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Acute cholangitis

Rodrigo Liberal, Charlotte R Grant
Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) constitute the classic autoimmune liver diseases (AILDs). While AIH target the hepatocytes, in PBC and PSC the targets of the autoimmune attack are the biliary epithelial cells. Persistent liver injury, associated with chronic AILD, leads to un-resolving inflammation, cell proliferation and the deposition of extracellular matrix proteins by hepatic stellate cells and portal myofibroblasts. Liver cirrhosis, and the resultant loss of normal liver function, inevitably ensues...
October 8, 2016: World Journal of Hepatology
Gen Tohda, Masahiro Ohtani, Masaki Dochin
AIM: To investigate the efficacy and safety of emergency endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients with acute cholangitis. METHODS: From June 2008 to May 2016, emergency ERCPs were performed in 207 cases of acute cholangitis at our institution. Patients were classified as elderly if they were aged 80 years and older (n = 102); controls were under the age of 80 years (n = 105). The patients' medical records were retrospectively reviewed for comorbidities, laboratory data, etiology of cholangitis (presence of biliary stones, biliary stricture and malignancy), details of the ERCP (therapeutic approaches, technical success rates, procedure duration), ERCP-related complications and mortality...
October 7, 2016: World Journal of Gastroenterology: WJG
Piotr Buda, Ryszard Grenda, Anna Wieteska-Klimczak, Piotr Gietka, Lidia Skobejko-Włodarska, Karina Felberg, Janusz Książyk
Eosinophilic cystitis (EC) is a rare inflammatory disorder of the urinary tract characterized by infiltration of bladder with eosinophils. The cause remains unclear, immunological mechanisms have been implicated in pathogenesis. Potential etiological factors include: tumors, allergy, parasitic infections, trauma. The disease may have a variable course, from a mild self-limiting, through common symptoms like: dysuria, hematuria, abdominal pain, tumor, to severe renal failure, with eosinophilic infiltration of the other organs and systemic complications...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Adriana Cavași, Voicu Mercea, Ofelia Anton, Ion Cosmin Puia
Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She had had two episodes of esophageal variceal bleeding, successfully treated by endoscopic banding. and an episode of acute cholangitis secondary to portal cavernoma cholangiopathy...
September 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Marta B Afonso, Pedro M Rodrigues, André L Simão, Dimitry Ofengeim, Tânia Carvalho, Joana D Amaral, Maria M Gaspar, Helena Cortez-Pinto, Rui E Castro, Junying Yuan, Cecília M P Rodrigues
Cholestasis encompasses liver injury and inflammation. Necroptosis, a necrotic cell death pathway regulated by receptor-interacting protein (RIP) 3, may mediate cell death and inflammation in the liver. We aimed to investigate the role of necroptosis in mediating deleterious processes associated with cholestatic liver disease. Hallmarks of necroptosis were evaluated in liver biopsies of primary biliary cholangitis (PBC) patients and in wild-type and RIP3-deficient (RIP3(-/-)) mice subjected to common bile duct ligation (BDL)...
2016: Cell Death & Disease
Keisuke Hata, Soichiro Ishihara, Hiroaki Nozawa, Kazushige Kawai, Tomomichi Kiyomatsu, Toshiaki Tanaka, Junko Kishikawa, Hiroyuki Anzai, Toshiaki Watanabe
Restorative proctocolectomy with ileal pouch-anal anastomosis has been the surgical treatment of choice for patients with ulcerative colitis who require surgery. The quality of life after this procedure is satisfactory in most cases; however, pouchitis is a troublesome condition involving inflammation of the ileal pouch. When a patient presents with symptoms of pouchitis, such as increased bowel movements, mucous and/or bloody exudates, abdominal cramps, and fever, endoscopy is essential for a precise diagnosis...
September 28, 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
H Grønbaek, M Kreutzfeldt, K Kazankov, N Jessen, T Sandahl, S Hamilton-Dutoit, H Vilstrup, H J Møller
BACKGROUND: Autoimmune hepatitis (AIH) is characterised by liver inflammation with reversibility upon anti-inflammatory treatment. Soluble (s)CD163, a specific macrophage activation marker, is associated with inflammation in other liver diseases, but never investigated in AIH. AIM: To investigate sCD163 in patients with acute AIH and in complete and incomplete responders to standard anti-inflammatory pharmacotherapy, and during follow-up in treatment naive patients...
