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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diagnosis of acute cholecystitis in critically ill patients is often difficult; clinical signs are subtle, and radiologic tests are nonspecific and have a high incidence of false-positive results. This study reviews our experience with intravenous morphine sulfate as an adjunct to promote gallbladder filling in 18 critically ill patients who demonstrated nonvisualization of the gallbladder during cholescintigraphy performed as part of a diagnostic workup for occult sepsis. Findings suggestive of a biliary source included fever, leukocytosis, abdominal tenderness, abnormal liver function test results, fasting, and total parenteral nutrition. Morphine was administered to all 18 patients after nonvisualization of the gallbladder; in 17 cases prompt visualization was noted, thus excluding cystic duct obstruction. The remaining patient underwent operation for acalculous cholecystitis. None of the 17 patients whose gallbladders were visualized had a subsequent clinical course consistent with untreated biliary sepsis. Radionuclide cholescintigraphy with morphine appears to be useful in the evaluation of critically ill patients with suspected biliary sepsis. It is particularly helpful in confirming or excluding the diagnosis of acute acalculous cholecystitis in patients who are fasting or receiving total parenteral nutrition and initially demonstrate nonvisualization of the gallbladder and in patients who have previously documented gallstones.
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PMID:Use of cholescintigraphy with morphine in critically ill patients with suspected cholecystitis. 279 41

The purpose of this study was to determine the incidence of death as the initial manifestation of cholelithiasis. Records of patients who died or underwent cholecystectomy for gallstone-related disease at Duke University Medical Center between 1976 and 1985 were reviewed. Thirty patients died, six of whom (20%) had previous episodes of biliary pain and stone documentation. Twenty-four (80%) were asymptomatic (three with previous incidental diagnosis of cholelithiasis). Reason for admission included acute cholecystitis (nine), pancreatitis (eight), biliary pain (six), cholangitis (four), jaundice (one), and endocarditis (one). Three patients died of gallstone complications without surgical intervention; one patient had renal failure and two had septicemia. Other causes of death were: sepsis (seven patients), cardiac failure (six), pulmonary complications (four), renal failure (three), cerebrovascular accident (three), liver failure (two), pancreatitis (one), and gastrointestinal bleeding (one). During this period, 1731 cholecystectomies were performed without mortality. In this group, the patients were younger (50 +/- 8 years vs. 64 +/- 13 years, p less than 0.001), and had a lower incidence of cirrhosis (p less than 0.001) and diabetes (p less than 0.002). The sex ratio was inverted (p less than 0.001). This study demonstrates that death from gallstones is uncommon (three cases per year), as is death from their initial clinical manifestation (1.2%). The risk of death is two- and ninefold higher in patients with acute cholecystitis or acute pancreatitis. Age, cirrhosis, and diabetes are important determinants of outcome.
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PMID:Deaths from gallstones. Incidence and associated clinical factors. 291 58

Sepsis is a common occurrence during long term transhepatic biliary drainage. Most of these episodes are attributed to cholangitis, are relatively minor and can be managed nonoperatively. During a 42 month period, nine patients who had sepsis develop after biliary drainage were found to have acute cholecystitis, a complication not previously noted after this procedure. Seven of the nine patients had an underlying malignant lesion, and three of these patients had undergone percutaneous biliary drainage for palliation of unresectable or metastatic tumor. Eight of the nine patients underwent cholecystectomy whereas percutaneous cholecystostomy was used in one patient with an unresectable cholangiocarcinoma. Operative and pathologic evidence of acute cholecystitis was present in all, but only two patients had gallstones. Seven patients survived the surgical procedure and were discharged at an average of 11.7 days postoperatively. Based on this series, we propose that acute cholecystitis should be considered as a source of sepsis in patients undergoing biliary drainage who do not respond to antibiotics and catheter manipulations. Moreover, cholecystectomy should be performed at the time of laparotomy, if prolonged transhepatic drainage is planned for unresectable malignant conditions.
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PMID:Acute cholecystitis occurring as a complication of percutaneous transhepatic drainage. 292 10

Acute cholecystitis is a frequent complication of cholelithiasis. Patients in advanced age are more often affected than others. Early operation has been widely accepted for treatment of acute cholecystitis, as it has proved to be effective as prophylaxis against perforation, sepsis, recurrent inflammation, and long-term sequels, such as enterocolic fistulae and abscesses. It should be acceptable to everyone, provided short-time individual preparation. Patients in advanced age are likely to draw particular benefit from no-delay surgery, since soon removal of the source of inflammation as well as short-time immobilisation and hospitalisation are good prerequisites for soon, definite healing. Operations for acute cholecystitis were performed von 257 patients, between 1977 and 1987. They accounted for 8.4 per cent of 3,059 gall surgery patients during the period under review. The lethality rate associated with early operations amounted to 1.6 per cent and was thus slightly below overall gall surgery lethality of 1.9 per cent during that period.
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PMID:[Results of early operation of acute cholecystitis]. 317 32

Results of gallbladder bile aspiration and culture were correlated with presence or absence of acute cholecystitis in 36 patients to test the role of these procedures in hospitalized patients with sepsis. Diagnostic aspiration of the gallbladder was performed in 11 patients, and in the remaining patients a combination of percutaneous aspiration, percutaneous cholecystostomy, or cholecystectomy was used. Bile culture was not helpful in the prediction of acute cholecystitis, since results were not available for a minimum of 24-48 hours after aspiration. In addition, gram-stained smears and bile cultures suffered from low sensitivity (48% and 38%, respectively); consequently, a negative test does not allow the diagnosis of acute cholecystitis to be excluded. Bile aspiration of the gallbladder thus has a limited role in the diagnosis of this condition.
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PMID:Acute cholecystitis: diagnostic accuracy of percutaneous aspiration of the gallbladder. 328 37

