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Biliary Tract Infection


Presentation

  • A cause of the development of bleeding tendency in obstructive jaundice presently observed may likely to be due to the occurrence of disseminated intravascular coagulation (DIC), i.e. hypercoagulability caused by the biliary tract infection is responsible[ncbi.nlm.nih.gov]
  • Charcot’s triad of right upper quadrant pain, fever, and jaundice is present in 70% of patients with acute bacterial cholangitis.[clinicalgate.com]
  • At present, though there are perspectives of rational conservative treat ment and though endoscopic techniques permit removing some of its complications even without laparotomy, the basic treatment method still remains, and probably shall remain for long[books.google.com]
Upper Abdominal Pain
  • Result of FA test was related to clinical findings such as fever and leucocytosis, but was not to upper abdominal pain, jaundice, liver function test abnormality and the presence of gallstones.[ncbi.nlm.nih.gov]
  • Parameters: (1) local symptoms (upper abdominal pain and tenderness, other) (2) body temperature and fever (3) erythrocyte sedimentation rate (ESR) (4) white blood cell (WBC) count (5) serum ALT (6) serum AST (7) serum conjugated bilirubin in µmol/L ([meducator3.net]
  • Ninety percent of the patients complain of upper abdominal pain and have enlarged intra- and extrahepatic bile ducts on abdominal ultrasonography.[dx.doi.org]
  • Sudden severe upper abdominal pain RUQ tenderness and guarding Low grade fever Jaundice is usually absent Complications Early Acute suppurative cholangitis Hepatic ascariasis Acute pancreatitis Late- calculi and strictures 37.[slideshare.net]
Chest Pain
  • Gallstone attacks can produce chest pain that may feel like a heart attack. If a pain is new and different than other pains the symptoms should be discussed with a physician.[patients.gi.org]
Biliary Colic
  • *Antibiotics are not required in: Biliary colic without sepsis Mild diverticulitis without sepsis and with no evidence of perforation on CT scan Acute pancreatitis unless there is co-existent cholangitis, suggested by jaundice and sepsis (see SIRS criteria[handbook.ggcmedicines.org.uk]
  • The examination of patients with biliary colic may only reveal RUQ or epigastric tenderness.[cdemcurriculum.com]
  • Since the biliary tract is an internal organ, it has no somatic nerve supply, and biliary colic due to infection and inflammation of the biliary tract is not a somatic pain.[en.wikipedia.org]
  • CHEMOTHERAPY Triclabendazole Single dose of 10 mg/kg Better absorption with fatty meal Adverse effect – biliary colic; antispasmodic to be administered concurrently Other drugs Bithionol dehydroemetine nitazoxanide 20.[slideshare.net]
  • For related pathophysiology, please see the Cholelithiasis and Cholecystitis and Biliary Colic articles.[emedicine.com]
Phenylketonuria
  • Be sure to tell your healthcare provider if you suffer from PKU, or phenylketonuria, before you start taking this medication to treat specific biliary tract infections. It comes as regular pills, chewable tablets and injections.[amoxil.net]

Workup

Haemophilus Parainfluenzae
  • Abstract Haemophilus parainfluenzae was isolated from a bile specimen of a 56-year-old patient with elevated liver enzymes and chronic cholecystitis.[ncbi.nlm.nih.gov]

Treatment

  • Both groups received comparable accompanying endoscopic antiobstructive treatment.[ncbi.nlm.nih.gov]
  • Whereas less severe cases with appropriate treatment have very good prognosis, severe cases with delayed treatment may result in grave complications such as sepsis or kidney failure Addressing issues of biliary tract obstruction in a timely manner may[dovemed.com]
  • Keep in mind that the effective treatment of biliary tract infections depends on different aspects, such as severity of your individual condition.[amoxil.net]

Prognosis

  • In severe cases of Cholangitis, endoscopic decompression may be required to drain the pus from the biliary tract The prognosis of Cholangitis depends upon the provision of timely treatment.[dovemed.com]
  • Prognosis The prognosis depends on several factors, including the following [6] : Early recognition and treatment of cholangitis Response to therapy Underlying medical conditions of the patient Mortality rate ranges from 5-10%, with a higher mortality[emedicine.com]

Etiology

  • Although a larger diameter stent is usually preferred, both stent size and type depend on the underlying etiology of the biliary stricture.[clinicalgate.com]
  • There are two other etiologies of acute cholangitis; Mirizzi syndrome and lemmel syndrome.[dx.doi.org]
  • Liver Biopsy Helpful in intrahepatic cholestasis to evaluate for various possible underlying etiologies. Treatment / Management Management of cholestatic jaundice widely depends upon underlying etiology and type of cholestasis.[ncbi.nlm.nih.gov]

Epidemiology

  • OBJECTIVES: To determine the epidemiology of bacteraemia due to biliary tract infection (BTI) and to identify independent predictors of mortality.[ncbi.nlm.nih.gov]
  • An epidemiological study of primary liver carcinomas in Pusan area with special reference to clonorchiasis. Korean J Pathol 1976;10:33–46. 34. Shin HR, Lee CU, Park HJ, Seol SY, Chung JM, Choi HC, et al.[kjronline.org]
  • Epidemiology[1] Up to 9% of patients admitted to hospital with gallstone disease have acute cholangitis[3]. Approximately 1% of patients develop cholangitis after ERCP[4].[patient.info]
  • Epidemiology, pathogenesis, and classification of cholangiocarcinoma. Available online: Bergquist A, von Seth E. Epidemiology of cholangiocarcinoma.[cco.amegroups.com]
Sex distribution
Age distribution

Pathophysiology

  • For related pathophysiology, please see the Cholelithiasis and Cholecystitis and Biliary Colic articles.[emedicine.com]

Prevention

  • Conversely, Kupffer cells and the tight junctions between hepatocytes help prevent bacteria and toxic metabolites from entering the hepatobiliary system from the portal circulation.[ncbi.nlm.nih.gov]
  • On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher.[books.google.com]
  • For most benign strictures, the authors prefer a straight stent with internal and external flaps to prevent stent migration.[clinicalgate.com]
  • […] tract obstruction in a timely manner may help an individual from developing Cholangitis Please find comprehensive information on Cholangitis regarding definition, distribution, risk factors, causes, signs & symptoms, diagnosis, complications, treatment, prevention[dovemed.com]

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