ABSTRACT
INTRODUCTION AND OBJECTIVES: Acute cholangitis, which is characterized by biliary infection and acute liver injury, may impact cirrhosis prognosis. However, the prognosis itself remains unclear. MATERIALS AND METHODS: This multicenter retrospective cohort study compared the mortality and liver function change between patients with and without cirrhosis who underwent endoscopic treatment for acute cholangitis caused by choledocholithiasis between January 2004 and December 2019. RESULTS: We analyzed 699 patients, 44 of whom had cirrhosis. The cirrhotic group had a significantly higher 30-day mortality rate than the noncirrhotic group (14% vs. 1%; P < 0.001). The cirrhotic group also had significantly lower total bilirubin and albumin recovery. However, all patients with cirrhosis who survived achieved total-bilirubin recovery, and 91% achieved albumin recovery within 90 days. In multivariable Cox regression analysis, the independent risk factors for total-bilirubin recovery included cirrhosis (hazard ratio, 0.37; 95%CI, 0.24â0.58; P < 0.001) and high total-bilirubin level (0.46; 95%CI, 0.34â0.60; P < 0.001), whereas those for albumin recovery were cirrhosis (0.51; 95%CI, 0.33â0.79; P = 0.002), high age (0.62; 95%CI, 0.47â0.82; P < 0.001), organ dysfunction (0.62; 95%CI, 0.39â0.96; P = 0.03), low albumin level (0.57; 95%CI, 0.36â0.91; P = 0.02), and high C-reactive protein level (0.73; 95%CI, 0.56â0.95; P = 0.02). CONCLUSIONS: Patients with cirrhosis complicated with acute cholangitis had poor prognosis. Recovery of liver function after endoscopic treatment was slow; nevertheless, most patients who survived could recover within 90 days.
Subject(s)
Cholangitis , Choledocholithiasis , Acute Disease , Albumins , Bilirubin , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangitis/etiology , Cholangitis/therapy , Choledocholithiasis/complications , Choledocholithiasis/surgery , Humans , Liver Cirrhosis/complications , Liver Cirrhosis/diagnosis , Prognosis , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
O objetivo deste estudo foi revisar as ferramentas diagnósticas e de manejo da colangite aguda, da tríade de Charcot aos critérios de Tóquio. Foi realizada revisão da literatura no PubMed® utili- zando a combinação dos descritores "Tokyo Guideline", "Char- cot's triad" e "Acute cholangitis". A tríade de Charcot foi a pri- meira ferramenta diagnóstica da colangite aguda. Apesar de sua contribuição, foram os critérios de Tóquio a primeira diretriz com evidência clínica para diagnóstico, classificação de severidade e estratégia para o manejo da colangite aguda. A literatura atual busca identificar marcadores de mau prognóstico do paciente, como a procalcitonina, assim como o tempo ideal para a terapia antibiótica e a drenagem biliar. É bem estabelecido o quanto a tríade de Charcot, juntamente dos critérios de Tóquios, contri- buiu para o melhor diagnóstico e manejo da colangite aguda. Todavia, mais estudos são necessários para validação científica dessas diretrizes na prática clínica-cirúrgica.
The objective of this study was to review acute cholangitis diag- nostic and management tools, from Charcot's triad to Tokyo guidelines. The keywords "Tokyo guideline", "Charcot's triad", and "Acute cholangitis" were searched in PUBMED® and used to review the literature. Charcot's triad was the first diagnostic tool in acute cholangitis. Despite its contribution, Tokyo guidelines were the first evidence-based parameters for diagnosis, severity assessment, and strategy for acute cholangitis management. The current literature searches for biomarkers of patient's bad prognostic, such as procalcitonin, as well the optimal timing of antibiotic therapy and biliary drainage. The good contribution Charcot's triad and Tokyo guidelines has made to improved diagnosis and management of acute cholangitis is well-esta- blished. However, further studies are required for scientific vali- dation of these guidelines in clinical-surgical practice.
