Clinical ManifestationsPatients with acute cholangitis usually have a prior history of biliary tract disease, particularly cholelithiasis or choledochelithiasis. The onset of cholangitis is usually acute, with high fevers, rigors, and abdominal pain. The classic Charcot triad of fever, RUQ abdominal pain, and jaundice can be found in up to 70% of cases. Patients with acute obstructive suppurative cholangitis, in which there is pus in the biliary tree, may additionally present with altered mental status and hypotension (Reynold's pentad). These extra findings are typically due to the presence of gram-negative sepsis, particularly by Escherichia coli or Klebsiella pneumoniae. A pyogenic liver abscess is a rare complication on acute cholangitis.
DiagnosisMost patients with acute cholangitis have marked leukocytosis, hyperbilirubinemia, and elevated alkaline phosphatase levels, but serum transaminases are usually only modestly elevated. Up to one third of cases have hyperamylasemia caused by concomitant obstruction of the pancreatic duct.Ultrasonography is the preferred study to confirm the diagnosis because of its ability to identify dilated biliary ducts. Significant biliary ductal dilatation in a patient with the appropriate clinical picture confirms the diagnosis. Ultrasonographic examination can also evaluate the gallbladder size, the presence of stones, masses associated with the bile ducts, and liver parenchymal changes.Endoscopic retrograde cholangiopancreatography (ERCP) provides the most accurate means of determining the cause and location of obstruction. This is the procedure of choice if common bile duct stones are present, since stone extraction and biliary stent placement can be performed, decompressing the biliary system. MRCP may also allow visualization oil the biliary tree but does not permit removal of the obstruction.An abdominal CT scan can demonstrate the presence and, potentially, the cause of biliary obstruction. Plain radiography and HIDA scans are less useful in confirming the diagnosis.*107/348/5*

Amebiasis is an infection caused by Endamoeba histolytica. About 30,000,000 Americans are said to carry this organism in their bowels. Most have no symptoms; others apparently more sensitive to the infestation develop fatigue, fail to gain weight, have difficulty in sleeping, may occasionally become nauseated and vomit, suffer from abdominal pain or tenderness and often a low-grade fever. The diagnosis depends on finding the organism in the material excreted by the bowel. This is examined with special stains and observed under the microscope. The condition, once thought to be a tropical disease, is now recognized rather generally throughout the world. A number of drugs have been developed which are quite effective in destroying the amebae and removing them from the body. The one most widely used throughout the world is emetine, but others, such as aralin, chiniofon, fumadil, and milibis are widely used. The patient must be watched carefully to see that he has enough fluids in the body. Signs of abscess-formation in the liver - a most serious complication - must be detected promptly to prevent fatality. Quite commonly used for mild cases is terramycin. For the prevention of the diarrhea, ordinary paregoric may be helpful. The diet should include soft foods, and vitamins are usually given, because the person who is having severe diarrhea with loss of appetite is quite certain not to get sufficient vitamins.
*26/318/5*