Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The records of all patients undergoing hepatobiliary imaging at our hospital from January 1980 to March 1983 were reviewed and 29 scans met the criteria for a pattern consistent with complete biliary tract obstruction. Biliary tract obstruction (due to choledocholithiasis, primary or secondary carcinoma involving the common bile duct, and pancreatitis) was documented in 24 of these patients. However, the remaining five patients had a patent common bile duct, and the etiologic factor was intrahepatic cholestasis secondary to sepsis in four and peritonitis in one. A classification of altered biliary dynamics in hepatobiliary imaging, which is based on the classification of jaundice, is proposed.
 ...
PMID:Etiology of the obstructive pattern in hepatobiliary imaging. 653 82

The results of autopsy carried out in 14 patients who died after undergoing papillotomy show that apart from non-method-related sepsis (4 cases) developing from a cholangitis in underlying choledocholithiasis, haemorrhage from the papillotomy wound is the most dangerous complication of this intervention. In one case the cause of bleeding was the severance of the retroduodenal artery, while in 3 cases bleeding occurred after a repapillotomy. In these patients the source of bleeding was a highly vascular granulation tissue in the early healing phase after the first papillotomy. In view of this danger, the primary papillotomy should as far as possible be a complete one, or else, no repapillotomy should be performed in the proliferation phase of wound healing.
 ...
PMID:[Causes of death following endoscopic papillotomy]. 713 28

The features of cholangitis were analyzed in 99 consecutive cases treated in the last ten years. The disease was severe and refractory in half the cases due to malignant stricture, and in 20% of those due to gallstones. Benign strictures, sclerosing cholangitis, and most cases of choledocholithiasis were associated with less severe cholangitis, which responded promptly to antibiotic therapy. High fever, a serum bilirubin level above 4 mg/dl, and hypotension characterized the most severe refractory cases in which emergency surgery was mandatory. Patients without manifestations were nearly always controlled successfully with antibiotics. We conclude that the term "suppurative cholangitis" is an unsatisfactory synonym for severe cholangitis, because the correlation between biliary suppuration and clinical manifestations in cholangitis is inexact; some patients with severe sepsis do not have pus in the bile duct, and a few patients with suppurative bile are only moderately ill.
 ...
PMID:Acute cholangitis. 736 92

The main complications of endoscopic retrograde cholangiography and sphincterotomy are bleeding, pancreatitis, perforation and sepsis. Two cases of unexplained prolonged cholestatic jaundice in patients who underwent endoscopic retrograde cholangiography (ERC) for biliary obstruction due to choledocholithiasis are reported. The patients were admitted because of right upper quadrant pain, vomiting and jaundice. Laboratory tests showed increased levels of total and conjugated serum bilirubin and increased alkaline phosphatase. Ultrasound examination showed cholelithiasis and choledocholithiasis with bile duct dilatation. ERC with sphincterotomy was performed and gallstones obstructing the common bile duct were removed endoscopically. Following ERC and despite complete patency of the biliary tree, a progressive increase of total and conjugated bilirubin and of alkaline phosphatase was noted, associated with itching and total stool discoloration. The insertion of nasobiliary drain did not improve the jaundice. Prednisolone treatment for 12 days was associated with progressive restoration of serum bilirubin alkaline phosphatase to normal levels. It was postulated that the radiocontrast material used may have acted toxically on the liver with disruption of the canalicular plasma membrane. It is proposed that intrahepatic cholestasis should be added in the list of complications of endoscopic retrograde cholangiography.
 ...
PMID:Prolonged cholestatic jaundice after endoscopic retrograde cholangiography. 922 70

We describe a case of Ofuji's papuloerythroderma (PE) in a 72-year-old man with biliary sepsis induced by choledocholithiasis. The PE disappeared completely after surgery with no relapse. This aetiology for PE does not appear to have been described previously, while its resolution after treatment of the primary process supports the idea that it may be a reactive disorder of multifactorial origin.
 ...
PMID:Ofuji's papuloerythroderma following choledocholithiasis with secondary sepsis: complete resolution with surgery. 969 13

