Charcot’s triad

Background: The albumin, a negative acute-phase protein, is important for perioperative morbidity, even in patients with normal preoperative levels. This study intend to determine the perioperative factors related with the postoperative reduction in serum albumin (ΔALB) and its influence on perioperative outcome in a pediatric general surgical cohort.Methods: This single-center retrospective review included 939 pediatric patients who underwent major gastroenterology surgery from August 2010 to August 2019. The patients were dichotomized into a high ΔALB group (≥14.6%) and a low ΔALB group (<14.6%) based on the mean value of ΔALB (14.6%). the independent risk factors for ΔALB, were explored using the propensity score matching to minimize potential selection bias and subjected to method multivariable logistic regression model. Furthermore, in 366 matched patients, the influences of operating time on perioperative outcomes were analyzed.Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 [odds ratio (OR) = 2.36 (95% CI, 1.51–3.86); p = 0.007], a longer operating time [OR = 1.18 (95% CI, 1.00–1.53); p = 0.014), and the presence of Charcot's triad [OR = 1.73 (95% CI, 1.05–2.83); p = 0.031] were factors that predicted a high ΔALB level. A high ΔALB level was also related with gastrointestinal functional recovery delay, reflected by the postoperative defecation (p = 0.013) and bowel movement (p = 0.019) delay and the high occurrence of postoperative complications (16.1 vs. 10.9%, OR, 1.57; 95% CI, 1.02–2.41, P = 0.0026).Conclusions: The high ΔALB level was correlated with postoperative outcome. To obtain a safe recovery and discharge after a major abdominal operation, the above risk factors for ΔALB could be addressed in the perioperative period.

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Cholangitis: Analysis of Admission Prognostic Indicators and Outcomes

The American Surgeon ◽

10.1177/000313480707301003 ◽

2007 ◽

Vol 73 (10) ◽

pp. 949-954 ◽

Cited By ~ 6

Author(s):

David K. Rosing ◽

Christian De Virgilio ◽

Alex T. Nguyen ◽

Monica El Masry ◽

Amy H. Kaji ◽

...

Keyword(s):

Positive Predictive Value ◽

Organ Failure ◽

Negative Predictive Value ◽

Predictive Value ◽

Acute Cholangitis ◽

Adverse Outcomes ◽

Prognostic Indicators ◽

Therapeutic Modalities ◽

Charcot’S Triad ◽

Sensitivity Specificity

Acute cholangitis is a life-threatening complication of biliary obstruction that is exacerbated by delays in diagnosis and treatment. Since the introduction of endoscopic retrograde cholangiography and endoscopic therapeutic modalities, few investigations have addressed admission prognostic indicators of adverse outcomes. A retrospective review of all patients with a diagnosis of acute cholangitis from 1995 to 2005 was performed. Primary endpoints were organ failure and death. One-hundred and seventeen patients met criteria for acute cholangitis. Only 49 (42%) had Charcot's triad and 3 (3%) had Reynolds’ pentad. One-hundred and four (89%) patients underwent biliary decompression, of which 79 (76%) were treated by endoscopic methods. There were 29 (25%) cases of organ failure and 9 (8%) deaths. The admission white blood cell (WBC) count ( P = 0.0003) and total bilirubin (TBili) ( P = 0.04) were statistically significant predictors of organ failure or death. With an admission of WBC ≥ 20,000 cells/mm3, the sensitivity, specificity, positive predictive value, and negative predictive value for organ failure and death were 50 per cent, 92 per cent, 63 per cent, and 88 per cent, respectively. A TBili of ≥10 mg/dL had sensitivity, specificity, positive predictive value, and negative predictive value of 56 per cent, 85 per cent, 21 per cent, and 96 per cent, respectively for predicting death. Admission WBC ≥ 20,000 cells/mm3 and TBili ≥ 10 mg/dL are selective predictors of adverse outcomes in acute cholangitis.

