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Query: UMLS:C0008325 (cholecystitis)
 3,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The management of patients with acute calculous cholecystitis has changed during recent years. The etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients younger than 70-80 years of age, but a high mortality has been reported in octogenerians. Selective intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis. Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by introduction of a catheter in the cystic duct is feasible but data are still scarce.
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PMID:Acute calculous cholecystitis. What is new in diagnosis and therapy? 129 90

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop hepatic dysfunction. Although hepatic injury may indirectly result from malnutrition, hypotension, administered medications, sepsis, or other conditions, the hepatic injury is frequently due to opportunistic hepatic infection, directly related to AIDS. Infection with Mycobacterium avium intracellulare typically occurs in patients with advanced immunocompromise and with systemic symptoms due to widely disseminated infection. In contrast, hepatic tuberculosis often occurs with less advanced immunocompromise. Cytomegaloviral infection may produce a hepatitis. Cytomegaloviral and cryptosporidial infections have been implicated as causes of acalculous cholecystitis and of a secondary sclerosing cholangitis. About 10-20% of patients with AIDS have chronic hepatitis B infection. These patients tend to develop minimal hepatic inflammation and necrosis. The clinical findings in patients with hepatic cryptococcal infection are usually due to concomitant extrahepatic infection. Hepatic histoplasmosis usually develops as part of a widely disseminated infection with systemic symptoms. Hepatic involvement by Kaposi's sarcoma is rarely documented ante mortem because an unguided liver biopsy is an insensitive diagnostic procedure. Patients with non-Hodgkin's lymphoma of the liver typically have lymphadenopathy, hepatomegaly, and systemic symptoms. As a pragmatic approach, patients with liver dysfunction and HIV-related disease should have a sonographic or computerized tomographic examination of the liver. Patients with dilated bile ducts should undergo endoscopic retrograde cholangiopancreatography because opportunistic infection may produce biliary obstruction. Patients with a focal hepatic lesion should be considered for a guided liver biopsy. Patients with a significantly elevated serum alkaline phosphatase level should be considered for a percutaneous liver biopsy. When performed for these indications, liver biopsy will demonstrate a significant disease involving the liver in about 50% of patients with AIDS and in about 25% of patients who are HIV seropositive but who are not known to have AIDS. The clinical impact of a diagnostic biopsy is blunted by a lack of efficacious therapy for many opportunistic infections.
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PMID:Hepatobiliary manifestations of the acquired immune deficiency syndrome. 198 33

Biliary complications have recently been reported in patients with AIDS. This may take the form of acalculous cholecystitis or more commonly cholangitis, which may or may not be associated with stenosis of the papilla. These conditions must be sought in patients presenting with right hypochondrial pain and elevated alkaline phosphatase. Infection with Cryptosporidium or cytomegalovirus is often associated.
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PMID:[Biliary diseases in acquired immunodeficiency syndrome. Apropos of 2 cases]. 219 80

Of 60 patients who were suffering from bacterial infections, 30 were treated with mezlocillin and 30 with carbenicillin in a randomized study. The patients received the recommended daily doses of 16 g and 30 g, respectively. Clinical efficacy was found in all patients. Mezlocillin eliminated the strains more reliably than carbenicillin. The bacteriological success rate was 27/30 and 16/30, respectively. We should also take into account the fact that the six patients with cholecystitis who were treated with carbenicillin could not be controlled after treatment.
Infection 1982
PMID:[Comparison of effect and tolerance of mezlocillin with carbenicillin in the treatment of bacterial infections]. 621 99

Diseases of the biliary tract are common problems, frequently encountered in clinical practice. Infection is a major cause of mortality in patients with extrahepatic obstruction, especially in the elderly patient. Survival in patients with biliary tract stones, complicating cholecystitis and ascending cholangitis or abscess formation depends on timing of surgery with decompression of the biliary tract, attention to fluid and electrolyte management and on prompt institution of antibiotics. The initial choice of antibiotics should be based on the organisms most frequently encountered in biliary tract sepsis, especially E. coli, enterococci, klebsiella, pseudomonas, clostridia and ps. aeruginosa. Serum levels as well as the concentration of the antibiotic in the bile are important factors determining efficacy. Cefoperazon (Cefobis), a new cephalosporin with a spectrum of antimicrobial activity that differs from some previously marketed cephalosporins, in that it is effective also against ps. aeruginosa, achieves high biliary concentrations. A clinical study is presented which proves this new antibiotic to be a safe drug and the cephalosporin of choice to treat biliary tract infections.
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PMID:[Acute and chronic biliary tract infections. Studies of the therapeutic effect of a new broad-spectrum cephalosporin]. 661 4

Three cases of acute gangrenous acalculous cholecystitis, revealed by a postoperative septic shock, are reported. Clinical examination was negative and the surgery gave the diagnosis. Infection with biliary stasis and ischaemia accounts for this pathological entity. The very serious prognosis of this condition can only be reversed by cholecystectomy.
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PMID:[Acute gangrenous acalculous cholecystitis disclosed by postoperative septic shock]. 662 37

