Cholangitis natural history, complications and 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) as well as evidence of acute cholangitis (fever accompanied by chills and shivering, jaundice, and abdominal pain), and 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 outcome is usually good with treatment, but poor without it.
Natural History
Primary sclerosing cholangitis (PSC) is a rare chronic cholestatic liver disease often associated with inflammatory bowel disease (IBD). It is characterized by classic findings of multiple segmental strictures in the intra-heptic and extra-heptic bile ducts that are secondary to inflammation and obliterative fibrosis. IBD is found in 65-90% of PSC cases. Natural history endpoints include liver transplant, cholangiocarcinoma, and death.[1]
Complications
Complications related to cholangitis include:[2][3]
- 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.[3]
Prognosis
Acute cholangitis is reported to have 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). Curren improvements in diagnosis and treatment have led to a reduction in mortality. Before 1980, the mortality rate was greater than 50%, but in the past thirty years, it has decreased to 10-30%. Such differences in mortality are probably attributable to differences in early diagnosis and improved 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.[2][3]
References
- ↑ Toy E, Balasubramanian S, Selmi C, Li CS, Bowlus CL (2011). "The prevalence, incidence and natural history of primary sclerosing cholangitis in an ethnically diverse population". BMC Gastroenterol. 11: 83. doi:10.1186/1471-230X-11-83. PMC 3160402. PMID 21767410.
- ↑ 2.0 2.1 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.
- ↑ 3.0 3.1 3.2 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.