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CHOLANGITIS – INFLAMMATION / BACTERIAL INFECTION OF THE BILIARY TRACT

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UNDERSTANDING THE PROBLEM

The biliary tract, (biliary tree or biliary system) refers to the liver, gall bladder and bile ducts, and how they work together to make, store and secrete bile. Bile consists of water, electrolytes, bile acids, cholesterol, phospholipids and conjugated bilirubin. Some components are synthesised by hepatocytes (liver cells), the rest are extracted from the blood by the liver.

Cholangitis is an infection of the biliary tract Many patients with acute cholangitis respond to antibiotic therapy; however, patients with severe or toxic cholangitis may become unresponsive and may require emergency biliary drainage. Choledocholithiasis in the past was the most common cause of biliary tract obstruction resulting in cholangitis. However over the past two decades, biliary tract manipulations/interventions and stents have reportedly become more common causes of cholangitis. Hepatobiliary malignancies are a less common cause of biliary tract obstruction and subsequent bile contamination.

UNDERSTANDING WHO SUFFERS

Cholangitis is reported in all ethnical races. A variant, namely Asian cholangitis is observed with increased frequency in Southeast Asia. The condition is reported in both females and males and has no clear predominance in either.

It mostly occurs in adults, with a reported median age at onset of 50-60 years. In neonates, extrahepatic biliary atresia (EHBA) is a cause of cholangitis. In children and young adults, choledochal cyst can cause cholangitis.

POTENTIAL SIGNS AND SYMPTOMS

The symptoms of biliary obstruction can depend on the cause of the obstruction, some are outlined below:

  • A patient with a history of choledocholithiasis or recent biliary tract manipulation
  • Fever
  • Abdominal pain in right upper quadrant.
  • Jaundice (the Charcot triad) is highly suggestive of cholangitis.

Fever reportedly occurs in nearly 95% of patients with cholangitis. Approximately 90% of patients have right upper quadrant tenderness, and 80% have jaundice.

EXAMINATIONS USUALLY REQUIRED

Because symptoms are common to a number of conditions which affect the biliary tree, doctors may prescribe several tests to determine the cause of the symptoms.

  • ultrasound, which can be used to detect the presence of stones
  • ERCP (endoscopic retrograde cholangiopancreatography)
  • MRCP (magnetic resonance cholangiopancreatography)
  • a cholangiogram or percutaneous transhepatic cholangiogram

The following blood tests may be routinely done to determine the present state of certain levels of enzymes in the bloodstream:

  • blood counts, especially the white blood count as this is an indicator of infection
  • bilirubin level (a pigment that is found in a person's blood and stool)
  • liver enzyme and function tests
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Gallbladder and Biliary Tract Disorders

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery.

AIMIS is an expert in Robotic Surgery for Robotic Assisted Cholecystectomy, Choledochotomy, Cholecystostomy and other minimal invasive procedures for the Gallbladder and Biliary Tract involving the best American and International surgeons who are experts in the field including:

  • Cholelithiasis – Gallstones - Cholecystectomy (Gallbladder removal), Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Cholecystitis - Gallbladder Inflammation - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Gallbladder Problems (Obstruction, Hydrops, Perforation, Fitsula) - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Bile Duct Problems (Obstruction, Hydrops, Perforation, Fistula) - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Cholangitis -Inflammation/bacterial infection of the biliary tract - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for gallbladder and biliary tract and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

FURTHER INFO
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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

One possible complication is sepsis, a condition in which the body has a severe response to bacteria. Human systems become inflamed when a person has sepsis. Blood pressure drops and organs begin to shut down. Without immediate medical treatment, sepsis can be fatal.

Cholangitis is a condition that needs to be addressed aggressively and quickly. Whenever multiple symptoms occur, it is always prudent to seek medical advice immediately.

FURTHER INFORMATION ON INCREASED RISK GROUPS

In the United States the incidence of biliary obstruction is approximately 5 cases per 1000 people. The racial predilection depends on the cause of the biliary obstruction.

Gallstones are the most common cause of biliary obstruction. Persons of Hispanic origin and Northern Europeans have a higher risk of gallstones compared to people from Asia and Africa.

Native Americans (particularly Pima Indians) have an increased incidence of obesity and diabetes within their population and are especially prone to developing gallstones. Pima women have a lifetime chance of developing gallstones as high as 80%.

Prevalence by Gender again depends on the specific cause of the biliary obstruction.

Gallstone disease is the most common cause of biliary obstruction. Women are much more likely to develop gallstones than men. By the sixth decade, almost 25% of American women develop gallstones, with as many as 50% of women aged 75 years developing gallstones. This increased risk is likely caused by the effect of estrogen on the liver, causing it to remove more cholesterol from the blood and diverting it into the bile.

Approximately 20% of men aged 75 years have gallstones, with more complicated disease courses occurring in those who have had cholecystectomies.

An individual is more likely to develop cholangitis if any of these risk factors are present:

  • A history of gallstones
  • Sclerosing cholangitis, a condition in which the ducts to the liver have been damaged
  • HIV (human immunodeficiency virus)
  • an abnormally narrow bile duct, which can be congenital (meaning the person was born with this condition)
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

It is important that cholangitis be addressed immediately, as complications can result which only exacerbate the condition. The pain and discomfort experienced by the person who has cholangitis can become quite severe.

  • Antibiotics are frequently used to arrest the infection that occurs in the biliary tree.
  • An ERCP can be done to remove stones or open strictures that may have caused cholangitis.
  • Laparoscopic or Robotic surgery is often considered in patients that do not respond to antibiotics or non-invasive procedures like ERCP.
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Cholecystectomy, Choledochotomy, Cholecystostomy and other minimal invasive procedures for the Gallbladder and Biliary Tract involving the best American and International surgeons who are experts in the field In contrast to other gallbladder-preserving minimally invasive or interventional methods, robotic is a one-session procedure avoiding the need for post-operative drainage of the gallbladder by a balloon catheter. Robotic cholecystectomy does not cause functional disturbances or severe bile duct injury, as is observed after cholecystectomy.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for gallbladder and biliary tract and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

Cholecystectomy through the belly button can be done using traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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