Development of biliary sludge in patients on intensive care unit: results of a prospective ultrasonographic study.

Murray, FE; Stinchcombe, Simon; Hawkey, C. J.

doi:10.1136/gut.33.8.1123

Cited by 50 publications

(21 citation statements)

References 9 publications

(2 reference statements)

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“…The similarities and differences of all reported non transplant patients with biliary cast syndrome underscore its multifactorial pathogenesis. It is known that sick patients, particularly abdominal surgical and neurosurgical patients, in intensive care units have been shown to develop biliary sludge frequently and rapidly [8,9] . Fasting promotes gallbladder hypocontractility due to insufficient secretion of cholecystokinin and may, in part, explain the abdominal surgical patient group preference [8,9] .…”

Section: Discussionmentioning

confidence: 99%

“…It is known that sick patients, particularly abdominal surgical and neurosurgical patients, in intensive care units have been shown to develop biliary sludge frequently and rapidly [8,9] . Fasting promotes gallbladder hypocontractility due to insufficient secretion of cholecystokinin and may, in part, explain the abdominal surgical patient group preference [8,9] . Other risk factors for sludge formation include TPN, pregnancy and acquired immunodeficiency syndrome [10,11] .…”

Section: Discussionmentioning

confidence: 99%

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Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Katsinelos

Kountouras²,

Chatzimavroudis

et al. 2008

WJG

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A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 1 5 d . S e ve n w e e k s a f t e r c h o l e c y s t e c t o my, h e presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the first time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Katsinelos

Kountouras²,

Chatzimavroudis

et al. 2008

WJG

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“…Development of such canalicular changes have been observed in septic shock patients and after long term treatment in the ICU and are associated with severe morbidity [42,43]. These histological findings can be accompanied by radiological abnormalities and biliary sludge, although ultrasonographic changes are also observed in patients without suspected biliary abnormalities [11,12]. However, as explained above, presence of CLD during critical illness is mostly suspected clinically by elevated plasma bilirubin, as liver biopsies that would be required to confirm true cholestasis are hardly ever available for this indication given the invasiveness of this procedure.…”

Section: Pathophysiological Manifestations Of the Critical Illness Asmentioning

confidence: 99%

“…Obstructive cholestasis due to acute mechanical blockage of the canalicular system or by inflammation-driven narrowing of the bile ducts can be easily and reliably diagnosed by ultrasonography, but is seldom the cause of what is referred to as "CLD" during critical illness [11,12]. In contrast, what is labeled CLD in critically ill patients is most often the result of non-obstructive intrahepatic alterations that may lead to accumulation of bilirubin and bile acids in the liver.…”

Section: Introductionmentioning

confidence: 99%

Cholestatic liver (dys)function during sepsis and other critical illnesses

et al. 2015

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Abstract:Objective: In ICU patients, abnormal liver tests are common. Markers of cholestasis are associated with adverse outcome. Research has focused on the possibility that mild hyperbilirubinemia, instead of indicating inadvertent cholestasis, may be adaptive and beneficial. These new insights are reviewed and integrated in the state-of-the-art knowledge on hepato-biliary alterations during sepsis and other critical illnesses.Data Sources: Relevant publications were searched in Medline with search terms bile, bile acids, cholestasis, critical illness, intensive care, sepsis, alone or in combination.

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“…These results coincide with those found by other authors. 22,24 In some patients asymptomatic with minimal laboratory abnormalities and ultrasonography or CT scan criteria of AAC, conservative treatment with antibiotics, total parenteral nutrition, gastric decompression by continuous nasogastric tube aspiration and hemodynamic stabilization, was eective in the remission of the clinical process. 10,22 Isolation of bacteria in the bile is infrequent but reports of bile cultures were sometimes positive for Enterococcus, Klebsiella, Pseudomonas, E coli, Candida, Staphylococcus and Bacteroides fragilis.…”

Section: 11mentioning

confidence: 99%

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

et al. 1997

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Acute acalculous cholecystitis (AAC) is a very serious complication which can be found in patients with multiple serious traumatic lesions (`polytrauma'). Very few patients have been reported in the literature with an acute spinal injury and associated AAC. We report seven patients with polytrauma and acute spinal cord injury who developed AAC. All had no complaint of the principal warning symptom: right upper quadrant abdominal pain. All presented with a palpable mass in this site and the laboratory results were compatible with cholestasis. The diagnosis of AAC was con®rmed both by ultrasound and CT scanning. We discuss the possible precipitating factors and the treatment. One hundred and ninety one patients were admitted to the Intensive Care Unit in our Hospital with SCI over a period of 2 years, all of these in the acute stage. AAC was diagnosed in seven patients among them. Our purpose is to call attention to this clinical condition which can complicate the outcome of patients with multiple trauma and acute spinal cord injury. To date AAC in this group of patients has been infrequently described in the available literature.

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Development of biliary sludge in patients on intensive care unit: results of a prospective ultrasonographic study.

Abstract: Biliary sludge may be a precursor of gall stones in man.

Cited by 50 publications

References 9 publications

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history

Cholestatic liver (dys)function during sepsis and other critical illnesses

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury

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