Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines

Abstract

This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.

Descriptive review of acute cholecystitis: Japan‐Taiwan collaborative epidemiological study

“…Our results were similar to these figures. The pathology of AC is determined by the obstruction of the cystic duct by gallbladder stones and the duration of this obstruction, and if the patient does not receive early treatment, the disease becomes more serious and complications occur [38]. Ambe et al mentioned that worsening preoperative severity grade correlated significantly with worsening pathology [39].…”

A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

“…[20][21][22] The 2008 update of the SIGN recommendations for antibiotic prophylaxis stated that it is considered good practice to give prophylactic antibiotics to high risk patients undergoing LC. 23 However, this was based on the clinical experience of the guidelines development group rather than evidence from the literature.…”

Akutno vnetje žolčnika – zgodnja operacija ali poskus konzervativnega zdravljenja?

“…6. trombocitopenija (< 100.000/mm3). strokoVni čLanek akutnim holecistitisom povišane vnetne kazalce (levkocitoza, povišan C-reaktivni protein, CRP), medtem ko so pri bolnikih z napadom biliarnih kolik vnetni kazalci praviloma v mejah normalnih vrednosti (3,4,16). Od slikovnih preiskav pride v prvi vrsti v poštev ultrazvočni pregled (UZ) trebuha.…”

“…Dejavniki, ki so povezani z nastankom žolčnih kamnov, so debelost, starost in določena zdravila, predvsem peroralna kontracepcijska sredstva (4). Akutno vnetje žolčnika je diagnostični problem pri sladkornih bolnikih in pri imunsko oslabljenih bolnikih zaradi zabrisane klinične slike ter tudi pri noseč-nicah.…”