Mortalitymorbidity mortality of cholangitis is high

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Mortality/Morbidity Mortality of cholangitis is high due to the predisposition in people with underlying disease. Historically, the mortality rate was 100%. With the advent of endoscopic retrograde cholangiography, therapeutic endoscopic sphincterotomy, stone extraction, and biliary stenting, the mortality rate has significantly declined to approximately 5-10%.
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The following patient characteristics are associated with higher morbidity and mortality rates: Hypotension Acute renal failure Liver abscess Cirrhosis Inflammatory bowel disease High malignant strictures Radiologic cholangitis Post percutaneous transhepatic cholangiography Female gender Age older than 50 years Failure to respond to antibiotics and conservative therapy Advanced age, concurrent medical problems, and delay in decompression increase the emergent operative mortality rate (17-40%). The mortality rate of elective surgery after medical stabilization is significantly less (approximately 3%). In the past, suppurative cholangitis was thought to have increased morbidity; however, prospective studies have not found this to be true. Race Cholangitis frequently occurs secondary to a gallstone obstructing the common bile duct. Therefore, it carries the same risk factors as that of cholelithiasis. Prevalence of gallstones is highest in fair- skinned people of Northern European descent as well as in Hispanic populations, Native Americans, and Pima Indians. In addition, certain Asian populations and inhabitants of countries where intestinal parasites are common are also at increased risk. Asians are more likely to have primary stones due to chronic biliary infections, parasites, bile stasis, and biliary strictures. Recurrent pyogenic cholangitis (Oriental cholangiohepatitis) rarely is observed in the United States African Americans with sickle cell disease are at increased risk. Sex Although gallstones are more common in women than in men, the male-to-female ratio is equal in cholangitis. Age Elderly patients are more likely to progress from asymptomatic gallstones to serious complications of gallstones and cholangitis. Suspect cholangitis in older patients presenting with sepsis and mental status changes. Elderly patients are more prone to gallstones and CBD stones and, therefore, cholangitis. The median age at presentation is between 50 and 60 years. History In 1877, Charcot described cholangitis as a triad of findings of right upper quadrant (RUQ) pain, fever, and jaundice. The Reynolds pentad adds mental status changes and sepsis to the triad. A spectrum of cholangitis exists, ranging from mild symptoms to fulminant overwhelming sepsis. With septic shock, the diagnosis can be missed in up to 25% of patients. Consider cholangitis in any patient who appears septic, especially in patients who are elderly, jaundiced, or who have abdominal pain. A history of abdominal pain or symptoms of gallbladder colic may be a clue to the diagnosis.
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  • Winter '18
  • Jane doe
  • Digestive System, bile duct, Hepatology, Gallstone

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