November 2016: Alimentary Pharmacology & Therapeutics
Mohammad S Khuroo, Ajaz A Rather, Naira S Khuroo, Mehnaaz S Khuroo
Hepatobiliary and pancreatic ascariasis (HPA) was described as a clinical entity from Kashmir, India in 1985. HPA is caused by invasion and migration of nematode, Ascaris lumbricoides, in to the biliary tract and pancreatic duct. Patients present with biliary colic, cholangitis, cholecystitis, hepatic abscesses and acute pancreatitis. Ascarides traverse the ducts repeatedly, get trapped and die, leading to formation of hepatolithiasis. HPA is ubiquitous in endemic regions and in Kashmir, one such region, HPA is the etiological factor for 36...
September 7, 2016: World Journal of Gastroenterology: WJG
Christopher J DiMaio, Jennifer M Kolb, Petros C Benias, Hiral Shah, Shashin Shah, Oleh Haluszka, Jennifer Maranki, Kaveh Sharzehi, Eric Lam, Stuart R Gordon, Sarah M Hyder, Pavlos Z Kaimakliotis, Satya B Allaparthi, Frank G Gress, Amrita Sethi, Ashish R Shah, Jose Nieto, Vivek Kaul, Shivangi Kothari, Truptesh H Kothari, Sammy Ho, Manhal J Izzy, Neil R Sharma, Rabindra R Watson, V Raman Muthusamy, Douglas K Pleskow, Tyler M Berzin, Mandeep Sawhney, Emad Aljahdi, Marvin Ryou, Clarence K Wong, Parantap Gupta, Dennis Yang, Susana Gonzalez, Douglas G Adler
BACKGROUND AND AIMS: The ability to safely and effectively obtain sufficient tissue for pathologic evaluation by using endoscopic ultrasound (EUS) guidance remains a challenge. Novel designs in EUS needles may provide for improved ability to obtain such core biopsies. The aim of this study was to evaluate the diagnostic yield of core biopsy specimens obtained using a novel EUS needle specifically designed to obtain core biopsies. PATIENTS AND METHODS: Multicenter retrospective review of all EUS-guided fine-needle biopsies obtained using a novel biopsy needle (SharkCore FNB needle, Medtronic, Dublin, Ireland)...
September 2016: Endoscopy International Open
Keunmo Kim, Eun Bee Kim, Yong Hyeok Choi, Youngmin Oh, Joung-Ho Han, Seon Mee Park
Endoscopic closure techniques have been introduced for the repair of duodenal wall perforations that occur during endoscopic retrograde cholangiopancreatography (ERCP). We report a case of successful repair of a large duodenal wall perforation by using double endoscopic band ligation (EBL) and an endoclip. Lateral duodenal wall perforation occurred during ERCP in a 93-year-old woman with acute calculous cholangitis. We switched to a forward endoscope that had a transparent band apparatus. A 2.0-cm ovalshaped perforation was found at the lateral duodenal wall...
September 13, 2016: Clinical Endoscopy
Jay Song, Sung Bum Kim, Kook Hyun Kim, Tae Nyeun Kim, Kyung Hee Lee
BACKGROUND: Gallbladder toxicity was reported in most motesanib studies with varying frequency and at variable times after initiation of treatment. METHOD AND RESULTS: A 44-year-old man was admitted due to severe epigastric pain. The patient was diagnosed with non-small cell lung cancer 9 months ago and received 6 cycles of chemotherapy with motesanib, paclitaxel, and carboplatin. Ultrasonography showed a large amount of sludge within gallbladder. Computed tomography scan demonstrated diffuse dilatation of biliary tree with distended gallbladder without evidence of stone and mild pancreatic swelling...
September 2016: Medicine (Baltimore)
Radan Keil
UNLABELLED: Pancreatitis of biliary etiology accounts for 30-60 % of all cases of acute pancreatitis. A number of randomized studies have been completed to assess the role of acute endoscopic retrograde cholangiopancreatography (ERCP) and papilosphincterotomy in the therapy of biliary pancreatitis. Analysis of the respective studies has shown that urgent endoscopy is clearly indicated for the patients with a severe form of acute biliary pancreatitis as well as for those with an ongoing acute cholangitis or obstructive icterus...
2016: Vnitr̆ní Lékar̆ství
Mirella Fraquelli, Giovanni Casazza, Dario Conte, Agostino Colli
BACKGROUND: Cholelithiasis refers to the presence of gallstones, which are concretions that form in the biliary tract, usually in the gallbladder. Cholelithiasis is one of the most common surgical problems worldwide and is particularly prevalent in most Western countries.Biliary colic is the term used for gallbladder pain experienced by a person with gallstones and without overt infection around the gallbladder. It is the most common manifestation of cholelithiasis, observed in over one-third of people with gallstones over the course of 10 or more years...
