Cholangitis natural history, complications and prognosis: Difference between revisions
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==Natural History== | ==Natural History== | ||
Acute cholangitis is the result of a bacterial infection that causes partial or complete obstruction of the [[biliary system]]. Patients with the disease present with a wide range of severity, from low-grade [[fever]] to severe [[sepsis]]. Patients usually present with Charcot's triad which is fever, abdominal pain and jaundice. Shock with [[pus]] within the biliary tree is indicative of acute suppurative cholangitis. Patients present with Reynold's pentad that comprises sepsis and mental confusion in addition.<ref name="book123">{{Citation | Acute cholangitis is the result of a bacterial infection that causes partial or complete obstruction of the [[biliary system]]. Patients with the disease present with a wide range of severity, from low-grade [[fever]] to severe [[sepsis]]. Patients usually present with Charcot's triad which is [[fever]], [[abdominal pain and jaundice]]. Shock with [[pus]] within the biliary tree is indicative of acute suppurative cholangitis. Patients present with Reynold's pentad that comprises [[sepsis]] and [[mental confusion]] in addition.<ref name="book123">{{Citation | ||
| last1 = Liu | | last1 = Liu | ||
| first1 = CL | | first1 = CL | ||
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*[[Pancreatitis]] | *[[Pancreatitis]] | ||
The risk of complications increased in subsequent years after gallbladder stones were first discovered, but have been decreasing since. Every year, 6-8% of patients whose symptoms progress from minor to serious undergo [[cholecystectomy]]. Fortunately, this percentage has been decreasing yearly.<ref name="pmid17252293">{{cite journal |vauthors=Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR |title=Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines |journal=J Hepatobiliary Pancreat Surg |volume=14 |issue=1 |pages=15–26 |year=2007 |pmid=17252293 |pmc=2784509 |doi=10.1007/s00534-006-1152-y |url=}}</ref> | The risk of complications increased in subsequent years after [[Gall stones|gallbladder stones]] were first discovered, but have been decreasing since. Every year, 6-8% of patients whose symptoms progress from minor to serious undergo [[cholecystectomy]]. Fortunately, this percentage has been decreasing yearly.<ref name="pmid17252293">{{cite journal |vauthors=Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR |title=Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines |journal=J Hepatobiliary Pancreat Surg |volume=14 |issue=1 |pages=15–26 |year=2007 |pmid=17252293 |pmc=2784509 |doi=10.1007/s00534-006-1152-y |url=}}</ref> | ||
==Prognosis== | ==Prognosis== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]
Overview
Patients who show early signs of multiple organ failure (renal failure, disseminated intravascular coagulation, alterations in the level of consciousness, and shock) or evidence of acute cholangitis, as well as those who do not respond to conservative treatment, should receive systemic antibiotics and undergo emergent biliary drainage. Unless early and appropriate biliary drainage is performed and systemic antibiotics are administered, death will occur. The prognosis is usually good with treatment but poor without treatment.
Natural History
Acute cholangitis is the result of a bacterial infection that causes partial or complete obstruction of the biliary system. Patients with the disease present with a wide range of severity, from low-grade fever to severe sepsis. Patients usually present with Charcot's triad which is fever, abdominal pain and jaundice. Shock with pus within the biliary tree is indicative of acute suppurative cholangitis. Patients present with Reynold's pentad that comprises sepsis and mental confusion in addition.[1] A history of biliary disease, such as gallstones, previous biliary procedures, or the placement of a biliary stent are factors that are very helpful in understanding the natural history of cholangitis.[2]
Complications
Complications related to cholangitis include:[3][4]
- Renal failure
- Respiratory failure
- The inability of the respiratory system to oxygenate blood and/or eliminate carbon dioxide
- Cardiac arrhythmia
- Wound infection
- Pneumonia
- Gastrointestinal bleeding
- Myocardial ischemia
- Acute cholecystitis
- Clinical jaundice
- Pancreatitis
The risk of complications increased in subsequent years after gallbladder stones were first discovered, but have been decreasing since. Every year, 6-8% of patients whose symptoms progress from minor to serious undergo cholecystectomy. Fortunately, this percentage has been decreasing yearly.[4]
Prognosis
Acute cholangitis bears a significant risk of death, with the leading cause being irreversible shock with multiple organ failure (which could have multiple possible complications of severe infections). Modern improvements in diagnosis and treatment have led to a reduction in mortality. Before 1980, the mortality rate was greater than 50%; in the past thirty years, it has decreased to 10-30%. These differences in mortality can likely be attributed to improvements in early diagnosis and supportive treatment. Patients with signs of multiple organ failure are likely to die unless they undergo early biliary drainage and treatment with systemic antibiotics. Other causes of death following severe cholangitis include heart failure and pneumonia.[3][4]
References
- ↑ Liu, CL & Fan, ST (2001), Surgical Treatment: Evidence-Based and Problem-Oriented (24 ed.), Munich, Germany: Zuckschwerdt
- ↑ Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, Nagino M, Tsuyuguchi T, Mayumi T, Yoshida M, Strasberg SM, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Gouma DJ, Fan ST, Chen MF, Padbury RT, Bornman PC, Kim SW, Liau KH, Belli G, Dervenis C (2007). "Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 27–34. doi:10.1007/s00534-006-1153-x. PMC 2784508. PMID 17252294.
- ↑ 3.0 3.1 Lai EC, Tam PC, Paterson IA, Ng MM, Fan ST, Choi TK, Wong J (1990). "Emergency surgery for severe acute cholangitis. The high-risk patients". Ann. Surg. 211 (1): 55–9. PMC 1357893. PMID 2294844.
- ↑ 4.0 4.1 4.2 Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR (2007). "Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 15–26. doi:10.1007/s00534-006-1152-y. PMC 2784509. PMID 17252293.