Three women and one man among 771 patients, who underwent laparotomy with diagnosis of symptomatic gallbladder disease over a period of 5 years, were found to have agenesis of the gallbladder. Preoperative ultrasonography suggested cholelithiasis in all the four patients; three patients with jaundice had choledocholithiasis in addition. The absence of gallbladder was established by meticulous operative exploration and carefully repeated ultrasonography in postoperative period. The patients having choledocholithiasis underwent choledocholithotomy, while the fourth patient had no definitive procedure. One patient expired on 17th postoperative day following biliary leak, septicemia and liver failure. Another two patients were well and symptom free, while the fourth patient remained symptomatic. Awareness of the possibility of agenesis of gallbladder may allow the surgeon to attempt confirmation of diagnosis by non-operative methods and avoid surgical exploration in specific instances.
 ...
PMID:Agenesis of gallbladder in symptomatic patients. 1155 90

Cholelithiasis, choledocholithiasis and hepatolithiasis are common biliary tract diseases. These diseases may cause severe infection and/or sepsis. In addition to surgical treatments, prompt administration of appropriate antibiotic is important to control the biliary tract infection. The purpose of this study is to illustrate the bacteriology in biliary tract disease and provide information for antibiotic choices. From Jan 1991 to Aug 2000, 1394 patients including gallbladder (GB) stones, common bile duct (CBD) stones, intrahepatic duct (IHD) stones, GB polyps and biliary malignancy were subjects for this retrospective study. The overall positive rate of bile culture is 36% in this study while it was 25%, 66%, 67% and 9% for GB stones, CBD stones, IHD stones and biliary malignancy, respectively. A significantly higher (p = 0.001) positive culture rate was found for GB stones with acute cholecystits (47%) compared with that without inflammation (17%). Similarly, the culture rate for hepatolithiasis with acute cholangitis was higher than that without cholangitis (75% vs 51%, p = 0.011). Long-term external biliary drainage in biliary malignancy increased the risk of bacterial culture rate. For gallstone diseases, the most common organisms cultured were Gram negative bacteria (74%), in which Escherichia coli (36%) and Klebsiella (15%) were most commonly found, followed by Gram positive (15%) bacteria such as Enterococcus (6%), Staphylcoccus (3%), Streptococcus (2%). Bacteroides (5%) and Clostridium (3%) were occasionally found anaerobes (9%). Polymicrobial infection was encountered in 19%, 31% and 29% for patients with GB stones, CBD stones and IHD stones, respectively; frequency of mixed aerobic and anaerobic infection was 7%, 12% and 9%. In the current study, ampicillin in combination with sulbactam and aminoglycoside is still a suggestive empirical therapy. Antibiotic treatment should be adjusted based on later bacteriological cultures and clinical condition.
 ...
PMID:Bacteriology and antimicrobial susceptibility in biliary tract disease: an audit of 10-year's experience. 1219 28

Acute cholangitis remains a life-threatening complication of biliary obstruction, particularly in the elderly with comorbid disease or when there is a delay in diagnosis and treatment. The initial management consists of fluid resuscitation, correction of coagulopathy, and administration of broad-spectrum antibiotics. The choice of antibiotics should cover both gram-negative and gram-positive organisms associated with cholangitis until the results of a blood culture are available. The timing and choice of biliary decompression varies depending on the response to antibiotic therapy, the presence of comorbid disease, and the underlying cause. Biliary sepsis resolves in most patients with conservative treatment, thus allowing time to perform more detailed non-interventional imaging (e.g., spiral computed tomography [CT], magnetic resonance cholangiopancreatography [MRCP]) to determine the underlying cause and level of biliary obstruction. Those with cholangitis who do not respond to conservative therapy will require urgent biliary decompression. In patients with choledocholithiasis, endoscopic drainage is now the treatment of choice or, if this fails, transhepatic biliary decompression is a useful alternative. Various endoscopic options are available for managing choledocholithiasis, ranging from endoscopic papillotomy (EP) and extraction of stones, to the placement of a biliary drainage system. In patients who respond to antibiotic therapy, EP with stone extraction is preferred, while in those with ongoing sepsis and multiple large stones, the placement of a stent with or without an EP is the safest option. Transhepatic biliary drainage is now reserved for failure of endoscopic drainage and for patients with suspected hilar cholangiocarcinoma or intrahepatic stones. Surgical biliary decompression is seldom required in the emergency setting, but still plays an important role in the definitive treatment of the underlying cause.
 ...
PMID:Management of cholangitis. 1471 59

