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Query: UMLS:C0008370 (cholestasis)
 9,378 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute cholecystitis due to Campylobacter fetus subsp. fetus is very uncommon. We report a case of cholecystitis and obstructive jaundice in which cultured bile grew this organism. The patient had a 4-year history of hepatocellular carcinoma, resulting in common bile duct obstruction due to abdominal lymph node metastasis. Microscopic examination of her bile showed multiple Gram-negative curved organisms and C. fetus subsp. fetus was isolated under microaerophilic conditions. Therefore, we should be aware of this organism and use microaerophilic culture in association with the result of microscopic examination of bile specimens.
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PMID:Campylobacter fetus subsp. fetus cholecystitis in a patient with advanced hepatocellular carcinoma. 918 60

A 73-year-old man was admitted to the hospital because of recurrent fever and intermittent cholestasis. A cholecystectomy with hepatico-duodenostomy was performed ten years ago because of acute cholecystitis and impacted bile duct stones. Recurrent episodes of cholangitis occurred postoperatively and ERCP showed shrinkage of the hepatico-duodenal anastomosis with sump syndrome and recurrent bile duct stones. Endoscopic sphincterotomy for the improvement of bile flow was considered too dangerous at this time-point because of unfavourable intraduodenal position of the papilla Vateri. The patient refused reoperation. During the present hospitalization, endoscopic sphincterotomy and gallstone removal were performed. Within hours after intervention, necrotizing pancreatitis developed which could be managed without operation. No further episodes of cholangitis reoccurred after discharge from hospital. This case report demonstrates the risks of bile duct surgery and endoscopic sphincterotomy.
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PMID:[A patient with choledocholithiasis--no therapy without risk]. 978 80

Initial therapy of acute cholecystitis and cholangitis is directed towards general support of the patient, including fluid and electrolyte replacement, correction of metabolic imbalances and antibacterial therapy. Factors affecting the efficacy of antibacterial therapy include the activity of the agent against the common biliary tract pathogens and pharmacokinetic properties such as tissue distribution and the ratio of concentration in both bile and serum to the minimum inhibitory concentration for the expected micro-organism. Antimicrobial therapy is usually empirical. Initial therapy should cover the Enterobacteriaceae, in particular Escherichia coli. Activity against enterococci is not required since their pathogenicity in biliary tract infections remains unclear. Coverage of anaerobes, in particular Bacteroides spp., is warranted in patients with previous bile duct-bowel anastomosis, in the elderly and in patients in serious clinical condition. In patients with acute cholecystitis or cholangitis of moderate clinical severity, monotherapy with a ureidopenicillin--mezlocillin or piperacillin--is at least as effective as the combination of ampicillin plus aminoglycoside. In severely ill patients with septicaemia, an antibacterial combination is preferable. Therapy with aminoglycosides, mostly for Pseudomonas aeruginosa-related infections, should not exceed a few days because the risk of nephrotoxicity seems to be increased during cholestasis. Relief of biliary obstruction is mandatory, even if there is clinical improvement with conservative therapy, because cholangitis is most likely to recur with continued obstruction. Emergency invasive therapy is reserved for patients who fail to show a clinical response to antibacterial therapy within the first 36 to 48 hours or for those who deteriorate after an initial clinical improvement. Immediate surgery is indicated for gangrenous cholecystitis and perforation with peritonitis. Long-term administration of antibacterials is required for recurrent cholangitis, as seen in bile duct-bowel anastomosis. Oral cotrimoxazole (trimethoprim/sulfamethoxazole) is the preferred agent. Wound infection rates after biliary tract surgery can be significantly reduced by preoperative administration of prophylactic antibacterials. Newer generation beta-lactams have not proven to be of greater benefit than older agents such as cefuroxime or cefazolin. Antibacterial prophylaxis before endoscopic retrograde cholangiopancreatography (ERCP) should be reserved for patients with obstructive jaundice, since the risk of infectious complications seems to be strongly associated with this clinical condition. Failure to achieve full biliary drainage is the most important factor in predicting septicaemia, and prophylaxis should be prolonged until the bile duct is unobstructed. Piperacillin, cefazolin, cefuroxime, cefotaxime and ciprofloxacin are effective for this indication.
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PMID:Biliary tract infections: a guide to drug treatment. 995 53

This article will focus on common clinical applications of scintigraphy in focal hepatic lesions, acute cholecystitis, biliary dyskinesia, biliary obstruction, postoperative liver and biliary tract, and neonatal cholestasis. The utility of positron emission tomography will also be addressed.
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PMID:Radionuclide imaging of hepatic and biliary disease. 1143 71

