Obstruction of the Biliary and Urinary System

O’Connell, W.; Shah, Jay; Mitchell, Jason W.; Prologo, J. David; Martin, Louis G.; Miller, Michael J.; Martin, Jonathan G.

doi:10.1053/j.tvir.2017.10.010

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…The clinical presentation is correlated with the severity of cholangitis. Classic symptoms include high fever, abdominal pain, and jaundice which is also known as Charcot’s triad [ 4 ]. Severe and more alarming symptoms include hypotension and altered mental status is termed Reynold’s pentad [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Ascending Cholangitis Caused by Methicillin-Resistant Staphylococcus aureus Species in a Patient With Cystic Fibrosis

Obeidat¹,

Singh²,

Altarawneh³

et al. 2021

Cureus

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Ascending cholangitis is a bacterial infection of the extra-hepatic biliary system and presents as a life-threatening systemic condition. Increased bacterial loads and biliary obstruction favor bacterial translocation into the vascular and lymphatic systems. Common organisms isolated are Escherichia Coli , Klebsiella , Enterococcus species, and Enterobacter species . Methicillin-resistant Staphylococcus aureus (MRSA) is a rare isolate in ascending cholangitis. We present a case of a 24-year-old patient with cystic fibrosis who presented with epigastric abdominal pain, low-grade fever, jaundice, dark urine, and nausea for two days. Initial workup revealed elevated liver enzymes, hyperbilirubinemia, leukocytosis, and an ultrasound which showed common bile duct dilation to 14 mm with choledocholithiasis. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction and bile fluid culture. Cultures grew out MRSA and the patient was treated with appropriate antibiotic therapy. The mainstay of therapy for ascending cholangitis is adequate hydration, antibiotics, and biliary decompression. Early recognition of the offending organism is critical in guiding therapy. Current guidelines focus on the empiric treatment of Gram-negative and anaerobic bacteria. Clinicians should be aware of the possibility of less common pathogens (such as MRSA), especially in a patient who is decompensating despite antibiotic therapy.

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Section: Discussionmentioning

confidence: 99%

“…Classic symptoms include high fever, abdominal pain, and jaundice which is also known as Charcot’s triad [ 4 ]. Severe and more alarming symptoms include hypotension and altered mental status is termed Reynold’s pentad [ 4 ]. Cases of acute cholangitis can be further broken down into severity.…”

Section: Discussionmentioning

confidence: 99%

Ascending Cholangitis Caused by Methicillin-Resistant Staphylococcus aureus Species in a Patient With Cystic Fibrosis

Obeidat¹,

Singh²,

Altarawneh³

et al. 2021

Cureus

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“…Toxic substances penetrate the blood-brain barrier, causing hepatic encephalopathy to develop [ 20 ]. Cholestasis has a damaging effect on both the tubular epithelium and hepatocytes [ 21 ]. The bile components (hydrophobic bile acids, bilirubin, cholesterol) present in high concentrations in obstructive jaundice have a toxic effect on hepatocyte mitochondria, directly or indirectly blocking the respiratory cycle and fatty acid oxidation [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Oxidative Stress and Free Radical Processes in Tumor and Non-Tumor Obstructive Jaundice: Influence of Disease Duration, Severity and Surgical Treatment on Outcomes

et al. 2022

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The aim of this study was to assess the patterns and pattern disruptions of free radical processes in patients with obstructive jaundice of various origins, and the severity of jaundice before and after decompression. Oxidative stress markers were determined in 128 patients with obstructive jaundice with a tumor genesis (23.4%) or non-tumor genesis (76.6%). The patients were hospitalized at different stages of clinical signs of jaundice. We studied the anti-peroxide activity in plasma, basal and stimulated indicators of the chemiluminescence intensity in leukocytes, leukocyte activity coefficients reflecting the level of reactive oxygen species generated by leukocytes, malondialdehyde levels indicative of the degree of lipid peroxidation and cellular destruction, liver enzymes (markers of cytolysis) and bilirubin levels. Data for hepatocyte death and markers of oxidative stress correlated with the severity of jaundice, its duration and the method of its surgical correction. It is proposed that using markers of free radical processes to assess the prognosis and effectiveness of treatment and to personalize treatment measures will improve the results of jaundice treatment.

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“…Stasis to the biliary flow favors colonization and multiplication of bacteria. The associated increased intra-ductal pressure can lead to reflux of biliary contents and bacteremia that can eventually lead to septic shock and death 22 .…”

Section: Discussionmentioning

confidence: 99%

Outcome and prognostic markers of cirrhotic and non-cirrhotic patients admitted to a hepatology ICU in a tertiary care university hospital

Abdellatif¹,

Eletreby²,

Samir³

et al. 2022

Afr H. Sci.

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Background and aim: Patients with decompensated liver cirrhosis are not given priority for ICU admission in the settings of limited place availability. Recently, advances in medical care led to improvement in their survival. Our aim is to study the outcome of patients admitted to our hepatology ICU. Methods: We retrieved the data of patients admitted to the Endemic Medicine Department ICU at Kasr Al-Ainy Hospital in the period from November 2014 to May 2018. We included 498 patients who had complete clinical and outcome data in this analysis. The primary outcome was ICU mortality and its predictors. Results: The overall mortality was 48.1% in the liver cirrhosis versus 52.9% in the non-cirrhosis group. The most common presentations of cirrhotic patients were hepatic encephalopathy and hypovolemic shock. The SOFA score and sepsis independently predicted mortality in the overall cohort. Conclusion:The mortality of cirrhotic patients admitted to ICU is not higher than non-cirrhotic patients. SOFA score is a good prognostic indicator in patients with cirrhosis. Keywords: Liver cirrhosis; ICU; SOFA score; mortality.

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Obstruction of the Biliary and Urinary System

Cited by 8 publications

References 11 publications

Ascending Cholangitis Caused by Methicillin-Resistant Staphylococcus aureus Species in a Patient With Cystic Fibrosis

Ascending Cholangitis Caused by Methicillin-Resistant Staphylococcus aureus Species in a Patient With Cystic Fibrosis

Oxidative Stress and Free Radical Processes in Tumor and Non-Tumor Obstructive Jaundice: Influence of Disease Duration, Severity and Surgical Treatment on Outcomes

Outcome and prognostic markers of cirrhotic and non-cirrhotic patients admitted to a hepatology ICU in a tertiary care university hospital

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