Content deleted Content added
Line 28:
==Causes==
Bile duct obstruction, which is usually present in acute cholangitis, is generally due to [[gallstone]]s. 10–30% of cases, however, are due to other causes such as [[benign]] stricturing (narrowing of the bile duct without an underlying tumor), postoperative damage or an altered structure of the bile ducts such as narrowing at the site of an [[anastomosis]] (surgical connection), various tumors ([[cholangiocarcinoma|cancer of the bile duct]], [[gallbladder cancer]], cancer of the [[ampulla of Vater]], [[pancreatic cancer]], [[small intestine cancer|cancer of the duodenum]]), [[anaerobic organism]]s such as [[Clostridium]] and [[Bacteroides]] (especially in the elderly and those who have undergone previous surgery of the [[biliary system]]).<ref name=Kinney/> Parasites which may infect the liver and bile ducts may cause cholangitis; these include the [[roundworm]] ''[[Ascaris lumbricoides]]'' and the [[liver flukes]] ''[[Clonorchis sinensis]]'', ''[[Opisthorchis viverrini]]'' and ''[[Opisthorchis felineus]]''.<ref>{{cite journal |author=Lim JH |title=Liver flukes: the malady neglected |journal=Korean J Radiol |volume=12 |issue=3 |pages=269–79 |year=2011 |pmid=21603286 |pmc=3088844 |doi=10.3348/kjr.2011.12.3.269 |url=http://www.kjronline.org/DOIx.php?id=10.3348/kjr.2011.12.3.269}}</ref> In people with [[AIDS]], a large number of opportunistic organisms has been known to cause ''AIDS cholangiopathy'', but the risk has rapidly diminished since the introduction of [[Antiretroviral drug|effective AIDS treatment]].<ref name=Kinney/><ref name=Kimura2007>{{cite journal |vauthors=Kimura Y, Takada T, Kawarada Y | title=Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines | journal=J Hepatobiliary Pancreat Surg | year=2007 | volume=14 | issue=1 | pages=15–26 | pmid=17252293 | doi=10.1007/s00534-006-1152-y | pmc=2784509|display-authors=etal}}</ref> Cholangitis may also complicate medical procedures involving the bile duct, especially ERCP. To prevent this, it is recommended that those undergoing ERCP for any indication receive prophylactic (preventative) antibiotics.<ref name=Williams/><ref>{{cite journal|last1=Brand|first1=M|last2=Bizos|first2=D|last3=O'Farrell P|first3=Jr|title=Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography.|journal=The Cochrane
The presence of a permanent biliary stent (e.g. in pancreatic cancer) slightly increases the risk of cholangitis, but stents of this type are often needed to keep the bile duct patent under outside pressure.<ref name=Kinney/>
Line 70:
=== Percutaneous biliary drainage ===
In cases where a person is too ill to tolerate endoscopy or when a retrograde endoscopic approach fails to access the obstruction, a [[percutaneous transhepatic cholangiography|percutaneous transhepatic cholangiogram]] (PTC) may be performed to evaluate the biliary system for placement of a percutaneous biliary drain (PBD).<ref name="García-García 663–670">{{Cite journal|last=García-García|first=Lorenzo|last2=Lanciego|first2=Carlos|date=2004-03-01|title=Percutaneous Treatment of Biliary Stones: Sphincteroplasty and Occlusion Balloon for the Clearance of Bile Duct Calculi|url=http://www.ajronline.org/doi/10.2214/ajr.182.3.1820663|journal=American Journal of Roentgenology|volume=182|issue=3|pages=663–670|doi=10.2214/ajr.182.3.1820663|issn=0361-803X}}</ref><ref name="Williams" /> This is often necessary in the case of a proximal stricture or a bilioenteric [[Anastomosis#Medicine|anastomosis]] (a surgical connection between the bile duct and small bowel, such as the [[duodenum]] or [[jejunum]]).<ref name="schwartz" /> Once access across the stricture is obtained, balloon dilation can be performed and stones can be swept forward into the duodenum.<ref
=== Cholecystectomy ===
| |||