Subject(s)
Humans , Cholangitis/diagnosis , Practice Guidelines as Topic , Severity of Illness Index , Drainage/methods , Cholangitis/therapy , Acute Disease , Sensitivity and Specificity , Early Diagnosis , Anti-Bacterial Agents/therapeutic useABSTRACT
Primary biliary cholangitis (PBC) is a chronic autoimmune cholangiopathy characterized by a selective destruction of biliary epithelial cells of small and medium caliber hepatic ducts, which mainly affects women. The main symptoms are fatigue and pruritus, however, a large proportion of patients may be asymptomatic. The diagnosis is based on AMA titers >1:40, alkaline phosphatase >1.5 times the upper limit for more than 24 weeks and compatible liver histology. It is associated with multiple autoimmune diseases mainly extrahepatic, thyroid diseases, bone diseases, among others. The first line treatment is ursodeoxycholic acid (UDCA), that improves liver function tests and delay the progression to cirrhosis. Currently, there are new treatments and adjuvant therapies on study. The purpose of this review is to offer an update in this topic, which is very important in gastroenterology and internal medicine. We formed an interdisciplinary team to search in the data base Medline thorough PubMed with the keywords describe below, we made a critical lecture of the titles and abstracts of each article to write this paper.
Subject(s)
Autoimmune Diseases , Cholangitis , Autoimmune Diseases/complications , Autoimmune Diseases/diagnosis , Autoimmune Diseases/therapy , Cholangitis/complications , Cholangitis/diagnosis , Cholangitis/therapy , Chronic Disease , Combined Modality Therapy , Diagnosis, Differential , Humans , PrognosisABSTRACT
La colangitis biliar primaria (CBP), es una colangiopatía crónica caracterizada por la destrucción selectiva de las células epiteliales biliares de conductos hepáticos de pequeño y mediano calibre, que afecta principalmente a mujeres. Los principales síntomas son la fatiga y el prurito, sin embargo, gran porcentaje de los pacientes pueden ser asintomáticos. El diagnóstico se basa en anticuerpos antimitocondriales (AMA) con títulos >1:40, fosfatasa alcalina >1,5 veces del límite superior normal por más de 24 semanas e histología hepática compatible con la patología. Se asocia con múltiples enfermedades principalmente de carácter autoinmune extra hepáticas, enfermedades tiroideas, óseas, entre otras. El tratamiento de primera línea es el ácido ursodesoxicólico (AUDC) que a pesar que no cura la enfermedad, mejora las pruebas del perfil hepático, así como el retraso en la progresión a cirrosis. Actualmente se encuentran en estudio nuevos tratamientos y terapias adyuvantes. El propósito de esta revisión es ofrecer una actualización de este tema que se presenta en los servicios de medicina interna y gastroenterología; para su realización se conformó un equipo interdisciplinar que desarrolló una búsqueda en la base Medline a través de PubMed con los tesauros correspondientes y se procedió a una lectura crítica y analítica de títulos, resúmenes y textos completos para el filtro, extracción y síntesis de la información encontrada
Primary biliary cholangitis (PBC) is a chronic autoimmune cholangiopathy characterized by a selective destruction of biliary epithelial cells of small and medium caliber hepatic ducts, which mainly affects women. The main symptoms are fatigue and pruritus, however, a large proportion of patients may be asymptomatic. The diagnosis is based on AMA titers >1:40, alkaline phosphatase >1.5 times the upper limit for more than 24 weeks and compatible liver histology. It is associated with multiple autoimmune diseases mainly extrahepatic, thyroid diseases, bone diseases, among others. The first line treatment is ursodeoxycholic acid (UDCA), that improves liver function tests and delay the progression to cirrhosis. Currently, there are new treatments and adjuvant therapies on study. The purpose of this review is to offer an update in this topic, which is very important in gastroenterology and internal medicine. We formed an interdisciplinary team to search in the data base Medline thorough PubMed with the keywords describe below, we made a critical lecture of the titles and abstracts of each article to write this paper
Subject(s)
Humans , Autoimmune Diseases , Cholangitis , Prognosis , Autoimmune Diseases/complications , Autoimmune Diseases/diagnosis , Autoimmune Diseases/therapy , Cholangitis/complications , Cholangitis/diagnosis , Cholangitis/therapy , Chronic Disease , Combined Modality Therapy , Diagnosis, DifferentialABSTRACT
Colangite aguda é uma infecção da árvore biliar que constitui uma emergência médica, sendo potencialmente fatal se não tratada imediatamente. Na maioria dos casos, ocorre devido à obstrução biliar por cálculos. Essa síndrome foi descrita pela primeira vez em 1877 por Charcot e o diagnóstico precoce pode oferecer melhor prognóstico.
Acute cholangitis is defined as infection of the bile ducts consisiting in a life-threatining emergency that should be treated immediately. It is mostly caused by common bile duct obstruction due to gallstones. This syndromme was first described by Charcot in 1877 and it must be promptly recognized in order to offer a better prognosis.