The microscopic identification of bile in sections of liver provides an important diagnostic challenge for the histopathologist, particularly in differentiating the many causes of intrahepatic cholestasis from mechanical bile duct obstruction. The pathologist's chief goal in evaluating the cholestatic liver is to distinguish intrahepatic cholestasis (seen in conditions such as drug hepatotoxicity, viral hepatitis, sepsis, or mutations affecting bile transporters) from large bile duct obstruction caused by conditions such as choledocholithiasis, pancreatic carcinoma, biliary stricture, or primary sclerosing cholangitis (PSC). This distinction carries major therapeutic and prognostic significance, because surgical, endoscopic,or radiologically guided intervention is likely to be undertaken if the pathologic features point to mechanical obstruction of the bile ducts. The histologic assessment of cholestasis, in broad terms, therefore, is a morphologic approach to distinguish between medical jaundice and surgical jaundice.
 ...
PMID:Histological assessment of cholestasis. 1506 91

Although laparoscopic cholecystectomy (LC) has become the gold standard for the management of gallstone disease, the application of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis has been slower. The aim of this study is to determine the feasibility and effectiveness of LCBDE. A retrospective cohort study was conducted to compare LCBDE (n = 82) with conventional common bile duct exploration (CCBDE) (n = 75) and endoscopic sphincterotomy (EST) (n = 80) in the management of choledocholithiasis. All our LCBDEs were performed through choledochotomy with T-tube placement. The mean operative time of the LCBDE group (124 +/- 48 minutes) was not significantly longer then the CCBDE group (118 +/- 35 minutes), while the postoperative hospitalization was shorter in both the LCBDE (8 +/- 5 days) and EST (9 +/- 4 days) groups than in the CCBDE (13 +/- 6 days) group. In the LCBDE group, 14 patients (17.1%) required postoperative choledochoscopy to clear residual stones through the T-tube tract. The only mortality occurred in the CCBDE group. The morbidity rate was 3.7% (3/82) in the LCBDE group, including bile leakage in 1 case and bile peritonitis in 2 cases; 6.7% (5/75) in the CCBDE group, including atlectasis in 2 cases, sepsis in 1, and wound infection in 2. There were 2 cases of postoperative pancreatitis (2.5%; 2/80) in the EST group. The difference in the average number of sessions needed for complete clearance of choledocholithiasis in each group was statistically significant (EST, 1.46 +/- 0.67; LCBDE, 1.23 +/- 0.42; and CCBDE, 1.09 +/- 0.28; P < 0.0001). Our results suggested that EST and LCBDE tended to require more therapeutic sessions then CCBDE, although these sessions were less invasive. The benefits of LCBDE include minimal invasiveness, concurrent treatment of gallbladder stone and CBD stones in a single session, and a shorter postoperative hospital stay. However a longer learning curve is needed. Selection of the most suitable therapeutic option for individual patients by an experienced surgeon gives the most benefits to patients.
 ...
PMID:Laparoscopic common bile duct exploration with T-tube choledochotomy for the management of choledocholithiasis. 1595 33


<< Previous 1 2 3 Next >>