Pylethrombosis is thrombosis of the portal vein or any of its branches. Five cases have been serendipitously detected, four by computed tomography and one by ultrasonography. Two patients had abdominal sepsis. A third patient had apparent acute cholecystitis with choledocholithiasis. The last two patients had a hypercoagulable state, mesenteric venous thrombosis, and enteric infarction that required resection. The newer diagnostic modalities of computed tomography and ultrasound may document unsuspected pylethrombosis. Surgery may be required because of signs of peritonitis, enteric ischemia, or unresolved sepsis. Anticoagulation is indicated for acute thrombosis of the portal or superior mesenteric veins to prevent further extension and enteric ischemia.
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PMID:Pylethrombosis. Serendipitous radiologic diagnosis. 331 Sep 61

Between 1979 and 1984, 21 male cirrhotic patients with advanced liver disease, cholecystitis, and jaundice were seen. Eight patients had persistent symptoms of acute cholecystitis despite intense symptoms of acute cholecystitis despite intense medical management. Of these patients, five underwent cholecystostomy and survived. The other three patients had cholecystectomy and one died. Thirteen patients presented with jaundice. Twelve patients underwent endoscopic retrograde cholangiography which revealed gallbladder stones in four but no stones in the common bile duct. They did not undergo further surgical procedures. One patient presented with jaundice, cholangitis, and pancreatitis was found to have stones in the common bile duct and underwent endoscopic sphincterotomy with removal of multiple small, pigmented stones. This patient died from sepsis and renal failure 37 days after sphincterotomy. Endoscopic retrograde cholangiography was unsuccessful in four patients who later underwent percutaneous transhepatic cholangiography which revealed stones in one and cirrhotic ductal changes in three. The remaining jaundiced patient underwent cholecystectomy and common bile duct exploration which revealed no ductal stones. This patient died 21 days after operation from sepsis and multiple organ system failure. Three of five patients with gallstones on endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography died, but none of the deaths were due to biliary tract disease. At last follow-up the two surviving patients were asymptomatic. The overall mortality rate was 14 percent (3 of 21 patients). Cholecystostomy in cirrhotic patients with advanced liver disease and acute cholecystitis is associated with minimal mortality and morbidity. Cirrhotic patients with jaundice are probably best evaluated initially by endoscopic retrograde cholangiopancreatography which is safe, diagnostic, and sometimes therapeutic.
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PMID:Therapeutic options for biliary tract disease in advanced cirrhosis. 334 96

The influence of diabetes on the risks associated with the operative treatment of acute cholecystitis has not been clearly defined. Therefore, a case-control study of 72 diabetics requiring urgent operation for acute cholecystitis was undertaken. Patients were matched for age, gender, and date of surgery with nondiabetic controls. Review of patient records revealed no significant difference in hospital stay or severity of operative and pathologic findings. However, diabetics suffered significantly more morbidity (38.9%) than nondiabetics (20.8%). Moreover, diabetic infection-related complications occurred at a rate nearly three times that of controls (19.4% vs 6.9%). The only mortalities were experienced by diabetics (4.2%) and were the direct result of the effects of sepsis. These findings suggest that acute cholecystitis in diabetics is associated with a higher incidence of infection-related complications and supports the need for expeditious operative therapy in symptomatic patients.
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PMID:Acute cholecystitis in the diabetic. A case-control study of outcome. 334 29

Microbiologic aspects of hepatobiliary tracts are reviewed. The gallbladder, the common duct and the liver are discussed separately. Special attention is paid to bacteriologic sampling technique. Factors associated with bactibilia are surveyed. The relation between biliary bacteria and stone formation is evaluated. The etiology of acute calculous and acalculous cholecystitis, cholangitis and pyogenic liver abscess is discussed from a microbiological point of view. The importance of new imaging techniques, such as ultrasound, radionuclide scanning and computerized tomography, in the diagnosis and treatment of biliary obstruction or hepatic abscess is recognized. The type of bacteria and their incidence in bile was strongly associated with the underlying condition and various host factors. The flora in acute cholecystitis closely resembled that of the small intestine, while cholangitis and hepatic abscess specimens grew species often found in the colon. In addition, 'microaerophilic streptococci' were especially abundant in hepatic abscess. Nonetheless, coliforms predominated at all loci. Depending on selection criteria of the study population, bacteria of biliary origin played varying roles in the development of postoperative sepsis. Principles of perioperative antibiotic prophylaxis and treatment of manifest infection are outlined.
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PMID:Microflora of the biliary tree and liver--clinical correlates. 354 64

Posttraumatic acute cholecystitis is an often unrecognized and potentially fatal complication seen among patients hospitalized for trauma, and differs in etiology from cholecystitis which develops de novo. The cause, although not yet clearly defined, is believed to be related to bile stasis, ischemia, bacterial infection, sepsis, the activation of factor XII, and the Shwarzman reaction. A case is described in which a 53-year-old man with pelvic fractures developed acute acalculous cholecystitis and died of multiple organ failure 3 weeks following cholecystectomy. The histopathological findings are also reported; these are most likely attributed to the Shwarzman reaction or the activation of the factor XII pathways. There has been a tendency to regard posttraumatic acute acalculous cholecystitis as induced by trauma, and calculous as mere coincidence. We believe, however, that it is not calculous but histopathological findings that determine whether acute cholecystitis following trauma was more than coincidence or just mere coincidence. Although progress in clinical care has improved the chances of survival of severely traumatized patients, posttraumatic acute cholecystitis has been increasing in frequency. We cannot be careful enough in judging the relationship of this fatal complication to the initial trauma.
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PMID:Posttraumatic acute cholecystitis. Relationship to the initial trauma. 360 14


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