Subject(s)
Humans , Cholangitis/diagnosis , Cholangitis/diagnostic imaging , Cholangitis/drug therapy , Cholangitis/therapyABSTRACT
A colangite aguda corresponde à infecção ascendente das vias biliares e geralmente está relacionada com as bactérias entéricas - gram-negativas, anaeróbios e enterococos. O fator patogênico mais importante é o obstrutivo, pois a presença de bactérias na bile não é suficiente para causar infecção das vias biliares se não estiver presente o componente obstrutivo. Dentre eles, a coledocolitíase é o principal elemento em cerca de 70% a 80% dos casos. Clinicamente, a tríade clássica - febre com calafrios, dor do hipocêndrio direito e icterícia - descrita por Charcot em 1877 manifesta-se em cerca de 70% a 80% dos pacientes. A ultrassonografia abdominal (e mais raramente a colangiopancreatografia por ressonância magnética) deve ser o método de escolha, por ser hábil em detectar dilatação da via biliar acima do local da obstrução e também por poder revelar sua causa. A terapêutica da colangite bacteriana aguda deve alicerçar-se na ressuscitação volêmica, antibioticoterapia e desobstrução da via biliar com consequente drenagem, sendo esta última a pedra angular da terapia emergencial da colangite aguda, que pode ser feita por via endoscópica (CPRE) ou transparietal (PTC).
Acute cholangitis corresponds to the ascending infection of the biliary tract and is usually associated with enteric bacteria - gram-negative, anaerobes and enterococci. The most important pathogenic factor is the obstruction because the presence of bacteria in bile is not sufficient to cause infection of the biliary tract in the absence of one obstructive component. Among these, choledocholithiasis is the main element in about 70% to 80% of cases. Clinically, the classic triad - fever with chills, pain in the right hypochondrium and jaundice - described by Charcot in 1877, manifests itself in about 70% to 80% of patients. The abdominal ultrasound (and, less frequently, magnetic resonance cholangiopancreatography) should be the method of choice because it is able to detect bile duct dilation above the site of the obstruction and also to reveal its cause. The treatment of acute bacterial cholangitis must be based on fluid resuscitation, antibiotics and clearing of the bile duct with subsequent drainage, the latter being the cornerstone of emergency therapy of acute cholangitis, which can be performed endoscopically (ERCP) or transparietal (PTC).
Subject(s)
Humans , Male , Female , Anti-Bacterial Agents/therapeutic use , Clinical Laboratory Techniques , Cholangitis/diagnosis , Cholangitis/etiology , Cholangitis/therapy , Cholangitis , Choledocholithiasis/complications , Diagnostic Imaging , Bile Duct Diseases/diagnosis , Enterobacteriaceae Infections/diagnosis , Cholangiopancreatography, Magnetic Resonance , Cholecystectomy, Laparoscopic/methods , Bile Duct DiseasesSubject(s)
Autoimmune Diseases/therapy , Cholangitis/therapy , Hepatitis, Autoimmune/therapy , Autoimmune Diseases/complications , Autoimmune Diseases/diagnosis , Autoimmune Diseases/immunology , Cholangitis/complications , Cholangitis/diagnosis , Cholangitis/immunology , Hepatitis, Autoimmune/complications , Hepatitis, Autoimmune/diagnosis , Hepatitis, Autoimmune/immunology , HumansSubject(s)
Humans , Male , Female , Cholangitis/diagnosis , Cholangitis/microbiology , Cholangitis/therapy , Endoscopy, GastrointestinalABSTRACT
La exploración quirúrgica de la vía biliar seguida de la instalación de una sonda de Kehr ha sido por años el tratamiento de elección de la colangitis aguda en los servicios de urgencia de nuestro país. Actualmente el drenaje endoscópico de la vía biliar se ha situado como la modalidad de elección dada su menor morbimortalidad. El objetivo del presente estudio es mostrar y analizar los resultados de la colangiografía endoscópica retrógrada (CPER) en el Hospital Clínico Regional de Valdivia en el tratamiento de la colangitis aguda. Se realiza un estudio retrospectivo mediante revisión de fichas clínicas en base a protocolo tipo de los pacientes intervenidos vía endoscópica con diagnóstico de colangitis aguda, entre los años 2004 y 2006 en dicho centro. Los datos fueron analizados mediante una planilla Excel. La serie está constituida por 70 pacientes, de los cuales el 62,9 por ciento corresponden a sexo femenino. La edad promedio corresponde a 70,4 años. Un 34,3 por ciento de los pacientes fue intervenido dentro de las primeras 24 horas de hospitalización. El tiempo de hospitalización total presentó una mediana de 5 días (1-19). La mediana del postoperatorio correspondió a 3 días (1-17). Un 91,4 por ciento de los pacientes es intervenido con diagnóstico preoperatorio de colangitis aguda, lo que se confirma en la totalidad de la muestra durante el procedimiento. A un 95,7 por ciento de los pacientes se les efectuó ecografía previa. Tomografía computada (TC) se realizó en un 5,7 por ciento de los casos y Colangioresonancia en un paciente (1,4 por ciento). Un 95,1 por ciento y un 77,1 por ciento de los pacientes presentó vía biliar dilatada ecográficamente y durante CPER respectivamente. En un 85,7 por ciento se confirma la presencia de coledocolitiasis. En un 1,7 por ciento no se logra la descompresión total de la vía biliar en un primer intento. En todos los casos se realizó tratamiento antibiótico, cuya mediana fue 10 días (2-17). No hubo complicaciones...
