Cholangitis
No Results
No Results
processing….
Cholangitis is an infection of the biliary tract with the potential to cause significant morbidity and mortality. Many patients with acute cholangitis respond to antibiotic therapy; however, patients with severe or toxic cholangitis may not respond and may require emergency biliary drainage. Jean M. Charcot recognized this illness in 1877 when he described a triad of fever, jaundice, and right upper quadrant pain. In 1959, Reynolds and Dargon described a more severe form of the illness that included the additional components of septic shock and mental confusion, which is referred to as the Reynolds pentad.
Historically, choledocholithiasis was the most common cause of biliary tract obstruction resulting in cholangitis. Over the past 20 years, biliary tract manipulations/interventions and stents have reportedly become more common causes of cholangitis. Hepatobiliary malignancies are a less common cause of biliary tract obstruction and subsequent bile contamination. [1]
Cholangitis is reported in all races. One variant, Asian cholangitis (also referred to as recurrent pyogenic cholangitis), is observed with increased frequency in Southeast Asia. [2]
The condition is reported in both females and males and has no clear predominance in either.
It mostly occurs in adults, with a reported median age at onset of 50-60 years. In neonates, extrahepatic biliary atresia (EHBA) is a cause of cholangitis. In children and young adults, choledochal cyst can cause cholangitis.
The prognosis is usually guarded, although it improves with early antibiotic treatment and appropriate drainage and decompression of biliary tract as needed. Factors reportedly associated with a poor prognosis include old age, female sex, acute renal failure, preexisting cirrhosis, and malignant biliary obstruction.
The mortality rate of acute cholangitis ranges from 5-10%, with a higher mortality rate in patients who require emergency decompression or surgery.
Cholangitis has significant potential for mortality and morbidity, especially if left untreated. Reported mortality rates have been as high as 88% for untreated cholangitis.
Complications include pyogenic liver abscess, cholangiolytic abscess (usually small and multiple) in the liver, longstanding recurrent cholangitis (eg, Asiatic cholangitis), and acute renal failure. Primary sclerosing cholangitis (PSC) can cause secondary biliary cirrhosis (SBC). [3]
Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol. 2009 Sep. 6 (9):533-41. [Medline].
Lee KF, Chong CN, Ng D, et al. Outcome of surgical treatment for recurrent pyogenic cholangitis: a single-centre study. HPB (Oxford). 2009. 11(1):75-80. [Medline]. [Full Text].
Mattner J. Impact of microbes on the pathogenesis of primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Int J Mol Sci. 2016 Nov 9. 17 (11):[Medline].
Fujii Y, Ohuchida J, Chijiiwa K, Yano K, Imamura N, Nagano M, et al. Verification of Tokyo Guidelines for diagnosis and management of acute cholangitis. J Hepatobiliary Pancreat Sci. 2011 Oct 28. [Medline].
Nishino T, Hamano T, Mitsunaga Y, et al. Clinical evaluation of the Tokyo Guidelines 2013 for severity assessment of acute cholangitis. J Hepatobiliary Pancreat Sci. 2014 Dec. 21(12):841-9. [Medline].
Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A. Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009. 2009:840208. [Medline]. [Full Text].
Li FY, Cheng NS, Mao H, Jiang LS, et al. Significance of controlling chronic proliferative cholangitis in the treatment of hepatolithiasis. World J Surg. 2009 Jul 30. epub ahead of print. [Medline].
Pitchumon CS. Choledocholithiasis and cholangitis. In: Floch MH, Floch NR, Kowdley KV, Pitchumon CS, eds. Netter’s Gastroenterology. 2nd ed. Saunders; 2010. 534-6.
Lin H, Li S, Liu X. The safety and efficacy of nasobiliary drainage versus biliary stenting in malignant biliary obstruction: A systematic review and meta-analysis. Medicine (Baltimore). 2016 Nov. 95 (46):e5253. [Medline].
Bai Y, Gao F, Gao J, Zou DW, Li ZS. Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: a meta-analysis. Pancreas. 2009 Mar. 38(2):126-30. [Medline].
Park TY, Choi JS, Song TJ, Do JH, Choi SH, Oh HC. Early oral antibiotic switch compared with conventional intravenous antibiotic therapy for acute cholangitis with bacteremia. Dig Dis Sci. 2014 Nov. 59(11):2790-6. [Medline].
Bilhartz LE, Horton JD. Gallstone disease and its complications. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 6th ed. 1998:948-972.
Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. 2000 Sep. 14(3):521-46. [Medline].
Kadakia SC. Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis. Med Clin North Am. 1993 Sep. 77(5):1015-36. [Medline].
Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. 1992 Jun 11. 326(24):1582-6. [Medline].
Lameris JS, Overhagen HV. Imaging and intervention in patients with acute right upper quadrant disease. In: Bailliere’s Clinical Gastroenterology. Vol 9. Harcourt Brace & Co. 1995:21-36.
Lee DW, Chung SC. Biliary infection. In: Bailliere’s Clinical Gastroenterology. Vol 11. Harcourt Brace & Co. 1997:707-724.
Leung JW, Yu AS. Hepatolithiasis and biliary parasites. Bailliere’s Clinical Gastroenterology. 1997. 11:681-706.
Lillemoe KD. Surgical treatment of biliary tract infections. Am Surg. 2000 Feb. 66(2):138-44. [Medline].
Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am. 1990 Dec. 70(6):1297-312. [Medline].
Mueller T, Beutler C, Picó AH, Shibolet O, Pratt DS, Pascher A, et al. Enhanced innate immune responsiveness and intolerance to intestinal endotoxins in human biliary epithelial cells contributes to chronic cholangitis. Liver Int. 2011 Nov. 31(10):1574-88. [Medline].
Raraty MG, Finch M, Neoptolemos JP. Acute cholangitis and pancreatitis secondary to common duct stones: management update. World J Surg. 1998 Nov. 22(11):1155-61. [Medline].
van den Hazel SJ, Speelman P, Tytgat GN, et al. Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clin Infect Dis. 1994 Aug. 19(2):279-86. [Medline].
Kwan KE, Shelat VG, Tan CH. Recurrent pyogenic cholangitis: a review of imaging findings and clinical management. Abdom Radiol (NY). 2016 Oct 21. [Medline].
Ma CL, Wang LP, Qiao S, et al. Risk factors for death of elderly patients with acute obstructive suppurative cholangitis. West Indian Med J. 2015 Dec 1. [Medline].
Copelan A, Kapoor BS. Choledocholithiasis: diagnosis and management. Tech Vasc Interv Radiol. 2015 Dec. 18 (4):244-55. [Medline].
Homayoun Shojamanesh, MD Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute; Clinical Assistant Professor of Medicine, University of New Mexico School of Medicine
Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Victor Nwakakwa, MD, MRCP
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine
BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.
Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS Professor of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS is a member of the following medical societies: Association of Surgeons of India, Indian Association of Surgical Gastroenterology, Indian Society of Gastroenterology, Medical Council of India, National Academy of Medical Sciences (India), Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.
Anil Minocha, MD, FACP, FACG, AGAF, CPNSS Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center; Clinical Professor, University of Mississippi School of Pharmacy
Anil Minocha, MD, FACP, FACG, AGAF, CPNSS is a member of the following medical societies: American Academy of Clinical Toxicology, American Society for Gastrointestinal Endoscopy, American Federation for Clinical Research, American Association for the Study of Liver Diseases, American College of Forensic Examiners Institute, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association
Disclosure: Nothing to disclose.
Cholangitis
Research & References of Cholangitis|A&C Accounting And Tax Services
Source
0 Comments