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Indirect Fist Percussion of the Liver Is a More Sensitive Technique for Detecting Hepatobiliary Infections than Murphy’s Sign

Current Gerontology and Geriatrics Research ◽

10.1155/2015/431638 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6

Author(s):

Takeshi Ueda ◽

Eri Ishida

Keyword(s):

Acute Cholecystitis ◽

Acute Cholangitis ◽

Clinical Findings ◽

Hepatic Cyst ◽

Charcot’S Triad ◽

Hepatobiliary Diseases ◽

Murphy’S Sign ◽

Low Sensitivity ◽

High Level ◽

Murphy's Sign

Background. Murphy’s sign and Charcot’s triad are established clinical findings of acute cholecystitis and cholangitis, respectively, but both show low sensitivity and limited clinical application. We evaluated if indirect fist percussion of the liver improves the efficiency of diagnosing cholecystitis and cholangitis when used as a diagnostic adjunct.Methods. The presence/absence of right upper quadrant (RUQ) tenderness, Murphy’s sign, and pain induced by indirect fist percussion of the liver was assessed, and the results were compared with the definite diagnosis based on ultrasound and additional examinations in patients aged over 18 who visited our outpatient clinic with suspected hepatobiliary diseases.Results. Four hundred and eight patients were investigated, and 40 had hepatobiliary infection (acute cholecystitis: 10, acute cholangitis: 28, liver abscess: 1, and hepatic cyst infection: 1). The sensitivity of indirect fist percussion of the liver for diagnosing hepatobiliary infection was 60%, being significantly higher than that of RUQ tenderness (33%) and Murphy’s sign (30%), and its specificity was 85%. There was no significant improvement in sensitivity or diagnostic accuracy when Murphy’s sign was combined with indirect fist percussion of the liver.Conclusion. Indirect fist percussion-induced liver pain is a useful clinical finding to diagnose hepatobiliary infection, with high-level sensitivity.

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Charcot of Charcot's triad

Gastroenterology ◽

10.1016/s0016-5085(98)70183-0 ◽

1998 ◽

Vol 115 (3) ◽

pp. 541 ◽

Cited By ~ 4

Author(s):

William S. Haubrich

Keyword(s):

Charcot’S Triad

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Diagnostic system of determination of an acute cholangitis

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2019.11-12.29 ◽

2019 ◽

Vol 86 (11-12) ◽

pp. 29-35

Author(s):

I. N. Mamontov

Keyword(s):

Clinical Laboratory ◽

Acute Cholangitis ◽

Diagnostic System ◽

Gallbladder Wall ◽

The Body ◽

Duodenal Papilla ◽

Temperature Level ◽

Charcot’S Triad ◽

Biliary Ducts

Objecive. To elaborate a diagnostic system, permitting to confirm or exclude the diagnosis of an acute cholangitis in patients, suffering biliary ducts obstruction. Materials and methods. The wok is based on analysis of clinical, laboratory and instrumental indices in 174 patients, suffering the biliary ducts obstruction (in 18 - with an acute cholangitis). Results. The diagnostic system was constructed, taking into account informativity of such indices, as ratio of the segmented and stab neutrophils quantity, quantity of stab neutrophils, bilirubin, a gallbladder wall thickness, quantity of monocytes, leukocytes, the Charcot’s triad presence, the body temperature, level of amylase, the duodenal papilla magna size, quantity of lymphocytes, presence of excluded gallbladder, presence of cholecystectomy in anamnesis, the immobile calculus of duodenal papilla magna, tumor, the eosinophils quantity, as well as the presence of any choledocholithiasis and age. Conclusion. The elaborated diagnostic scheme for determination of an acute cholangitis in patients, suffering biliary ducts obstruction, owes high security (≥ 95%), because the part of failed diagnosis did not exceeded 5% and have constituted 2.8%.

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Extreme hyperbilirubinaemia associated with choledocholithiasis without ascending cholangitis

Polish Annals of Medicine ◽

10.29089/2020.20.00157 ◽

2021 ◽

Author(s):

Ikhwan Sani Mohamad ◽

Syed Hassan Syed Aziz ◽

Ong Yan Zie ◽

LEOW Voon Meng ◽

Zaidi Zakaria

Keyword(s):

Case Report ◽

Obstructive Jaundice ◽

Male Patient ◽

Total Bilirubin ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Charcot’S Triad ◽

Ascending Cholangitis ◽

Hypochondriac Pain

Introduction: Charcot’s triad was traditionally used to diagnose ascending cholangitis. However it is already proven that only minority of patients with ascending cholangitis who fulfill the triad of fever, jaundice and right hypochondriac pain. Aim: We would like to highlight the rarity of severe hyperbilirubinaemia secondary to benign cause as most of the incidence raised more suspicion for primary liver disease or malignancy. Case study: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Results and discussion: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Conclusions: Benign conditions such as common bile duct stones still can lead to severe hyperbilirubinaemia even though it is very rare. The usage of appropriate imaging is needed to exclude malignant causes.