The side effects caused by malaria prophylaxis with mefloquine (Lariam) are well known. We describe the case of a 42-year-old female Caucasian patient suffering from painless jaundice and showing elevated liver, cholestasis and inflammation laboratory findings 7 days after returning from Tanzania. Acute cholecystitis was diagnosed by ultrasound. Treatment with parenteral nutrition and antibiotic therapy did not show any beneficial effect. Excluding the possibility of infectious diseases, the elevated laboratory and ultrasound findings were normalized after the discontinuation of the malaria prophylaxis.
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PMID:[Painless jaundice after holidays in Tanzania]. 1598 54

An analysis of surgical treatment of cholelithiasis, acute cholecystitis was made which had appeared in 107 patients against the background of chronic diseases of the liver. Current diagnostic methods were used for differential diagnostics of jaundice: USI, CT, retrograde cholecystopancreatography, duodenoscopy. All the patients were operated upon against the background of hepatotropic and anti-ulcer therapy being performed. The main component of anesthesia during operation in most patients was epidural blockade which unlike multicomponent anesthesia had no negative effects on the indices of bilirubin in blood and aminotranspherase activity. Cholecystectomy, sanitation and decompression of bile ducts in patients with acute cholecystitis which appeared against the background of chronic lesion of the liver allowed to eliminate the source of portal toxemia, liquidate the mechanical source of cholestasis that, as a rule, results in liquidation of acute hepatic failure. The optimal method of differential diagnostics of jaundices was intraoperative cholangiography and choledochotomy.
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PMID:[Acute cholecystitis in combination with chronic hepatitis and cirrhosis of the liver]. 1676 50

A 7-year-old, male, castrated, Labrador Retriever with a history of pancreatitis and inflammatory bowel disease presented for vomiting and anorexia. Serum biochemistry findings were indicative of cholestasis, hepatocellular insult, and decreased hepatic function. Ultrasound examination showed sediment and gas within the gallbladder, and a diagnosis of emphysematous cholecystitis was made. Emergency gallbladder resection was performed. Cytologic examination of bile fluid collected at surgery showed a mixed population of bacteria (bactibilia) together with fungal organisms consistent with Cyniclomyces guttulatus (previously known as Saccharomycopsis guttulatus). Similar fungal organisms were seen on a fecal smear. Bacteria cultured were normal gastrointestinal flora, supporting ascending infection; the fungal organisms were interpreted as incidental. Histopathology of the gallbladder indicated active (suppurative) and chronic (lymphocytic) cholecystitis and sections of liver tissue had evidence of chronic liver disease. A positive liver culture indicated concurrent bacterial hepatitis or cholangiohepatitis. Despite supportive care, the dog continued to decline and was euthanized 30 days later. Necropsy results confirmed end stage liver disease, but an initiating cause was not found. This case highlights the role of bactibilia in the development of acute cholecystitis and the unique cytologic appearance of C guttulatus as an incidental finding in bile fluid.
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PMID:Gallbladder aspirate from a dog. 1712 57

Epstein-Barr virus (EBV) is known to be one of the causes of viral hepatitis, but its association with cholecystitis is known to be rare. Cholestasis by EBV-induced hepatitis might be a cause of acute cholecystitis in all of the recently reported cases. In contrast, we experienced the case of a 20-year-old woman who was infected with EBV and presented with acute cholecystitis without cholestasis.
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PMID:A case of acute cholecystitis without cholestasis caused by Epstein-Barr virus in a healthy young woman. 1970 Mar 58

A variety of gallbladder pathology (eg, carcinoma, acute and chronic cholecystitis, adenomyomatosis, cholestasis) has been imaged with F-18 fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography. The pericholecystic rim sign seen on conventional Tc-99m hepatobiliary scintigraphy is a marker of acute cholecystitis, possibly complicated by perforation or gangrene. A case of increased fluorodeoxyglucose uptake within the gallbladder fossa secondary to locally invasive gallbladder carcinoma reminiscent of a classic rim sign is presented.
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PMID:Pericholecystic rim sign on PET/CT secondary to locally invasive gallbladder carcinoma. 2070 52

Acute cholecystitis is most frequently concomitant with cholelithiasis, whereas acute acalculous cholecystitis is usually of an infectious aetiology. Among the aetiological factors, Epstein-Barr virus (EBV) infection is also mentioned. The case of a 17-year-old girl is described, hospitalised in the Children's Clinical Hospital, Paediatric Clinic, at the Medical University in Lublin, due to fever, upper abdomen pain lasting for a week, and nausea for several days. Based on the diagnostic - laboratory tests performed and ultrasonographic examination, acute acalculous cholecystitis was diagnosed, taking course with elevated aminotransferase activity and features of cholestasis. Serological tests confirmed an acute infection with Epstein-Barr virus. After 2 weeks of hospitalisation, the patient, receiving conservative treatment, was discharged home in good condition. A follow-up examination performed 2 weeks later did not show deviation from normal.
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PMID:Acute acalculous cholecystitis in a 17-year-old girl with Epstein-Barr virus infection. 2596 Aug 17


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