morphine and Cholestasis

The metabolism of bile acids in man is disturbed under the conditions of cholestasis. Besides of the main bile acids atypical bile acids can be found, which are mainly eliminated by renal excretion as sulphate esters and glucuronides. The pattern of urinary bile acids up to now renders no conclusions with respect to the underlying disease, although intrahepatic cholestasis seems to be in some way connected with disturbances in the metabolism of 3 beta-hydroxy-5-cholenoic acid, a bile acid, which exerts cholestatic effects by itself. The metabolites to be found seem to reflect a derepression of a genotypical synthesis program, which is not phenotypically apparent in healthy adults, but which may have been active during prenatal developmental stages of the liver.

Topics: Bile Acids and Salts; Bile Ducts; Biological Evolution; Cell Membrane; Cholestanol; Cholestanols; Cholestasis; Cholesterol; Glucuronates; Humans; Meconium; Phenobarbital

To identify the incidence and outcomes of cholestasis and meconium ileus (MI) in infants with cystic fibrosis (CF).. Retrospective cohort study.. Single-centre study.. From January 1986 to December 2011, 401 infants with CF (69 with MI) presented to our centre.. (1) incidence of cholestasis, (2) identification of risk factors for cholestasis, (3) association between the presence of cholestasis and MI and the development of clinically significant CF-associated liver disease (CFLD) defined as multilobular cirrhosis with portal hypertension.. Cholestasis occurred in 23 of 401 infants (5.7%). There was a significantly higher incidence of cholestasis in infants with MI (27.1%) compared to those without MI (1.2%) (p<0.001). Infants with MI had a 30.36-fold increased risk of developing cholestasis compared to those without MI (p<0.001). Cholestasis resolved in all children, at a median (range) age of 9.2 (0.8-53.2) months in the MI group and 10.2 (2.0-19.4) months in the non-MI group. The majority of cholestatic infants (87.0%) and infants with MI (92.8%) did not develop clinically significant CFLD, not significantly different than either the 93.9% of non-cholestatic infants nor the 93.7% infants without MI.. Cholestasis is an uncommon condition in CF affecting only 5.7% of the screened newborn CF population. The greatest risk factor for developing cholestasis is the presence of MI. However, the presence of MI appears not to be associated with the development of CFLD. An effect of neonatal cholestasis on the development of CFLD cannot be excluded by this study.

Topics: Cholestasis; Cohort Studies; Cystic Fibrosis; Female; Humans; Ileus; Incidence; Infant; Infant, Newborn; Male; Meconium; Prognosis; Retrospective Studies; Risk Factors

Topics: Amniotic Fluid; Cholestasis; Female; Fetal Development; Fetal Hypoxia; Fetus; Gastrointestinal Tract; Gestational Age; Humans; Meconium; Pregnancy; Pregnancy Complications; Uterine Diseases

A method has been developed for microanalysis of fetal bile acids in biological fluids from neonates by capillary gas chromatography-mass spectrometry using negative-ion chemical ionization of pentafluorobenzyl ester-dimethylethylsilyl ether derivatives of bile acids. Calibration curves for the bile acid derivatives are useful over the range 0.1-100 pg and the detection limit for bile acids was 1 fg (S/N = 5) using isobutane as a reagent gas. Recoveries of the bile acids and their glycine and taurine conjugates from bile acid-free serum and dried blood discs ranged from 92 to 101% and from 93 to 108%, respectively, of the added amounts of their standard samples. The analysis of bile acids on a dried blood disc, meconium and urine from infants, exhibited significant hydroxylation at the 1 beta-, 2 beta-, 4 beta- and 6 alpha-positions of the usual bile acids, cholic and chenodeoxycholic acids, for the urinary or fecal excretion of bile acids in the fetal and neonatal periods. The present method was applied clinically to analyze bile acids on a dried blood disc from neonatal patients with congenital biliary atresia and hyper-bile-acidemia.

Topics: Bile Acids and Salts; Body Fluids; Chenodeoxycholic Acid; Cholestasis; Cholic Acid; Cholic Acids; Fetus; Gas Chromatography-Mass Spectrometry; Humans; Hydroxylation; Infant, Newborn; Meconium

Between 1960 and 1994 cystic fibrosis was found in nine out of 1474 infants investigated for neonatal cholestasis. Four had delay in passing meconium. In all patients cholestatic jaundice was present during the first 48 hours and in three patients cholestasis was complete, mimicking biliary atresia. Serum cholesterol concentrations were normal in all but two children. Sweat chloride was repeatedly above 95 mmol/l in all instances. Three children had another condition enhancing the risk of cholestasis (alpha1-antitrypsin deficiency, hypopituitarism, perinatal asphyxia, and total parenteral nutrition). Liver histology displayed portal fibrosis and inflammation with bile duct proliferation; mucous plugs in bile ducts were observed in only one patient. Only one child died from cirrhosis. These results indicate that cystic fibrosis is not a major cause of neonatal cholestasis. However early signs of intestinal obstruction and low concentrations of serum cholesterol may indicate cystic fibrosis, regardless of liver histology. Neonatal cholestasis has no prognostic value concerning evolution to cirrhosis.

Topics: Cholestasis; Cystic Fibrosis; Female; Humans; Infant; Infant, Newborn; Jaundice, Neonatal; Liver; Male; Meconium

In this prospective study we evaluate the role of serum bile acids in the investigation and management of cholestasis of pregnancy in a detailed study of 18 patients. Bile acids were the most sensitive diagnostic test. The increased incidence of fetal distress (33.3% in this series) and meconium-stained fluid (58.3%) did not correlate with very high values of bile acids in maternal serum, umbilical cord serum, or amniotic fluid. Treatment of pruritus with cholestyramine and/or phenobarbital is ineffective in this condition, induction of labor is suggested once fetal lung maturity is established.

Topics: Adolescent; Adult; Amniotic Fluid; Bile Acids and Salts; Cholestasis; Cholestyramine Resin; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Fetal Blood; Fetal Distress; Fetal Organ Maturity; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Lung; Meconium; Phenobarbital; Pregnancy; Pregnancy Complications; Prospective Studies

Topics: Bile Acids and Salts; Cholestasis; Female; Fetus; Humans; Meconium; Pregnancy

Topics: Bile Acids and Salts; Cholestasis; Female; Humans; Infant, Newborn; Meconium; Pregnancy

Topics: Adult; Amniotic Fluid; Birth Weight; Cholecystectomy; Cholecystography; Cholelithiasis; Cholestasis; Female; Follow-Up Studies; Gallbladder Diseases; Humans; Infant, Newborn; Jaundice; Liver Function Tests; Meconium; Middle Aged; Pregnancy; Pregnancy Complications; Pruritus

Topics: Amniotic Fluid; Asphyxia Neonatorum; Birth Weight; Cholestasis; Female; Fetal Death; Follow-Up Studies; Gestational Age; Hepatitis A; Humans; Infant, Newborn; Infant, Newborn, Diseases; Jaundice; Male; Maternal-Fetal Exchange; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pruritus; Recurrence

Topics: Aspartate Aminotransferases; Bilirubin; Blood Glucose; Cholestasis; Humans; Hypoglycemia; Infant, Newborn; Intestinal Obstruction; Jaundice, Neonatal; Jejunum; Liver; Male; Meconium; Prednisolone

Topics: Cholestasis; Cystic Fibrosis; Esophageal Perforation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Polyhydramnios; Pregnancy; Prognosis