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Charcot's triad

International Journal of Emergency Medicine ◽

10.1186/1865-1380-4-18 ◽

2011 ◽

Vol 4 (1) ◽

Cited By ~ 4

Author(s):

Jean Louis Frossard ◽

Florent Bonvin

Keyword(s):

Charcot’S Triad

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Diagnosis and Treatment of Visual Disturbances in Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073-12.3.106 ◽

2010 ◽

Vol 12 (3) ◽

pp. 106-113

Author(s):

John H. Pula ◽

Jorge C. Kattah

Keyword(s):

Multiple Sclerosis ◽

Treatment Options ◽

Current Treatment ◽

Intention Tremor ◽

Visual Examination ◽

Charcot’S Triad ◽

Visual Problems ◽

Clinical Description ◽

Visual Abnormalities ◽

Visual Disturbances

In 1868, Jean Charcot described what he considered to be the three cardinal features of multiple sclerosis (MS): dysarthria, intention tremor, and nystagmus. These three symptoms subsequently became known as “Charcot's triad.” Thus visual abnormalities have been a distinguishing feature of MS since the disease's initial clinical description. In this article, we differentiate three major visual problems in MS: visual loss, diplopia, and oscillopsia. We then describe elements of the afferent (sensory) and efferent (motor) visual examination in MS. Finally, we present an update on current treatment options related to each of these visual disturbances.

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Factors affecting perioperative serum albumin variation and short term complications in pediatric patients undergoing major gastroenterology surgery

10.21203/rs.2.24434/v2 ◽

2020 ◽

Author(s):

Qingshuang Liu ◽

Kai Gao ◽

Xiaomin Sun ◽

Chunbao Guo

Keyword(s):

Risk Factors ◽

Serum Albumin ◽

Pediatric Population ◽

Operating Time ◽

Length Of Hospital Stay ◽

Postoperative Recovery ◽

Perioperative Outcomes ◽

Perioperative Morbidity ◽

Charcot’S Triad ◽

The Mean

Abstract Background: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. The decrease in serum albumin might be important for perioperative morbidity, even in patients with normal preoperative levels in pediatric population. We here intend to determine the perioperative factors associated with the reduction in serum albumin within 2 postoperative days compared with the preoperative level (∆ALB) and its influence on the perioperative outcome in a pediatric general surgical cohort. Methods: This single-center retrospective review included 939 patients who underwent Roux-en-Y hepaticojejunostomy between August 2010 and Aug 2019. Based on the mean valure of ∆ALB (14.6%), patients were separated into two groups, including a high ∆ALB group (≥14.6%) and a low ∆ALB group (<14.6%). Multivariable logistic regression analyses were performed to determine the independent risk factors for the reduction in serum albumin. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 366 matched patients, influences of operating time on perioperative outcomes, including postoperative recovery, complications measurement, and length of hospital stay between the two groups were analyzed. Results: For all 996 patients reviewed, 939 patient records were enrolled into the final analysis. Controlling for other factors, multivariate analysis showed that the high CRP on POD 3 or 4 (odds ratio[OR] =2.36 [95% CI, 1.51-3.86]; p =0.007), presence of Charcot's triad (OR=1.73[95% CI, 1.05-2.83]; p = 0.031), the longer operating time (OR=1.18[95% CI, 1.00 -1.53]; p=0.014) were factors that predicted the high ∆ALB level. The high ∆ALB level was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (p= 0.013) and first bowel movement (p=0.019) and the high occurrence of postoperative complications (16.1% vs 10.9%, OR, 1.57; 95 %CI, 1.02-2.41, P=0.0026). The mean length of postoperative stay was longer than that of patients with ∆ALB < 14.0% group, although no statistic significant was stained (p=0.057). Conclusions: We showed that change in albumins was associated with postoperative outcomes. The risk factors for ∆ALB could be intervened in the perioperative period to permit patients gain a safe recovery and discharge after major abdominal operations.

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