This study was performed to investigate modifications in the serum
bilirubin forms, hepatobiliary
enzymes, and some glycoproteic substances in patients during the course of
extrahepatic cholestasis (stage A) and following its clinical resolution (stage B). The series consisted of 16 patients: 11 had main bile duct stones; two, benign
stenosis of the main bile duct; and three, main
bile duct cancer.
Cholestasis resolved spontaneously in one case, under endoscopy in two, and following surgery in 13. Five patients with
liver cirrhosis and a picture of
intrahepatic cholestasis following
anesthesia were also investigated. Serum
bilirubin forms were measured using van den Bergh's method and the alkaline methanolysis-HPLC procedure; the mono- and di-conjugated forms were considered together in the overall evaluation of the results. The hepatobiliary
enzymes (ALP, GGT, and AST) were increased at stage A and significantly decreased at stage B. Similar patterns were observed in total (TB), unconjugated (UB), and conjugated
bilirubin (CB) and in the percentage of CB out of TB (% CB). In the majority of patients, % CB at stage B was lower than at stage A, whereas in subjects with a high initial UB value, a different % CB pattern was observed. The direct
bilirubin percentage (% DB), on the other hand, had a different pattern, and the variations between stages A and B were not significant. The pathophysiological
bilirubin pattern was similar in patients with
intrahepatic cholestasis. At stage A, in a number of patients the levels of glycoproteic substances (CA 19-9, TPA and
ferritin) were raised, but at stage B they tended to decrease towards the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)