Efeitos da derivação ileocólica e da exclusão total do íleo terminal na morfologia e nas funções de fígado, rins e íleo terminal de ratos submetidos a ligadura do ducto hepático comum

Abstract

Cholestatic diseases and their evolution into fibrosis and cirrhosis are well-known. Despite the increase in therapies, such as liver transplants, this group of affections still represents a challenge in medical practices, from the diagnosis to the treatment, and is commonly linked to high rates of morbidity and lethality, coupled with high treatment costs. New conducts and the search for the physiopathological mechanisms involved are constantly emerging. The purpose of the present study was to evaluate the influence and effect of the partial or total exclusion of the terminal ileum in the liver, kidney, and ileum, in presence of obstructive cholestasis. Thirty-two male Wistar rats were divided into four groups (n = 8). Groups 2, 3, and 4 underwent the ligation of the common hepatic duct. After four weeks, an internal biliary drainage was performed by means of hepaticoduodenostomy, using a nelaton prosthesis. In the animals from Group 3, a laterolateral ileocolic anastomosis, with a partial exclusion of the final 10 centimeters of the terminal ileum, could be observed. In the animals from Group 4, the sectioning and closing of 10 distal centimeters of the terminal ileum, as well as a terminolateral anastomosis of the ileum with ascending colon, were performed. Group 1 was the control group, in which the rats were undertaken to only laparotomy and laparorrhaphy. At the end of eight weeks, all the rats from the four groups were killed and material was collected for exams. The biochemical exams included: albumin, aspartate-aminotransferase (AST), alanine-aminotransferase (ALT), alkaline phosphatase, -glutamiltransferase, direct bilirubin, indirect bilirubin, urea, and creatinine. The liver, kidneys, and a segment of the terminal ileum were also collected for 4 anatomopathological analyses. The results were submitted to statistical analyses by means of the ANOVA, Kruskal-Wallis, Pearson, and Fisher exact tests. Persistence in the varying degrees of fibrosis could be observed in the rats from groups 2, 3, and 4, with no significant difference amongst these groups. The control group did not present hepatic fibrosis. In the histology of the kidney and the terminal ileum, no differences could be identified among the four groups. Concerning the biochemical analyses, the values of AST, ALT, direct bilirubin, -glutamiltransferase, urea, and creatinine were greater in Group 4 as compared to the control group (p < 0.05). Group 4 presented urea and creatinine values that were higher than those from groups 2 and 3 (p < 0.05). In conclusion, in male Wistar rats, the ileocolic partial shunt of the terminal ileum and the total exclusion of the final centimeters of the terminal ileum after internal biliary drainage of the extra-hepatic cholestasis did not alter the intensity of hepatic fibrosis. These procedures did not modify the morphology of the kidney or the terminal ileum. The total exclusion of the terminal ileum worsened the biochemical samples from the liver and kidney. No benefit in the ileocolic shunt in either the morphology or function of the liver and kidneys could be observed. The total exclusion of the terminal ileum after biliary drainage for obstructive cholestasis worsened renal biochemical samples.