Pathogenesis and clinical features of acute cholangitis accompanied by shock

Shimada, Hiroshi; Nakagawara, Gizo; Kobayashi, Mamoru; Tsuchiya, Shuji; Kudo, Takuya; Morita, Shuhei

doi:10.1007/bf02469641

Cited by 30 publications

(26 citation statements)

References 11 publications

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“…Its clinical presentation ranges from mild forms responding to medical treatment to severe, life-threatening forms that require intensive care and urgent biliary drainage. Advances in intensive care, antibiotic treatment regimens, and biliary drainage techniques have dramatically improved the mortality rate of more than 50% prior to the 1970s [2,3] to less than 7% in the 1980s [4,5]. However, the mortality rate in severe cholangitis remains significant without appropriate management.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Acute Cholangitis

Mosler

2011

Curr Gastroenterol Rep

111

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Acute cholangitis is a potentially life-threatening systemic disease resulting from a combination of infection and obstruction of the biliary tree, secondary to different underlying etiologies. Common causes of cholangitis (eg, gallstones, benign and malignant biliary strictures) are well known. However, others (eg, immunoglobulin-G subclass-4-related sclerosing cholangitis) have been described only recently, are still under evaluation, and need to gain broader attention from clinicians. The diagnosis of acute cholangitis is based on clinical presentation and laboratory data indicating systemic infection, as well as diagnostic imaging modalities revealing signs of biliary obstruction and possibly an underlying etiology. The clinical presentation varies, and initial risk stratification is important to guide further management. Early medical therapy, including fluid resuscitation and appropriate antibiotic coverage, is of major importance in all cases, followed by a biliary drainage procedure and, if possible, definitive therapy of the underlying etiology. The type and timing of biliary drainage should be based on the severity of the clinical presentation, and the availability and feasibility of drainage techniques, such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and open surgical drainage. ERCP plays a central role in the management of biliary obstruction in patients with acute cholangitis. Endoscopic ultrasound-guided biliary drainage recently emerged as a possible alternative to PTC for second-line therapy if ERCP fails or is not possible.

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Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Acute Cholangitis

Mosler

2011

Curr Gastroenterol Rep

111

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“…Mild acute cholangitis improves with antibiotic therapy [4][5][6][7][8], but patients who do not respond to conservative treatment or those with moderate to severe cholangitis are likely to show rapid exacerbation of the condition, leading to considerably high morbidity and mortality [9,10]. This group of patients should be offered early biliary decompression along with systemic antibiotic treatment [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

et al. 2011

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“…Shimada et al (13,14) reported that sepsis induced biliary tract infection in highly complicated DIC and/or multiple organ dysfunction. Therefore, therapeutic management of DIC in these patients should be a critical issue in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of recombinant human soluble thrombomodulin in patients with sepsis and disseminated intravascular coagulation in the gastroenterology field

et al. 2015

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Abstract. Recombinant human soluble thrombomodulin (rTM) was approved recently and has been used for treatment of disseminated intravascular coagulation (DIC). The aim of the present study was to evaluate the efficacy of rTM for DIC. The data of 53 inpatients with sepsis-induced DIC were retrospectively analyzed. Patients were classified into the rTM treatment group (n=25) and conventional treatment group (rTM not used) was the control group (n=28). Diagnosis of DIC was made according to the criteria for acute DIC of the Japan Association of Acute Medicine. Platelet count, prothrombin time-international normalized ratio, levels of fibrin/fibrinogen degradation products (FDP), C-reactive protein and DIC scores were measured on days 0, 3 and 7. Furthermore, the DIC resolution rate was assessed on days 3 and 7. Prior to treatment, DIC scores were 5.0±1.0 in the rTM group and 5.9±1.3 in the control group (P<0.05). Significant intra-group improvements were observed in all the parameters, except for FDP in the two groups. Significant improvements were observed in the DIC scores in the rTM group (Δ2.0±1.9 vs. Δ1.5±1.9, P=0.001). Therefore, the results suggest that rTM would be a useful medicine for treatment of DIC in the gastroenterology field.

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Pathogenesis and clinical features of acute cholangitis accompanied by shock

Cited by 30 publications

References 11 publications

Diagnosis and Management of Acute Cholangitis

Diagnosis and Management of Acute Cholangitis

Fever-based antibiotic therapy for acute cholangitis following successful endoscopic biliary drainage

Efficacy of recombinant human soluble thrombomodulin in patients with sepsis and disseminated intravascular coagulation in the gastroenterology field

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