The hydrocholeretic bile acid dehydrocholic acid is a safe and moderately effective treatment for recurrent acute cholangitis due to biliary stasis

Afferent loop syndrome is a rare complication after gastrectomy with Billroth II or Roux-en-Y reconstruction, caused by an obstruction in the proximal loop. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of acute cholangitis. We present the case of a male patient who had previously undergone gastrectomy with Roux-en-Y reconstruction and later experienced multiple episodes of acute cholangitis secondary to choledocolithiasis. He underwent an open exploration of the bile ducts with choledocolitotomy, but the events of cholangitis persisted. Further investigation permitted to identify a dilation of the biliary loop of the Roux-en-Y anastomosis, suggesting enterobiliary reflux as the cause of recurrent acute cholangitis. Therefore, a bowel enterectomy and new jejunojejunostomy were undertaken, and normal biliary flow was re-established. The surgical treatment is mandatory in benign causes, leading to the resolution of the obstruction and subsequent normalisation of bile flow.

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Studies on the origin of biliary phospholipid. Effect of dehydrocholic acid and cholic acid infusions on hepatic and biliary phospholipids

Biochemical Journal ◽

10.1042/bj2700691 ◽

1990 ◽

Vol 270 (3) ◽

pp. 691-695 ◽

Cited By ~ 22

Author(s):

F Chanussot ◽

H Lafont ◽

J Hauton ◽

B Tuchweber ◽

I Yousef

Keyword(s):

Bile Acid ◽

Bile Acids ◽

Cholic Acid ◽

Bile Flow ◽

Normal Values ◽

Specific Radioactivity ◽

Regulatory Effect ◽

Experimental Protocol ◽

Dehydrocholic Acid ◽

Cellular Organelles

The correlation between the secretion of biliary phospholipid (PL) and bile acid suggests a regulatory effect of bile acid on PL secretion. Bile acids may influence PL synthesis and/or the mobilization of a preformed PL pool. The objective of this study was to determine the contribution of these two sources to biliary PL, by using an experimental protocol in which dehydrocholic acid (DHCA) and cholic acid (CA) were infused to manipulate biliary PL secretion. In control rats, there was a steady state in bile flow. PL secretion and the biliary secretion of newly synthesized phosphatidylcholine (PC). The specific radioactivity of PC in bile was significantly higher than in plasma, microsomes and canalicular membranes. DHCA infusion decreased biliary PC secretion rate by 80%, and secretion returned to normal values at the transport maximum of CA. The specific radioactivity of biliary PC was decreased by 30% by DHCA infusion and reached normal values during CA infusion. There were no significant changes in the specific radioactivity of PC in plasma or cellular organelles during infusion of bile acids. These data indicate that: (1) newly synthesized PC contributes a small percentage to biliary PC; thus a preformed pool (microsomal and extrahepatic) is a major source of biliary PL; (2) the contribution of the extrahepatic pool to the biliary PL may be more important than the microsomal pool.

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103-OR: The Glucagon-Like Peptide-1 Analog, Liraglutide Is a Safe and Effective Treatment of Bile Acid Malabsorption: A Proof of Concept Study

Diabetes ◽

10.2337/db21-103-or ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 103-OR

Author(s):

MARTIN L. KÅRHUS ◽

ANDREAS BRØNDEN ◽

JULIE FORMAN ◽

ANNE HAABER ◽

EBBE LANGHOLZ ◽

...

Keyword(s):

Bile Acid ◽

Effective Treatment ◽

Proof Of Concept ◽

Concept Study ◽

Bile Acid Malabsorption ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1

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Identifying and Treating Ascending Cholangitis. A case report and review of literature.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v2i2.10 ◽

2018 ◽

Vol 2 (2) ◽

Author(s):

Phillip Linholm ◽

Patrick E. Young ◽

Walter Reed

Keyword(s):

