| Theme |
The Present State of Management of Acute Cholangitis and Cholecystitis |
| Title |
Etiology and Disease State of Acute Cholangitis and Cholecystitis |
| Author |
Yasutoshi Kimura |
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University |
| Author |
Koichi Hirata |
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University / JR Sapporo Hospital |
| Author |
Tadahiro Takada |
Department of Surgery, Teikyo University |
| [ Summary ] |
Acute biliary infectious diseases are classified broadly into two categories, acute cholangitis and acute cholecystitis. The former is a systemic infectious disease with high mortality that requires prompt treatment. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis may also be caused by ischemia；chemicals in that enter biliary secretions ; motility disorders associated with drugs ; infections with microorganisms, protozoa, or parasites；collagen disease ; and allergic reactions. Acute acalculous cholecystitis is associated with adjacent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Health care‒associated biliary infection is a novel concept that also requires treatment. This concept is defined as infections in patients hospitalized for long periods and nursing home residents with gastrostomy or tracheotomy, repeated aspiration pneumonia, decubitus, urinary catheterization, history of recent postoperative infection, or antimicrobial therapy for other diseases as "health care‒associated". Health care‒associated acute cholangitis or cholecystitis should be treated independently from community‒acquired acute cholangitis or cholecystitis, because these patients have high risk of carrying antimicrobial‒resistant microorganisms. Broader‒spectrum antimicrobial therapy with appropriate de‒escalation is beneficial in such patients. |