Management of acute cholecystitis and acute cholangitis in emergency setting

Abstract

<jats:title>Abstract</jats:title><jats:p>Acute biliary infection (acute cholecystitis and acute cholangitis) is one of the common emergency conditions which carries significant morbidity and mortality. The risk factors are often associated with gallstones, biliary stasis and bile infection. Gram-negative bacteria are frequent isolates from bile and blood cultures in infectious cholangitis. Endotoxaemia from the gram-negative microbes results in circulatory shock and organ dysfunction. Therefore, prompt diagnosis with severity stratification and recognition of its potential rapid progression to life-threatening shock and multi-organ failure ensure execution of the three fundamental interventions in the initial management strategy, namely: resuscitation to support the organ, antimicrobial therapy and biliary decompression drainage to control the infection. This is the core principle in the management of severe acute cholangitis.</jats:p>

Usefulness of the Delta Neutrophil Index as a Promising Prognostic Marker of Acute Cholangitis in Emergency Departments

“…Acute cholangitis is an acute condition that manifests as biliary tract inflammation and infection, leading to significant morbidity and mortality (1)(2)(3). This condition is characterized by fever, abdominal pain, and jaundice (Charcot triad), as well as confusion and septic shock (Reynolds pentad) (1,3).…”

“…This condition is characterized by fever, abdominal pain, and jaundice (Charcot triad), as well as confusion and septic shock (Reynolds pentad) (1,3). Common aetiologies of acute cholangitis include choledocholithiasis, biliary stricture, hepatolithiasis, hepatobiliary tract and pancreatic malignancy, endobiliary stent occlusion, or biliary parasites (2). Although the reported mortality rate for acute cholangitis was approximately 50% in the 1970s, this rate decreased rapidly to <7% by the 1980s, following specific advances in endoscopic drainage and appropriate antibiotic therapy (4).…”

Acute Cholangitis: An Update in Management Based on Severity Assessment

“…Acute cholangitis is an acute tract. 1,2 Clinical presentation of AC ranges from mild symptoms to severe life-threatening with septic shock conducting rapidly to death. 2 described the Charcot's triad -a clinical pattern with intermittent fever accompanied by chills and rigor, right upper abdominal pain and jaundice.…”

“…They called it Reynold's pentad with the underlying pathology of acute obstructive cholangitis. [1][2][3][4] Longmire described these two conditions as acute suppurative cholangitis and acute obstructive suppurative cholangitis. They are associated with increased morbidity and mortality.…”

“…They are associated with increased morbidity and mortality. 1 The most common cause of acute cholangitis is common bile duct stone (choledocholithiasis). 2 Other causes of AC are malignancy, benign strictures, and interventions to the biliary ducts that cause biliary obstruction.…”