The role of bacterial translocation and immunological disturbances in the development of infectious complications in obstructive jaundice

Abstract

Surgery in patients with jaundice is still connected with a high risk of postoperative complication development. Various etiological factors responsible for their occurrence as well as prevention methods were described. In the paper endotoxin-related pathophysiology, bacterial translocation and immunological disturbances were discussed. The lack of bile in the intestine lumen, decrease of intestinal perfusion and impaired bowel movement are responsible for the bacterial and endotoxin translocation. Additionally, endotoxins can influence the liver function, by decreasing the portal blood flow, impairment of the Kupffer cell phagocytosis or due to a decrease in fibrinolytic activity. Immunological disturbances are related to an impairment of the hepatic reticulo - endothelial system, the Kupffer cell activity, extrahepatic phagocytes and excretion of the specific immunological mediators (TNF, soluble TNF receptors, IL-6, IL-8, IL-10, IL-12, IL-18, TGF-b, PAF). In accordance with the above-mentioned findings, an improvement of the intestine wall condition and immunomodulation may decrease the total mortality rate in cholestatic patients.