Epidemiological profile, referral routes and diagnostic accuracy of cases of acute cholangitis among individuals with obstructive jaundice admitted to a tertiary-level university hospital: a cross-sectional study

Abstract

BACKGROUND: Obstructive jaundice may lead to ominous complications and requires complex diagnostic evaluations and therapies that are not widely available. OBJECTIVE: To analyze the epidemiological profile, referral routes and diagnostic accuracy at admittance of cases of acute cholangitis among patients with obstructive jaundice treated at a referral unit. DESIGN AND SETTING: Cross-sectional study at a tertiary-level university hospital. METHODS: Patients with obstructive jaundice who were treated by means of endoscopic retrograde cholangiopancreatography, resection and/or surgical biliary drainage were evaluated. The main variables analyzed were epidemiological data, referral route, bilirubin levels and time elapsed between symptom onset and admittance and diagnosing of acute cholangitis at the referral unit. The accuracy of the clinical diagnosis of acute cholangitis was compared with a retrospective analysis on the medical records in accordance with the Tokyo criteria. RESULTS: Female patients predominated (58%), with an average age of 56 years. Acute cholangitis was detected in 9.9% of the individuals; application of the Tokyo criteria showed that the real prevalence was approximately 43%. The main referral route was direct contact (31.8%) and emergency care (29.7%); routing via official referral through the public healthcare system accounted for 17.6%, and internal referral from other specialties, 20%. The direct route with unofficial referral was the most important route for cases of neoplastic etiology (P < 0.01) and was the fastest route (P < 0.01). CONCLUSIONS: There is a deficiency in the official referral routes for patients with obstructive jaundice. The accuracy of the clinical diagnosis of acute cholangitis was poor. Wider dissemination of the Tokyo criteria is essential.

Effect of transient obstructive cholestasis on liver histology: a cross-sectional study

“…Functional recovery after decompression is not immediate in animal models, with persistent short-term hepatocytic insufficiency. [17][18][19] Steatosis and portal inflammation were significantly associated with age in the general population and did not differ between groups. This suggested that non-alcoholic fatty liver disease (NAFLD) had a greater influence on these changes than did biliary conditions.…”

“…Functional recovery after decompression is not immediate in animal models, with persistent short-term hepatocytic insufficiency. 17 , 18 , 19 …”

Relationships of hepatic histopathological findings and bile microbiological aspects with bile duct injury repair surgical outcomes: A historical cohort

“…Our findings are comparable with those of Negi et al [19] who identified liver fibrosis or cirrhosis in 92% of patients. Although most histological changes are reversible after stricture repair in experimental studies, the presence of liver cirrhosis is an important risk factor for postoperative morbidity and mortality, in addition to being a predictor of surgical repair failure [20][21][22][23][24].…”

Perceptions of transitional care services among patients with percutaneous transhepatic biliary drainage and multicentre health professionals: A qualitative study

“…Obstructive jaundice is characterized by abnormal yellow skin, mucosa and sclera, itching and dark urine. 1,2 In recent years, the incidence of these diseases has been increasing. For example, in 2020 alone, there were nearly 1.51 million new cases of pancreatic, liver and gallbladder cancer worldwide, reflecting an increasing prevalence of obstructive jaundice.…”