Acute Cholangitis ◽

Initial Assessment ◽

Biliary Stents ◽

E Coli ◽

Charcot’S Triad ◽

The Us ◽

Common Causes ◽

Ascending Cholangitis ◽

Biliary Stasis ◽

Parasitic Worms

Acute cholangitis is an infection of the biliary system that typically results from obstruction. Common causes include choledocholithiasis, strictures, foreign bodies (such as biliary stents) parasitic worms (e.g. ascarids) and compression from an external structure. Obstruction allows for higher bacterial concentrations and bacterial proliferation. With biliary stasis and increases in intraductal pressure, bacteria migrate into the venous and lymphatic systems with subsequent bacteremia. The rate of gallstone development is 3-4 % annually in those >60 years old with up to a 15% overall prevalence in the US. In the US, 85% of ascending cholangitis cases are a consequence of choledocholithiasis. The gram-negative bacteria E coli, Klebsiella, Pseudomonas and Enterobacter are the most commonly identified pathogens. Anaerobes are less common.Ascending cholangitis is classically diagnosed by the presence of Charcot’s triad – fever, right upper quadrant pain and jaundice. Though very specific, the presence of Charcot’s triad is only 26% sensitive and thus its absence does not rule out the diagnosis. All patients with suspected ascending cholangitis should undergo appropriate fluid resuscitation, be given broad spectrum antibiotics to cover the likely enteric pathogens, and closely monitored for worsening in their clinical condition.Once initial assessment is complete and resuscitative efforts begun, imaging is often helpful in confirming the diagnosis of ascending cholangitis. After the diagnosis has been confirmed, ERCP and biliary drainage is indicated.

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Management of acute cholecystitis and acute cholangitis in emergency setting

Open Medicine ◽

10.2478/s11536-013-0301-3 ◽

2014 ◽

Vol 9 (3) ◽

pp. 357-369

Author(s):

Kui-Hin Liau ◽

Catherine Teh ◽

Alejandro Serrablo

Keyword(s):

Acute Cholecystitis ◽

Acute Cholangitis ◽

Rapid Progression ◽

Emergency Setting ◽

Initial Management ◽

Gram Negative ◽

Life Threatening ◽

Biliary Stasis ◽

The Common ◽

Prompt Diagnosis

AbstractAcute 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.

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Identifying and Treating Ascending Cholangitis: A case report and review of literature.

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v2i2.18 ◽

2018 ◽

Vol 2 (2) ◽

pp. 126-135

Author(s):

Phillip Lindholm ◽

Patrick E. Young ◽

Walter Reed

Keyword(s):

Acute Cholangitis ◽

Initial Assessment ◽

Biliary Stents ◽

E Coli ◽

Charcot’S Triad ◽

The Us ◽

Common Causes ◽

Ascending Cholangitis ◽

Biliary Stasis ◽

Parasitic Worms

Acute cholangitis is an infection of the biliary system that typically results from obstruction. Common causes include choledocholithiasis, strictures, foreign bodies (such as biliary stents) parasitic worms (e.g. ascarids) and compression from an external structure. Obstruction allows for higher bacterial concentrations and bacterial proliferation. With biliary stasis and increases in intraductal pressure, bacteria migrate into the venous and lymphatic systems with subsequent bacteremia. The rate of gallstone development is 3-4 % annually in those >60 years old with up to a 15% overall prevalence in the US. In the US, 85% of ascending cholangitis cases are a consequence of choledocholithiasis. The gram-negative bacteria E coli, Klebsiella, Pseudomonas and Enterobacter are the most commonly identified pathogens. Anaerobes are less common.Ascending cholangitis is classically diagnosed by the presence of Charcot’s triad – fever, right upper quadrant pain and jaundice. Though very specific, the presence of Charcot’s triad is only 26% sensitive and thus its absence does not rule out the diagnosis. All patients with suspected ascending cholangitis should undergo appropriate fluid resuscitation, be given broad spectrum antibiotics to cover the likely enteric pathogens, and closely monitored for worsening in their clinical condition.Once initial assessment is complete and resuscitative efforts begun, imaging is often helpful in confirming the diagnosis of ascending cholangitis. After the diagnosis has been confirmed, ERCP and biliary drainage is indicated.

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Qualitative Examination of Children's Naming Skills through Test Adaptations

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1803.206 ◽

1987 ◽

Vol 18 (3) ◽

pp. 206-216 ◽

Cited By ~ 16

Author(s):

Melanie Fried-Oken

Keyword(s):

Effective Treatment ◽

Language Disorder ◽

Treatment Goals ◽

Expressive Vocabulary ◽

Qualitative Information ◽

Word Finding ◽

Confrontation Naming ◽

Naming Test

A new procedure entitled the Double Administration Naming Technique is proposed to assist the clinician in obtaining qualitative information about a client's visual confrontation naming skills. It involves the administration of the standard naming test followed by a readministration of the instrument. A series of naming cues then are presented. By examining the number and types of naming errors produced during the two test presentations, the clinician distinguishes word-finding problems from expressive vocabulary limitations and qualitatively describes the language disorder. The cues that facilitate correct naming are used to plan effective treatment goals.

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