Showing papers in "Clinics in gastroenterology in 1977"

The Enterohepatic Circulation of Bile Acids in Man

Abstract: Steady-state and dynamic descriptions of the enterohepatic circulation of bile acids in healthy man are given Methods for characterizing the enterohepatic circulation of bile acids in health and disease are summarized

Diagnostic value of serum bile acids.

Abstract: SUMMARY With the development of simplified methods of bile acid analysis, a new era has dawned in the evaluation of hepatobiliary disease. 1. A total serum bile acid particularly in the postprandial period is more sensitive than either BSP or ICG for the detection of minimal liver disease and will become a useful screening method. 2. The ratio of chenodeoxycholate to cholate in serum together with the total concentration can often distinguish hepatitis and cirrhosis from intrahepatic and extrahepatic cholestasis with normal liver cell parenchyma. However, in practice this is usually of less value than the total serum bile acid level. 3. Changes in serum bile acids throughout a 24 hour cycle reflect the enterohepatic circulation of bile acids and the capacity of the liver to transport them. These patterns are most useful in judging the severity of cholestasis and response to resin therapy. They also provide new insights into the pathophysiology of bile acid metabolism and excretion in different diseases of the liver.

Neonatal necrotizing enterocolitis: a disease of altered host defense.

Abstract: SUMMARY AND CONCLUSIONS Unlike retrolental fibroplasia from oxygen toxicity or the ‘grey-baby syndrome’ of vascular collapse from chloramphenicol, we have yet to implicate a single aetiology for neonatal necrotizing enterocolitis. We have reviewed how each predisposing condition can best be considered an insult to the immature local intestinal immune barrier of the neonate. Figure 3 summarizes how each of the myriad predisposing conditions might interact with the host defenses. As has been noted, the pathological features of NEC cannot be explained solely on the basis of direct bacterial invasion of enteric flora. Instead, at least from experimental models, an interaction of mucosal disruption, enteric flora and oral feedings is postulated. The potential roles of endotoxin, antigen-antibody complexes, bile salts, and small vessel platelet/fibrin thrombi remain to be elucidated. It has been noted that NEC may occur in a mild or benign form (Richmond and Mikity, 1975). This has also been our experience, as any insult will vary from patient to patient. However, this represents only a retrospective appraisal and in no way alters the need for vigorous therapeutic endeavours. We have suggested that one such therapeutic endeavour be directed at reduction in the antigen load to the intestinal tract coupled with enhancement of the epithelial surface immunity through the use of human breast milk.

Bile acid metabolism in infants and children.

Abstract: SUMMARY It is apparent that bile acid metabolism in the young child must be evaluated within the context of a maturing organism Accordingly information has been presented so that the physician and the investigator will be able to integrate new data concerning mechanisms of bile salt action or pose new questions concerning previously existing hypotheses of hepatic and intestinal function in children

Intractable diarrhoea of infancy.

Abstract: The intractable diarrhoea syndrome of infancy continues to be a major diagnostic and therapeutic challenge to the paediatrician and paediatric gastroenterologist. A carefully organized, staged approach to diagnosis will provide the best method of identifying those infants in whom a specific aetiology exists and for whom specific therapy is often available. Regardless of aetiology, however, the early use of appropriate nutritional support will not only reduce morbidity and mortality in these infants, but will prevent the development of many of the secondary consequences of malnutrition. The physician must compulsively pay attention to the details of daily management and provide an organized approach to diagnosis and treatment in order to improve the outcome of infants with intractable diarrhoea.

Vomiting and regurgitation.

Abstract: Heavy metal poisoning, as well as proventricular, ventricular or lower alimentary tract diseases are possible causes. However, anything that disrupts the normal gastric secreting or grinding functions of the proventriculus and ventriculus may lead to a secondary overgrowth of bacteria or fungi in the small and large intestines. Foreign bodies obstructions (usually seen in nestlings and fledgling birds kept on inappropriate substrates, such as wood chips or saw dust.