September 9, 2016: Cochrane Database of Systematic Reviews
Masaaki Shimatani, Makoto Takaoka, Kazuichi Okazaki
We report a successful endoscopic stone extraction using a short type double-balloon endoscope (DBE) (EI-530 B; FUJIFILM Co, Tokyo, Japan) combined with long-type ultra-slim endoscope (L-USE) (EC-530XP; FUJIFILM Co, Tokyo, Japan) without using contrast media for intrahepatic stones in patient allergic to iodine with post-operation. A 43 year-old man with a history of congenital biliary dilatation who had undergone choledocojejunostomy and Roux-en Y reconstruction 37 years previously (Fig. 1-A) and posterior lateral hepatic segmentectomy and caudate lobectomy for intrahepatic stone 10 years previously was admitted for acute cholangitis caused by recurrence of intrahepatic stone and stenosis in choledochojejunal anastomosis (Fig...
September 8, 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
Pouya Iranmanesh, Olivier Tobler, Sandra De Sousa, Jean-Louis Frossard, Philippe Morel, Christian Toso
BACKGROUND AND AIMS: Initial cholecystectomy for patients at intermediate-risk of common bile duct (CBD) stone (including increased liver function tests but bilirubin <4 mg/dL and no cholangitis) showed decreased length of stay (LOS) and fewer common bile duct investigations without increased morbidity compared with sequential CBD endoscopic assessment and subsequent cholecystectomy in a randomized controlled trial. The objectives were to prospectively validate these results in daily clinical practice and discuss current guidelines...
August 24, 2016: Gastrointestinal Endoscopy
Hyunchul Kim, Taeyoung Kong, Sung Phil Chung, Jung Hwa Hong, Jong Wook Lee, Youngseon Joo, Dong Ryul Ko, Je Sung You, Incheol Park
PURPOSE: Recent technological advances have led to analyses of the delta neutrophil index (DNI), which reflects the fraction of circulating immature granulocytes, using specific automated blood cell analysers. We evaluated the significance of the DNI as a prognostic marker for early severity in patients with acute cholangitis. METHODS: We retrospectively analysed patients initially diagnosed with acute cholangitis at emergency department (ED) admission, followed by diagnostic confirmation, during a set period...
August 24, 2016: Shock
Alexander C Schwed, Monica M Boggs, Xuan-Binh D Pham, Drew M Watanabe, Michael C Bermudez, Amy H Kaji, Dennis Y Kim, David S Plurad, Darin J Saltzman, Christian de Virgilio
Importance: Acute cholangitis (AC), particularly severe AC, has historically required urgent endoscopic decompression, although the timing of decompression is controversial. We previously identified 2 admission risk factors for adverse outcomes in AC: total bilirubin level greater than 10 mg/dL and white blood cell count greater than 20 000 cells/µL. Objectives: To validate previously identified prognostic factors in AC, evaluate the effect of timing of endoscopic retrograde cholangiopancreatography on clinical outcomes, and compare recent experience with AC vs an historical cohort...
August 24, 2016: JAMA Surgery
Michael W Wandling, Eric S Hungness, Emily S Pavey, Jonah J Stulberg, Ben Schwab, Anthony D Yang, Michael B Shapiro, Karl Y Bilimoria, Clifford Y Ko, Avery B Nathens
Importance: There are currently 2 widely accepted treatment strategies for patients presenting to the hospital with choledocholithiasis. However, the rate of use for each strategy in the United States has not been evaluated, and their trends over time have not been described. Furthermore, an optimal management strategy for choledocholithiasis has yet to be defined. Objective: To evaluate secular trends in the management of choledocholithiasis in the United States and to compare hospital length of stay between patients with choledocholithiasis treated with endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy (ERCP+LC) vs laparoscopic common bile duct exploration with laparoscopic cholecystectomy (LCBDE+LC)...
August 24, 2016: JAMA Surgery
Kenric M Murayama
No abstract text is available yet for this article.
August 24, 2016: JAMA Surgery
Yuichi Takano, Masatsugu Nagahama, Naotaka Maruoka, Eiichi Yamamura, Nobuyuki Ohike, Tomoko Norose, Hiroshi Takahashi
BACKGROUND AND STUDY AIMS: Gallstone impaction at the ampulla of Vater is a critical condition, and the standard treatment is endoscopic papillotomy. However, the clinical features remain largely unclear, and some patients are reluctant to undergo papillotomy because of a bleeding tendency. The aim of this study was to clarify the clinical features of gallstone impaction at the ampulla of Vater and to examine the effectiveness of endoscopic biliary drainage without papillotomy. PATIENTS AND METHODS: We retrospectively examined 30 patients who had undergone endoscopic treatment for gallstone impaction at the ampulla of Vater between 2010 and 2015...
July 2016: Endoscopy International Open
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