Campylobacter jejuni (previously called "related vibrio") has recently become recognized as an important cause of acute diarrhoeal disease in many countries. As with other intestinal pathogens, the clinical picture of C. jejuni infection varies from symptomless excretion to severe disease. The incubation period averages two to five days. Fever, abdominal pain and bloody diarrhoea are the usual symptoms of campylobacter enteritis. Although it is normally a self-limiting disease, complications such as cholecystitis, peritonitis, septicaemia and meningitis occasionally arise. The small intestine is thought to be the main site of infection, but the colon is also regularly involved. The disease might be more accurately described as an enterocolitis. Campylobacters, like salmonellae and yersiniae, are thought to be pathogenic by virtue of their invasive ability. Chemotherapy is usually effective. Erythromycin is commonly used for patients ill enough to require specific treatment. Although the infection can be transmitted from person to person, it is mainly a zoonosis with many possible routes of infection. Poultry is a potential source of infection, dogs may also transmit the disease and there have been major outbreaks of campylobacter enteritis from the consumption of untreated or inadequately treated milk and water. Further epidemiological work is hampered by the lack of suitable typing techniques.
Infection 1982
PMID:Campylobacter Enteritis. 710 20

Today, hepatic and biliary surgery includes conventional biliary surgery, laparoscopic surgery, interventional radiology, endoscopy and hepatic resection surgery. In conventional biliary surgery, the benefit of antibiotic prophylaxis has been demonstrated. Among the risk factors, some are specific (age > 65 years, gallstones in the common bile duct with or without jaundice, history of acute cholecystitis or of biliary surgery) and the others are non specific such as the CDC new index risk (for scoring from 0 to 3, wound infection rates are respectively 1.36, 2.01, 7.11, 11.54%). The targets for antibiotics used in conventional biliary surgery are E. coli, Klebsiella and Streptococcus. In biliary laparoscopic surgery, the rate of infectious complications and results of antibiotic prophylaxis have not been assessed. However, in laparoscopic surgery, the use of an antibiotic prophylaxis similar to that employed in conventional biliary surgery seems logical. In interventional radiology and endoscopy, the modalities and the benefit of antibiotic prophylaxis have not yet been assessed. Infections (angio-cholecystitis) secondary to these procedures are frequent and severe. They are due to multiresistant hospital microorganisms. Antibiotic prophylaxis regimens for hepatic resections have not yet been assessed and are the same as for conventional biliary surgery.
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PMID:[Antibiotic prophylaxis in hepatobiliary surgery]. 777

Human immunodeficiency virus (HIV) affects all organ systems. Infection of the heart can manifest with evidence of myocarditis, pericarditis, or cardiomyopathy. The most common gastrointestinal symptom is diarrhea, which can result from infection with a variety of bacterial, fungal, or protozoal organisms. In about 15% of cases, no pathogen is recognized and the diarrhea syndrome is termed AIDS enteropathy. Any portion of the alimentary tract can be affected as well as the liver, gallbladder, and pancreas. Cryptosporidium, a previously infrequent cause of human illness, has emerged as an important pathogen in the HIV-infected patient and is responsible for chronic diarrhea, cholecystitis, and biliary tract obstruction. Evidence of neurologic involvement is present in more than 80% of patients at the time of autopsy. Cryptococcal meningitis, toxoplasma encephalitis, and neurosyphilis are the most often encountered central nervous system infections. While all three are responsive to therapy, treatment must be prolonged or persist for the duration of the patient's life to avoid recurrence. Peripheral nervous system manifestations include myelopathy, myopathy, and a variety of peripheral neuropathies. Retinal infection with cytomegalovirus (CMV) and toxoplasma can lead to irreversible loss of vision. Cotton wool spots are a common benign physical finding that must be differentiated from the early signs of CMV or toxoplasma infection. Management of the HIV-infected patient, while most often conducted by specialists in Internal Medicine or Infectious Diseases, is often an issue for the emergency physician. Many of the commonly afforded therapies are reviewed. Part 1 of this two-part series discussed the pathophysiology and clinical expression, epidemiology, laboratory testing, and the general clinical manifestations of AIDS, as well as dermatologic, pulmonary, and cardiac symptoms. Part 2 discusses the gastrointestinal, neurologic, and ocular symptoms, as well as the treatment and management of the AIDS patient.
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PMID:The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2. 796 96

Thirty-two patients with severe biliary tract infections (cholecystitis and cholangitis) were treated with ciprofloxacin intravenously followed by oral ciprofloxacin. Complete clinical and bacteriological cure has been observed in 28 out of 32 patients and therapy failure occurred in four patients. Overall, no major adverse effects were encountered. These data suggest that intravenous ciprofloxacin followed by oral administration is an effective and safe agent for the therapy of severe biliary tract infections.
Infection
PMID:Biliary tract infections treated with ciprofloxacin. 822 35


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