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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Caroli disease is an autosomal recessive disease that is associated with medullary sponge kidney and renal cysts. Patients most often present in the second and third decades of life with recurrent cholangitis. Caroli disease is a type V choledochal cyst according to the Todani classification. The absence of strictures on MRCP excludes primary sclerosing cholangitis and primary biliary cirrhosis as diagnoses. In polycystic liver disease the cysts do not communicate with the biliary tree. A choledochocele is defined as a dilation of the duodenal part of the common bile duct.
Biliary Tract Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Hemant M. Kocher, Vincent S. Yip, Ajit T. Abraham
PBD has not been shown to significantly decrease morbidity or mortality, but is still controversial.56 It increases the risk of cholangitis and increases hospital stay, but it must be considered in patients with severe cholestasis who otherwise run the risk of liver failure and with existing suspected cholangitis. In general, it is now accepted that in the majority of cases, proximal biliary obstruction that is suitable for major hepatic resection requires PBD; whereas middle-distal obstruction might not require routine biliary drainage, if curative surgery can be performed in a timely manner.57 Despite that, one of the most recent meta-analyses reaffirmed that preoperative drainage seems to be associated with higher postoperative morbidity.58 However, it is important to note that all studies included in the meta-analysis were retrospective series, and are therefore not the best evidence.
Cholangitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Biochemistry often shows a cholestatic picture with increased liver function tests, but the increased bilirubin, Gamma-glutamyl transferase (GGT) and alkaline phosphatase should raise suspicion. An ultrasound may show dilated biliary ducts, aerobilia, stricture and stones. The most frequent cause of cholangitis is biliary stones.
Risk factors for post-endoscopic retrograde cholangiopancreatography cholangitis in patients with hepatic alveolar echinococcosis—an observational study
Published in Annals of Medicine, 2022
Fei Du, Wenhao Yu, Zhixin Wang, Zhi Xie, Li Ren
The incidence of cholangitis after ERCP is about 0.5–5% [20] and has a high mortality rate of about 4.5–8% [21,22]. In most cases of cholangitis, it is not clear how bacteria enter the obstructed bile duct. Several studies have shown a direct relationship between the development of bacteraemia or endotoxemia and the pressure within the biliary system [23–26]. In addition, the reverse invasion of ERCP can lead rapidly to bacterial translocation, colonization, and cholangitis [27]. An obstructed biliary tract also promotes bacterial translocation to normally sterile sites [28]. When biliary obstruction leads to elevated biliary pressure, bacteria and bacterial products can retrograde from the bile and leak into the body circulation, leading to clinical manifestations of sepsis and cholangitis.
Platelet index on admission as a predictor of bacteremia in acute cholangitis: a 7-year retrospective observational study
Published in Platelets, 2022
XiaoYing Chen, Fu Wei, Dan Zhang, Shijing Tian
In this retrospective observational study, we completed an investigation of the association between bacteremia and platelet index in 285 patients with acute cholangitis. The results showed that the incidence of bacteremia in acute cholangitis is high, especially in grade III patients, which can reach half the proportion. And Platelet count and plateletcrit have a certain value for early prediction of bacteremia in patients with acute cholangitis. Currently, there have been few reports of platelet index predicted bacteremia in patients with acute cholangitis. The current study provides clinical evidence for platelets could predict bacteremia. In cholangitis, a sustained increase in bile duct pressure causes bacteria to enter the bloodstream and lead to bacteremia or sepsis. In our investigation, the incidence of bacteremia in patients with acute cholangitis was 48.42%, which is similar to the results reported in patients with acute cholangitis in which the positive rate of blood culture was between 21% and 71% [13]. All of the above results suggest that the incidence of bacteremia in acute cholangitis is extremely high. In our study, the patients in bacteremia group had a higher APACHE II score than that in non-bacteremia group, the rate of bacteremia in grade III (severe) patients was as high as 51.45%, and the mortality rate was as high as 12.32%. This shows that the appearance of bacteremia significantly increases the severity and mortality of acute cholangitis, Therefore, there are important clinical implications for early identification of bacteremia.
Real-life analysis of treatment approaches and the role of inflammatory markers on survival in patients with advanced biliary tract cancer
Published in Current Medical Research and Opinion, 2022
Sabin Goktas Aydin, Burcin Cakan Demirel, Ahmet Bilici, Atakan Topcu, Musa Barış Aykan, Seda Kahraman, Ilgın Akbıyık, Muhammed Mustafa Atci, Omer Fatih Olmez, Arzu Yaren, Mehmet Ali Nahit Sendur, Caglayan Geredeli, Mesut Seker, Yuksel Urun, Nuri Karadurmus, Ahmet Aydin
In the univariate analysis for PFS, the presence of cholangitis at any time of disease, the presence of curative surgery, choice of treatment, ECOG PS, NLR and SII were found to be prognostic factors (p = .04, p = .03, p < .001, p < .001, p = .01, p = .003, respectively). Thus, the median PFS was 4.9 months and 6.9 months in patients with NLR >2.76 and NLR ≤2.76, respectively (p = .01) (Figure 2a). Moreover, the median PFS was significantly worse for patients with SII >390 compared to those with SII ≤390 (4.5 vs. 6.6 months, respectively, p = .003) (Figure 3a). The median PFS time was 2.2 months in the BSC group, 4.5 months in the single-agent chemotherapy group, 6.9 months in the doublet regimens group and 6.5 months in the triplet regimens group (Figure 4). Tumor localization, PLR, CRP, PTCD, gender and age were not found to be significant for PFS in univariate analysis (Table 4).