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis/epidemiology , Cholangitis/therapy , Drainage/statistics & numerical data , Drainage/methods , Acute Disease , Age and Sex Distribution , Comorbidity , Chile/epidemiology , Cholangitis/etiology , Biliary Tract Diseases/complications , Retrospective Studies , Time Factors , Treatment OutcomeSubject(s)
Cholestasis/therapy , Cholangitis/diagnosis , Cholangitis/pathology , Cholangitis/therapy , Cholestasis/diagnosis , Cholestasis/pathology , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/etiology , Cholestasis, Intrahepatic/pathology , Cholestasis, Intrahepatic/therapy , Hepatitis, Alcoholic/diagnosis , Hepatitis, Alcoholic/pathology , Hepatitis, Alcoholic/therapy , Humans , Liver Cirrhosis, Biliary/diagnosis , Liver Cirrhosis, Biliary/pathology , Liver Cirrhosis, Biliary/therapy , RecurrenceSubject(s)
Humans , Sepsis/epidemiology , Sepsis/history , Sepsis/etiology , Sepsis/classification , Sepsis/physiopathology , Sepsis/metabolism , Sepsis/therapy , Encephalitis, Viral/etiology , Encephalitis, Viral/physiopathology , Encephalitis, Viral/diagnosis , Meningitis/diagnosis , Meningitis/epidemiology , Meningitis/pathology , Meningitis/therapy , Surgical Wound Infection/pathology , Surgical Wound Infection/diagnosis , Surgical Wound Infection/therapy , Pneumonia/etiology , Pneumonia/epidemiology , Respiration, Artificial , Respiration, Artificial/adverse effects , Catheterization , Catheterization/adverse effects , Cholangitis/etiology , Cholangitis/epidemiology , Cholangitis/physiopathology , Cholangitis/complications , Cholangitis/therapy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , HIV , Anti-Bacterial Agents/administration & dosageSubject(s)
Humans , Sepsis/epidemiology , Sepsis/history , Sepsis/etiology , Sepsis/classification , Sepsis/physiopathology , Sepsis/metabolism , Sepsis/therapy , Encephalitis, Viral/etiology , Encephalitis, Viral/physiopathology , Encephalitis, Viral/diagnosis , Meningitis/diagnosis , Meningitis/epidemiology , Meningitis/pathology , Meningitis/therapy , Surgical Wound Infection/pathology , Surgical Wound Infection/diagnosis , Surgical Wound Infection/therapy , Pneumonia/etiology , Pneumonia/epidemiology , Respiration, Artificial , Respiration, Artificial/adverse effects , Catheterization , Catheterization/adverse effects , Cholangitis/etiology , Cholangitis/epidemiology , Cholangitis/physiopathology , Cholangitis/complications , Cholangitis/therapy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , HIV , Anti-Bacterial Agents/administration & dosageABSTRACT
Antecedentes: las complicaciones biliares (CB) son consideradas por muchos el "Talón de Aquiles" del Trasplante Hepático. Su incidencia varía entre un 7 a un 35 por ciento. Se pueden agrupar según su frecuencia de presentación en estenosis, bilirragias y misceláneas. En la actualidad se cuenta con un manejo multimodal que incluye los procedimientos percutáneos, endoscópicos y/o quirúrgicos. Objetivos: describir la incidencia y tipos de CB en nuestra serie de 300 trasplantes y describir las modalidades terapéuticas empleadas y sus resultados. Diseño: estudio retrospectivo y descriptivo. Población: entre enero de 1988 y junio de 2000, 300 trasplantes hepáticos fueron realizados en 276 pacientes en la Unidad de Trasplante Hepático del Hospital Italiano de Buenos Aires. Método: se evaluaron en el receptor la edad, indicación del trasplante, tipo de injerto, tipo de reconstrucción biliar, existencia de trombosis de la arteria hepática. De la CB se evaluaron el tipo, tratamiento y su resultado. Resultados: las CB ocurrieron en 52 de los 300 injertos trasplantados, lo que corresponde a un 17,33 por ciento, presentándose en 24 receptores pediátricos y en 28 receptores adultos lo que representa un índice de CB en dichas poblaciones del 20 y 15 por ciento respectivamente. Las CB más frecuentemente halladas en la serie total, fueron las estenosis (9 por ciento) y las bilirragias (5 por ciento). La hepático-yeyuno anastomosis tuvo 23,8 por ciento de CB, mientras que la colédoco-colédoco lo tuvo en un 12,3 por ciento. 