The Role Of The Biliary Tract On Multiple Organ Dysfunction Syndrome Caused By Intra-abdominal Hypertension

Intra-abdominal hypertension and abdominal compartment syndrome are serious clinical conditions. The current research focuses on the pathophysiology of heart, lung, intestinal and others of Intra-abdominal hypertension, but the changes and significance of biliary pressure during Intra-abdominal hypertension have not been clear. Clinical findings show that acute suppurative cholangitis can rapidly lead to septic shock and MODS, at which point it increases biliary pressure and elevates bile inflammatory factors. If we once to lower biliary pressure, MODS can rapidly improved. The drainage of bile can improve organ changes caused by hemorrhagic shock. Intra-abdominal hypertension can quickly lead to MODS. It often combined liver dysfunction, cholestasis. But if the biliary drainage can timely and positively carry out, MODS can also be improved. All those indicate that the biliary tract pressure may play an important role in the development of I AH induced MODS. So we start to figure it out on two parts.PART1 The effect of different Intra-abdominal pressure on the biliary tract pressure, the inflammatory factors of blood and bile, and the vital organsObjective:Observe the effect of different Intra-abdominal pressure on the biliary tract pressure, the inflammatory factors of blood and bile, and the vital organsMethods:Using nitrogen gas and abdominal retrograde duodenal papilla larg common bile duct cannulation method to copy abdominal hypertension+ porcine model of biliary home housekeeper; pigs randomly divided into four groups, each group 6, the first group is not applied intraperitoneally pressure (control group), the remaining three groups of different abdominal pressure is applied (the experimental group) were 15mmHg (group 2),20mmHg (group 3),30mmHg (group 4), the duration of the applied pressure are nine hours. Observe changes in their vital signs, measuring biliary pressure and measuring blood levels of inflammatory cytokines and bile in the corresponding point in time, the end of the experiment lung, liver, intestinal pathological examination. All measurement data were expressed as mean ± standard deviation, the data between SPSS 19.0 statistical software group long on a one-way analysis of variance (LSD method), comparison between the two groups with q test.Results:Biliary abdominal pressure with increasing pressure and significantly increased in the control group was significantly less than the pressure duct IAP=30 mmHg group 15.86 ± 3.52 vs 42.30 ± 8.82mmHg, p= 0.003, with the increase in abdominal pressure, the more vital signs of swine increasingly tends to be unstable, heart rate and biliary pressure was positively correlated, R= 0.739, P<0.001, MAP and biliary pressure was negatively correlated, R= 0.-779, P<0.001..Compared to the control group and the fourth group bile TNF-a levels in the experiment 9h to 7.9 ± 4.1 vs 3178 ± 924, P= 0.015; serum compared to 8.5 ± 4.1 vs 1375 ± 336, P= 0.002; bile IL-1 levels compared to 31 ± 15 vs 1168 ± 279, P= 0.028; serum compared to 43 ± 18 vs 965 ± 265, P= 0.004. Abdominal pathology score in each group found that the higher the pressure, the organ pathology score worse.Conclusions:When abdominal pressure increases, along with increased biliary pressure, when the pressure reaches 30mmHg biliary abdominal pressure increased significantly, massive release of inflammatory mediators, causing the occurrence and development of MODS. Serum and bile of inflammatory cytokines are elevated IAP with elevated blood levels of inflammatory cytokines may be partly derived from bile.PART2 The role of biliary decompression on organ function of intra-abdominal hypertensionObjective:The aim of this study is to figure out The role of biliary decompression on organ function of intra-abdominal hypertensionMethods:The method of this study is same with the first part, the pigs were randomly divided into two groups, Group 1:IAP= 30mmHg group, n=6 (same), Group 2:IAP = 30mmHg+gallbladder decompression (gallbladder puncture) group, n= 6, the pressure applied to both the duration of 9 hours. Observe changes in their vital signs, measuring biliary pressure and measuring blood levels of inflammatory cytokines and bile in the corresponding point in time, the end of the experiment lung, liver, intestinal pathological examination. All measurement data were expressed as mean ± standard deviation, the data for independent samples t test using SPSS 19.0 statistical software.Results:Intra-abdominal pressure 30mmHg pressure group compared with gallbladder puncture vital signs, heart rate:161.3±11.1 vs 167.2±13.5, P= 0.697; MAP:72.15 ± 8.63 vs 86.29±10.36, P= 0.018; breathing:23.06±4.82 vs 24.26± 3.51, P=10.374.9h after the experiment two serum levels of TNF-α as compared to 1375±336 vs 1236±275, P= 0.48; bile compared to 3178 ± 924 vs 1948 ± 859, P= 0.004; serum levels of IL-1 9h after the experiment, compared to 965 ± 265 vs 746± 237, P= 0.008 bile compared to 1168± 279 vs 965±265, P= 0.004.30mmHg pressure group and lung pathology score 8.50 ± 0.63 vs 9.64 ± 0.54, P= 0.03, liver 5.50 ± 0.03 vs 6.51 ± 0.59, P= 0.49, small intestine 4.43 ± 0.21 vs 4.96 ± 0.96, P= 0.02, colon 7.64 ± 0.31 vs 9.86 ± 0.81, P<0.01.Conclusions:Biliary decompression can improve vital signs of intra-abdominal hypertension pigs, reduce inflammation and improve organ functionsFull Text Conclusion:While Intra-abdominal pressure increase, the biliary tract pressure will also increase; the biliary tract pressure and heart rate in pigs positively correlated while which may have negative correlation with MAP; biliary decompression can improve vital signs of intra-abdominal hypertension pigs, reduce inflammation and improve organ functions; the change of biliary tract pressure may be one of the reasons that IAH leading to MODS. But what is the truth, we need further study to work it out.