Hepatic cirrhosis secondary to obstruction of the biliary system

Scobie, Brian A.; Summerskill, W.H.J.

doi:10.1007/bf02236664

Cited by 64 publications

(16 citation statements)

References 10 publications

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“…[1,13,20,21] In our study too, overall improvement of all histological parameters from was observed (Table 4), which is also observed by Sikora et al [9] and Hammel et al [13] This supports the fact that decompression surgery is beneficial in obstructive jaundice.…”

Section: Discussionsupporting

confidence: 78%

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Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Chaturvedi¹,

Chaudhari²,

Kekan³

et al. 2017

APALM

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Background: Biliary obstruction can present with distressing symptoms and increased morbidity which leads to liver fibrosis, cholestasis, portal inflammation and ductular proliferation. Experimental studies showed reversal of histological findings in liver after biliary decompression surgery; however only a limited data is available regarding the same. Methods:Prospective observational study of 28 liver biopsies from 14 patients of obstructive jaundice, who underwent decompression surgery and showed clinical deterioration at 6 weeks with normal HIDA scan. Patients were clinically evaluated. Both intra (1st bx) and postoperative (2nd bx) liver biopsies were studied for fibrosis, cholestasis, ductular proliferation and portal inflammation.Result: Patient's age ranged from 24 to 75 years (8 Males and females 6), commonest symptom being jaundice. In 1st bx, most of the patients showed histological evidence of obstruction, which improved at least partially after surgery. There was no definite correlation of fibrosis with etiology. Fibrosis was less commonly seen with shorter duration of symptoms and younger males had higher prevalence. Increase/ static grades of fibrosis were seen in 35.71% patients each, while 28.57% showed regression. No correlation of age and etiology with status of fibrosis was observed. Regression was more common in males and with absence of cholangitis while progression was more common in females and with presence of cholangitis. Conclusion:We wonder whether younger males are more prone for fibrosis but males in general have better prognosis regarding the reversal. Also, cholangitis could be an important factor for deciding the further course of fibrosis. However we require larger data with multivariate analysis for the confirmation of the same.

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Section: Discussionsupporting

confidence: 78%

“…Scobie et al [20] observed that cirrhosis was more commonly associated with benign etiology. In our study, in 1 st bx, patients with both benign and malignant etiology showed fibrosis which was slightly more common in association with malignancy (66.66% vs. 62.50%).…”

Section: Discussionmentioning

confidence: 99%

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Chaturvedi¹,

Chaudhari²,

Kekan³

et al. 2017

APALM

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“…Secondary biliary cirrhosis by itself has a poor prognosis and a high late mortality rate despite the patency of the hepaticojejunostomy [28]. The time required for the development of secondary biliary cirrhosis after benign biliary stenosis is reported to be 7.1 years: 4.6 years for those with common bile duct stones, and 0.8 years for patients with malignant biliary obstruction [29]. Recent studies describe the time of obstruction, the basal alanine aminotransferase (ALT) level, and the time to normalization of ALT level after surgical repair as predictive factors in the development of hepatic fibrosis [30].…”

Section: Secondary Biliary Cirrhosis and Portal Hypertensionmentioning

confidence: 99%

Bile duct injuries: management of late complications

et al. 2006

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“…Malignant biliary obstruction in adults or biliary atresia in infants can lead to cirrhosis within one year (Scobie and Summerskill, 1965). Progression can be rapid also in protoporphyria (Bloomer, 1988).…”

Section: Time-course and Reversibility Of Fibrosismentioning

confidence: 99%

Chronic liver injury, TGF-β, and cancer

Bissell

2001

Exp Mol Med

155

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Cells termed myofibroblasts are prominent in the injury response of all epithelial tissues. They exhibit proliferation, migration, production of collagen and other extracellular matrix (ECM) molecules, and contraction, all for containing the injury and closing the wound. When the injury is limited in time, the final stage of the repair involves a dismantling of the cellular apparatus and restoration of normal tissue structure. With multiple cycles of repair, however, there is net accumulation of ECM, to the detriment of tissue structure and function. Repair-related ECM coalesces into fibrous bundles and, over time, undergoes changes that render it resistant to degradation. The result is a scar. In the skin, a scar may have cosmetic importance only. In the liver, however, extensive scarring is the setting for unregulated growth and neoplasia; also, fibrous bands disrupt normal blood flow, leading to portal hypertension and its complications. With regard to therapy for fibrosis, the first consideration is elimination of the injury factor. However, given that many liver diseases do not have effective therapies at present, strategies targeting fibrogenesis per se are under development. The main source of myofibroblast-like cells and ECM production in the liver is the perisinusoidal stellate cell, which responds to injury with a pleiotypic change termed activation. Activation is orchestrated by cytokines and the ECM itself. Among the cytokines involved in this process, transforming growth factor-beta (TGF-β) is particularly prominent. The early changes in ECM include de novo production of a specific "fetal" isoform of fibronectin, which arises from sinusoidal endothelial cells. It is stimulated by TGF-β and acts directly on stellate cells to promote their activation. Based on these and other advances in understanding the fundamentals of the injury response, several strategies now exist for altering fibrogenesis, ranging from agents that block TGF-β to traditional Chinese herbal extracts. Arrest of fibrogenesis, even with underlying cirrhosis, is likely to extend life or prolong the time to transplant. Whether it reduces the risk of hepatocellular carcinoma remains to be proven. Although TGF-β antagonists are effective anti-fibrogenic agents, they will require detailed safety testing because of the finding that several forms of epithelial neoplasia are associated with altered regulation of TGF-β.

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Hepatic cirrhosis secondary to obstruction of the biliary system

Cited by 64 publications

References 10 publications

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Analysis of morphological changes in liver in obstructive jaundice with special emphasis on fibrosis

Bile duct injuries: management of late complications

Chronic liver injury, TGF-β, and cancer

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