Obstruction of the Biliary and Urinary System
| Autor: | Louis G. Martin, Michael J. Miller, J. David Prologo, Jason W. Mitchell, W. O’Connell, Jay Shah, Jonathan G. Martin |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Abdominal pain medicine.medical_specialty Adolescent Cholangitis medicine.medical_treatment Fulminant Radiography Interventional 030218 nuclear medicine & medical imaging Kidney Calculi 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Radiology Nuclear Medicine and imaging Hydronephrosis Nephrostomy Percutaneous Ultrasonography Aged 80 and over Cholestasis business.industry Endovascular Procedures Angiography Jaundice medicine.disease Surgery Jaundice Obstructive Treatment Outcome Nephrostomy Drainage Female 030211 gastroenterology & hepatology Chills medicine.symptom Pyonephrosis Cardiology and Cardiovascular Medicine Urinary tract obstruction business Ureteral Obstruction |
| Zdroj: | Techniques in Vascular and Interventional Radiology. 20:288-293 |
| ISSN: | 1089-2516 |
| DOI: | 10.1053/j.tvir.2017.10.010 |
| Popis: | Biliary and urinary obstructions can be managed endoscopically or cystoscopically, surgically or by percutansous intervention or drainage. If the obtructed system is infected, emergent decompression is needed. Early recognition and treatment is paramount in both conditions. Acute cholangitis can present many different ways, from mild symptoms to fulminant sepsis. It is usually a result of ascending bacterial colonization and biliary obstruction resulting in bacterial overgrowth. Therefore, those patients with recent biliary instrumentation or previous biliary modification are at higher risk. Charcot's triad of fever, right upper quadrant abdominal pain, and jaundice is only seen in 50%-70% of patients. Fever is seen in over 90% of cases, pain is seen in 70% of cases, and jaundice is seen in 60% of cases. Altered mental status and hypotension are associated with severe cases. All 5 symptoms of fever, right upper quadrant abdominal pain, jaundice, altered mental status, and hypotension are referred to as Reynold's Pentad. Acute pyonephrosis can also present many different ways, from minimal symptoms to fulminant sepsis. Fever, chills, and flank pain are the classic symptoms, although some patients may be relatively asymptomatic. Pyonephrosis may present with a classic triad of fever, flank pain, and hydronephrosis, or simply hydronephrosis and sepsis. Pyonephrosis usually occurs as a result of urinary obstruction with either an ascending infection of the urinary tract or hematogenous spread of a bacterial pathogen as the culprit. Up to 75% of cases are related to urinary stone disease. Patients are at increased risk for pyonephrosis when they haven anatomic urinary tract obstruction, certain chronic diseases (diabetes meliitus and AIDS), or are immunosuppressed due to immunodeficiency or medications, (chronic steroid therapy). |
| Databáze: | OpenAIRE |
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