Article

Sepsis and cholestasis.

Medical Service, Ann Arbor VA Health Sysytem, and Department of Internal Medicine, University of Michigan Medical Center, USA.
Clinics in Liver Disease (impact factor: 3.18). 03/2004; 8(1):83-94. DOI:10.1016/S1089-3261(03)00134-X pp.83-94
Source: PubMed

ABSTRACT Sepsis-associated cholestasis should always be considered as part of the differential diagnosis of jaundice in the hospitalized or critically ill patient. The development of a disproportionate elevation of serum bilirubin in comparison with serum alkaline phosphatase and serum aminotransferases should be considered an early warning sign of an underlying infection, even in the absence of fever,leukocytosis, or other signs or symptoms. Prompt recognition and appropriate medical and surgical intervention may reduce morbidity and mortality.

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    Article: Effects of Japanese herbal medicine Inchin-ko-to on endotoxin-induced cholestasis in the rat.
    Juan Pablo Arab, Carolina Ramírez, Pablo Muñoz, Margarita Pizarro, Nancy Solís, Arnoldo Riquelme, Marco Arrese
    [show abstract] [hide abstract]
    ABSTRACT: Inchin-ko-to (ICKT) is an herbal medicine used in Japan to treat jaundice and liver fibrosis.We investigated the effect of oral ICKT supplementation on endotoxin-induced cholestasis in the rat. Lipopolysaccharide (LPS) injection (1 mg/kg body weight i.p.) was used as a model of sepsis-induced cholestasis. Bile flow, biliary bile salt secretion, biliary glutathione secretion and protein expression of the main hepatobiliary transporters Na(+)-taurocholate-cotransporting peptide (Ntcp), multidrug resistance protein 2 (Mrp2) and bile salt export pump (Bsep) were analyzed by conventional techniques in ICKT treated and non-treated animals. Injection of LPS induced a significant decrease of bile flow (-24%), biliary bile salts (-40%) and glutathione excretion (-70%) as well as a significant decrease in Ntcp (-90%) and Mrp2 (-80%) protein levels. ICKT supplementation partially prevented the effects of LPS determining a less intense reduction in bile flow (-10%), a normalization of glutathione excretion as well as a significant increase in Mrp2 protein levels to 60% of the levels observed in control animals. ICKT administration did not modify the effects of LPS on BS secretion or Ntcp protein levels. Our data show that oral supplementation of ICKT partially prevents LPS-induced cholestasis by increasing Mrp2 protein levels and biliary glutathione excretion thus increasing bile salt-independent flow.
    Annals of hepatology: official journal of the Mexican Association of Hepatology 8(3):228-33. · 1.81 Impact Factor
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Keywords

appropriate medical
 
critically ill patient
 
Prompt recognition
 
Sepsis-associated cholestasis
 
serum alkaline phosphatase
 
serum aminotransferases
 
serum bilirubin
 
surgical intervention
 
underlying infection
 
warning sign
 

Richard H Moseley