PURPOSE: To investigate the effects of ileal exclusion on hepatic and renal morphology in extra-hepatic cholestasis. METHODS: Twenty four rats were distributed into three groups. Group 1 (control) underwent laparotomy and laparorrhaphy. The animals in groups 2 and 3 underwent hepatic duct ligature and kept in cholestasis for four weeks. After this period, the rats in groups 2 and 3 underwent internal biliary derivation. In Group 3, the last ten centimeters of the terminal ileum were by passed and excluded. Four weeks later, histological and biochemical analysis were performed in all animals of the three groups. RESULTS: In Group 1, no abnormalities regarding hepatic morphology were observed. All animals from groups 2 and 3 presented hepatic fibrosis. No difference was observed between the two groups. No morphological differences in renal histology could be identified among the three groups. There were differences in AST (p<0.05), ALT (p<0.05), direct bilirubin (p<0.05), ƔGT (p<0.05), urea (p<0.05) and creatinine (p<0.05) in Group 3 compared to control. CONCLUSION: The distal ileum exclusion had no influence upon the hepatic and renal morphological alterations, and biochemical liver and kidney tests have worsened.

OBJETIVO: verificar se a exclusão ileal interfere nas alterações funcionais hepáticas e renais, secundárias à colestase extra-hepática.MÉTODOS: foram estudados 24 ratos, distribuídos em três grupos (n=8): Grupo 1 (controle), Grupo 2 (ligadura do ducto hepático combinada com drenagem biliar interna) e Grupo 3 (ligadura do ducto hepático combinada com drenagem biliar interna e exclusão do íleo terminal). Os animais do Grupo 1 (controle) foram submetidos a laparotomia e laparorrrafia. Os animais dos grupos 2 e 3 foram submetidos a ligadura e secção do ducto hepático e mantidos em colestase por oclusão biliar durante quatro semanas. A seguir, foram submetidos a derivação biliar interna. No Grupo 3, associou-se a exclusão dos últimos dez centímetros do íleo terminal e anastomose ileocólica à derivação biliodigestiva. Após outras quatro semanas de acompanhamento, foi colhido sangue de todos os animais dos três grupos, para avaliação bioquímica do fígado e dos rins (albumina, ALT, AST, bilirrubinas direta e indireta, fosfatase alcalina, cGT, creatinina e ureia).RESULTADOS: houve aumento dos valores de ALT, AST, bilirrubina direta, cGT, creatinina e ureia nos ratos do Grupo 3 (p < 0,05).CONCLUSÃO: no modelo murino de colestase extra-hepática, a exclusão ileal piorou as funções hepáticas e renais, sendo desvantajosa como proposta terapêutica para afecções colestáticas.

OBJECTIVE: To verify whether the ileal exclusion interferes with liver and kidney functional changes secondary to extrahepatic cholestasis.METHODS: We studied 24 rats, divided into three groups with eight individuals each: Group 1 (control), Group 2 (ligation of the hepatic duct combined with internal biliary drainage), and Group 3 (bile duct ligation combined with internal biliary drainage and exclusion of the terminal ileum). Animals in Group 1 (control) underwent sham laparotomy. The animals of groups 2 and 3 underwent ligation and section of the hepatic duct and were kept in cholestasis for four weeks. Next, they underwent an internal biliary bypass. In Group 3, besides the biliary-enteric bypass, we associated the exclusion of the last ten centimeters of the terminal ileum and carried out an ileocolic anastomosis. After four weeks of monitoring, blood was collected from all animals of the three groups for liver and kidney biochemical evaluation (albumin, ALT, AST, direct and indirect bilirubin, alkaline phosphatase, cGT, creatinine and urea).RESULTS: there were increased values of ALT, AST, direct bilirubin, cGT, creatinine and urea in rats from Group 3 (p < 0.05).CONCLUSION: ileal exclusion worsened liver and kidney functions in the murine model of extrahepatic cholestasis, being disadvantageous as therapeutic procedure for cholestatic disorders.

OBJETIVO: A evolução para fibrose hepática e, posteriormente, para cirrose são fatos bem estabelecidos na colestase extra-hepática prolongada. A despeito dos avanços nos métodos diagnósticos e terapêuticos, essas complicações continuam de difícil solução, principalmente, quando não é possível reverter a causa da colestase. Neste trabalho, procurou-se verificar, em modelo experimental de colestase pela ligadura do ducto hepático comum, se a exclusão do íleo terminal reduziria o desenvolvimento de fibrose hepática. Não houve abordagem direta da causa da colestase, mas atuou-se nos mecanismos de secreção e regulação do fluxo biliar êntero-hepático. MÉTODO: Foram utilizadas trinta e cinco ratas Wistar, distribuídas em três grupos: Grupo 1, apenas laparotomia e laparorrafia; Grupo 2, ligadura do ducto hepático comum; Grupo 3, ligadura do ducto hepático comum associada a ressecção do íleo terminal, com reconstrução do trânsito intestinal, por meio de anastomose íleo-cólon ascendente. Após trinta dias, os animais foram mortos e o fígado de cada rata foi retirado, para a análise histológica. RESULTADOS: Os resultados foram submetidos a análise estatística pelo teste de Kuskal-Wallis, com nível de significância de 95 % (p < 0,05). Verificou-se que houve fibrose hepática nos grupos 2 e 3, porém sem cirrose. O Grupo 3 apresentou fibrose menos acentuada que o Grupo 2. CONCLUSÕES: Conclui-se que a ressecção do íleo terminal associa-se a menor alteração histológica, no fígado de ratas, decorrente de colestase obstrutiva.

BACKGROUND: Progression to hepatic fibrosis, and later to cirrhosis, is a well-established fact. Despite the advances in the diagnostic and therapeutic methods, this syndrome continues to be of difficult solution, especially when it is not possible to reverse the cause of cholestasis. The development of new therapeutic proposals is necessary in order to prevent the occurrence of hepatic fibrosis or cirrhosis.The present study, conducted on an experimental model of cholestasis induced by ligation of the common bile duct, was carried out in order to determine whether exclusion of the terminal ileum would reduced the development of hepatic fibrosis. There was no direct approach to the cause of cholestasis, but there was an intervention in the mechanisms of secretion and regulation of enterohepatic bile flow. METHODS: Thirty-five female Wistar rats were divided into three groups: Group 1 was submitted only to laparotomy and laparorrhaphy, Group 2 to ligation of the common bile duct, and Group 3 to ligation of the common bile duct in combination with resection of the terminal ileum, with reconstruction of intestinal transit by means of an ileum-ascending colon anastomosis. After 30 days the animals were killed and the liver of each rat was removed for histological analysis. RESULTS: The results were analyzed the Kruskal-Wallis test, with the level of significance set at 95 % (p < 0.05). Hepatic fibrosis, but not cirrhosis, was detected in Groups 2 and 3. Group 3 presented less marked fibrosis than Group 2. CONCLUSION: We conclude that resection of the terminal ileum is associated with less marked histological alterations due to obstructive cholestasis in the liver of female rats.