Cholangitis acute

Van den Hazel SJ, Speelman P, Tytgat GNJ, Dankert J, Van Leeuwen DJ Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clin Infect Dis 1994 19 279-286. 

Some surgeons use presumptive antibiotics for cases of acute cholecystitis or cholangitis and defer surgery until the patient is afebrile, in an attempt to decrease infection rates further, but this practice is controversial. 

The classical inflammation criteria such as exudation, cellulation and proliferation can only be applied to the liver with some reservations, since the emphasis in this instance is on the sinusoids, which already display maximum permeability under normal conditions. The increase in capillary permeability, required by the definition of infiammation, is really only applicable to the area of the vascularized portal fields, e.g. in purulent cholangitis. The definition of inflammation can only be applied to classic acute viral hepatitis, (s. p. 415)... 

Complications The following complications have been reported (i.) cholangitis, (2.) obstructive jaundice, (i.) intrahepatic cholelithiasis, (4.) sepsis, (J.) portal hypertension (oesophageal varices, portal vein thrombosis, chronic Budd-Chiari syndrome, etc.), (6.) thrombosis of the inferior vena cava, (7.) amyloidosis, (8.) immune complex-associated glomerulonephritis, (9.) metastases, (10.) acute on chronic liver insufficiency or acute liver failure, and (11.) bronchobiliary fistula. 

Jessen, K., A1 Mofleh, I., AI Moferreh, M. Endoscopic treatment of ascariasis causing acute obstructive cholangitis. Hepatogastroenterol. 1986 33 275-277... 

Pereira-Lima, J.C., Jacobs, R., da Silva, C.R, Coral, G.R, da Silveira, L.L., Rynkowski, C.B., Riemann, JJ . Endoscopic removal of Ascaris lumbricoides from the bihary tract as emergency treatment for acute suppurative cholangitis. Z. Gastroenterol. 2001 39 793-796... 

Acute cholangitis The acute course is initially diagnosed clinically. It is characterized by Charcot s triad (7.) sud-... 

Acute cholangitis Thickened bile-duct walls with inflammatory infiltration as well as focal ulcerations are found histologically. The portal fields are expanded by oedema and reveal pericholangiolar and intracholangiolar infiltrations from leucocytes. Ductal tortuosity reflects increased pressure in the biliary ducts. Periductular abscesses can develop during the course of cholangitis, (s. fig. 32.2)... 

As long as there is no positive bacteriological result from the bile (or blood), antibiotics are administered on empirical and plausible principles. In this case, mezlocillin or piperacillin is initially recommended, 3x2 (-4 or -5) g/day, i.v. (55) These antibiotics are effective against virtually all bacteria in acute cholangitis, since they can reach high biliary concentrations. Once the course of disease has entered a more severe stage, an additional dose of tobramycin, for example, is indicated (e.g. 3 x 80 mg/day, i.v.). A septic clinical picture requires a course of triple therapy with ureidopenicillin + aminoglycoside (see above) + metronidazole (3 x 500 mg/ day, i.v.). 

Arai, K., Kawai, K., Kohda, W., Tatsu, H., Matsui, O., Nakahama, X Dynamic CT of acute cholangitis early inhomogeneous enhancement of the liver. Amer. J. Roentgen. 2003 181 115-11 ... 

Gigot, J.F., Leese, X, Dereme, X, Coutinho, J., Castaing, D., Bismuth, H. Acute cholangitis. Multivariate analysis of risk factors. Ann. Surg. 1989 209 435-43 ... 

Gogel, H.K., Runyon, B.A., Volpicelli, N.A., Palmer, R.C Acute suppurative obstructive cholangitis due to stones treatment by urgent endoscopic sphincterotomy. Gastrointest. Endosc. 1987 33 210—213... 

Kawada, N., Takemura, S., Minamiyama, Y., Inoue, M. Pathophysiology of acute obstructive cholangitis. Hepato-Bil.-Pancr.-Surg. 1996 3 4-8... 

Urgent endoscopic drainage for acute suppurative cholangitis. Lancet 1989/1 1307-1309... 

Acute bacterial cholangitis. An analysis of clinical manifestation. Arch. Surg. 1982 117 437-441... 

UDCA The administration of UDCA offers the least risk due to its relative lack of side effects or interactions. It is the therapy of choice in all overlap syndromes with PBC or PSC features and also in cases with autoimmune cholangitis phenomenology. In view of the above-mentioned positive effects on chronic and acute viral hepatitis as well as in AIH, UDCA is both pharmacologically and clinically plausible as adjuvant therapy. 

Contraindications The following contraindications should be observed acute cholecystitis, acute cholangitis, obstruction of the cystic duct and common bile duct as well as frequent biliary colic. 

There have been several reports of fatal hepatic failure (SED-12, 132) (50), granulomatous hepatitis (SED-12, 132) (51-53), cholestatic hepatitis (SEDA-16, 71), and cholangitis ascribed to carbamazepine. Most acute hepa-totoxic reactions caused by carbamazepine are accompanied by fever, rash, eosinophilia, and other signs of hypersensitivity, although they have also occurred without rash and eosinophilia (SEDA-19, 66). 

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