The effect of decreased portal blood flow on the biliary system |
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Authors: | Yutaka Saji |
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Institution: | (1) The First Department of Surgery, Hokkaido University School of Medicine, Kita 15 Nishi 7, Kita-ku, 060 Sapporo, Japan |
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Abstract: | A disturbance in the regional portal blood flow adjacent to the dilated bile duct in the liver is often observed in patients
with hepatolithiasis. The effects of this disturbed portal blood flow on the biliary system, with or without cholangitis,
were therefore investigated. Young rabbits were divided into the following four groups; (1) controls that had a laparotomy
only (n=3), (2) those that had a ligation of the portal branch of the right posterior lobe (RP lobe) (PL) (n=10), (3) those
that had tubing inserted into the bile duct through the duodenal papilla (BS) (n=10), and (4) PL+BS (n=10). Despite marked
atrophy of the RP lobe, no distinct changes were seen in the biliary systems of groups 1 or 2. In groups 3 and 4, however,
infiltration of inflammatory cells and glandular proliferation in the wall of the markedly dilated extrahepatic bile duct
(proliferative cholangitis (PC), characteristic to hepatolithiasis) were seen. Findings of PC were also noted in the intrahepatic
bile duct of the atrophied RP lobes of these 2 groups. The incidence of PC was 20 per cent in group 3 and 60 per cent in group
4, respectively, but the PC of the intrahepatic bile ducts in group 3 was more localized than in group 4. Goblet cell metaplasia
was seen in the epithelial cells of PC. Bacteriologically, bile samples were aseptic in groups 1 and 2, however, samples of
bile from groups 3 and 4 were all contaminated withEscherichia coli orStreptococcus Faecalis. The biliary contents of phospholipids, total cholesterol and total bile acid were significantly decreased in groups 3 and
4, when compared with groups 1 and 2. In conclusion, a disturbance in portal blood flow, accompanied by cholangitis and segmental
liver atrophy, may play an important role in the clinical course of hepatolithiasis. |
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Keywords: | hepatolithiasis portal blood flow cholangitis |
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