10 de los 11 pacientes que presentaron trombosis de la arteria hepática presentaron CB. Se practicó tratamiento inicial quirúrgico en un 21 por ciento, percutáneo en un 52 por ciento, endoscópico en un 23 por ciento y tratamiento médico en sólo un 4 por ciento de los pacientes. La mortalidad atribuida a las CB fue sólo un 1,9 por ciento. Conclusiones: 1. Las CB son causa frecuente de morbilidad en el trasplante hepático. 2. Las trombosis de la arteria hepática se asocian a una mayor incidencia de CB, por lo que debe plantearse su diagnóstico frente a la aparición de una CB. 3. Los procedimientos percutáneos y endoscópicos son eficaces como único tratamiento en una importante proporción de los pacientes optimizando el estado general y local de los pacientes que requirieron tratamiento quirúrgico ulterior...(AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Adult , Middle Aged , Aged , Liver Transplantation/adverse effects , Postoperative Complications/surgery , Retrospective Studies , Cholangitis/etiology , Cholangitis/therapy , Biliary Fistula/etiology , Biliary Fistula/therapy , Cholestasis/etiology , Cholestasis/therapy , Biliary Tract Surgical Procedures , Thrombosis/complications , Hepatic Artery/pathology , Postoperative Complications/classification , Postoperative Complications/diagnosis , Postoperative Complications/therapySubject(s)
Humans , Male , Female , Duodenal Obstruction/surgery , Duodenal Obstruction/diagnosis , Intestinal Obstruction/surgery , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Acute Disease , Hernia, Inguinal/surgery , Hernia, Inguinal/complications , Hernia, Umbilical/surgery , Hernia, Umbilical/complications , Hernia, Umbilical/diagnosis , Mesenteric Vascular Occlusion , Mesenteric Arteries , Pancreatitis/surgery , Pancreatitis/diagnosis , Peritonitis/diagnosis , Peritonitis/etiology , Peptic Ulcer/surgery , Peptic Ulcer/complications , Peptic Ulcer/diagnosis , Abdominal Injuries/surgery , Abdominal Injuries/diagnosis , Thoracic Injuries/surgery , Splenic Rupture/surgery , Splenic Rupture/diagnosis , Appendicitis/surgery , Appendicitis/classification , Appendicitis/diagnosis , Cholangitis/surgery , Cholangitis/etiology , Cholangitis/diagnosis , Cholangitis/therapy , Gastrointestinal Hemorrhage/surgeryABSTRACT
Ascariasis is the most common intestinal helminthiasis worldwide. Heavily infected individuals are prone to develop bowel obstruction or perforation as well as biliary disease. Nevertheless, the presence of roundworms in the biliary tree outside endemic areas is very uncommon. The migration of these worms to the biliary system can cause biliary colic, pancreatitis, or even acute suppurative cholangitis with hepatic abscesses and septicemia. We report here on 2 infants with 14 and 15 months and a 9-year-old boy who suffered from massive biliary ascariasis and who presented with acute suppurative cholangitis. All cases were successfully treated by endoscopic retrograde cholangiopancreatography with worm extraction and adjuvant medical therapy. Physicians should be aware of ascariasis in patients with pancreatobiliary symptoms who have traveled to endemic areas or in immigrants from these areas.