic effects on the heart, impaired sympathetic vasoconstriction response and profound natriuresis and diuresis that might lead to volume depletion. In addition, systemic endotoxemia contributes to the prerenal etiology of renal impairment and promotes direct nephrotoxicity and acute tubular necrosis. On the other hand, the renal failure observed in the chronic BDL model (with development of biliary cirrhosis, portal hypertension and ascites) shares pathophysiological similarities with HRS, but the accordance of the chronic BDL model to the diagnostic criteria of HRS (e.g. absence of spontaneous bacterial peritonitis, no renal function improvement after plasma volume expansion) should have been confirmed. In conclusion, we think that the BDL model is not suitable for the study of the natural history of HRS, but the chronic BDL model might be valid for the study of established HRS and its potential therapies.
