Hepatobiliary Sepsis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Sepsis is a critical medical condition characterized by the body's extreme response to bacteria, viruses, or other diseases. As a result, bacteria, viruses, and other pathogen toxins are released into the blood or tissues. Sepsis is otherwise called blood poisoning. Hepatobiliary sepsis is an infection spreading to the biliary tract. Hepatobiliary sepsis is a life-threatening condition that often results in death.

What Is Hepatobiliary Sepsis?

Hepatobiliary sepsis is a grave condition that rapidly progresses and leads to serious complications, often resulting in death. Hepatobiliary sepsis is an infection that spreads to the biliary tract. Biliary tract sepsis is a severe disease. The liver, gallbladder, and bile duct form the biliary system. Bile is secreted by the liver and transported by the biliary duct. The biliary tract is responsible for bile transportation. Sepsis is the most common cause of multi-organ failure. It is the body's inflammatory response against the pathogen's toxin.

The following condition characterizes sepsis:

• Hypertension (low blood pressure) below 100 mmHg.

• Altered mental status.

• Respiratory rate more than or equal to 22 breaths per minute.

What Causes Hepatobiliary Sepsis?

Proliferating clusters of bacteria resulting in infection are responsible for causing infection (sepsis). Any obstruction in the biliary tract due to infections or other causes can result in hepatobiliary sepsis. Infection within the biliary system can also lead to sepsis. Sometimes, an infection from the lungs or other organs can travel to the biliary tract, obstructing the excretion of the liver and resulting in infection. The following conditions cause hepatobiliary sepsis:

• Gall bladder stones (deposition of hard material).

• Cholangitis (inflammation of the bile duct).

• Cholestatic disease (a condition characterized by impaired bile flow).

• Hepatocellular carcinoma (liver cancer).

• Biliary cirrhosis (prolonged bile duct obstruction).

• Cholecystitis (inflammation of the gallbladder).

• Choledocholithiasis (stones in the common bile duct).

• Carcinoma of the gall bladder (gallbladder cancer).

• Cholangiocarcinoma (a condition in which a tumor can arise anywhere in the biliary tree).

• Adenomyomatosis of the gallbladder - a condition in which hyperplasia (enlargement or growth of tissue or organ) of the muscle and the mucosa of the gallbladder occurs.

• Liver cell damage.

• Surgery of gallbladder disease.

• Surgery of liver disease.

• Fibrosis of the portal tract of the liver.

• Immunocompromised patients, such as patients with human immunodeficiency virus (HIV) or tuberculosis, are susceptible to the broad spectrum of infectious microorganisms.

What Are the Signs and Symptoms of Hepatobiliary Sepsis?

The following are the symptoms of hepatobiliary sepsis:

• High fever.

• Loss of appetite.

• Nausea and vomiting.

• Severe abdominal pain.

• Pain in the shoulder.

• Jaundice.

• Generalized itching.

• Lethargy.

• Weakness.

• Confusion.

• Shortness of breath.

• Profuse sweating.

• Headache.

• Myalgia (muscle pain).

• Arthralgia (joint pain).

• Irritability.

• Depression.

• Fatigue.

• Weight loss.

• Hepatomegaly (liver enlargement).

• Mild splenomegaly (spleen enlargement).

The following are the signs of hepatobiliary sepsis:

• Hypertension (low blood pressure) below 100 mmHg.

• Altered mental status.

• Respiratory rate more than or equal to 22 breaths per minute.

• Jaundice.

• Pale stools.

• Dark urine.

• Low urine output.

How Is Hepatobiliary Sepsis Diagnosed?

Hepatobiliary sepsis is a condition that warrants immediate medical attention, and they need to be hospitalized. Hepatobiliary sepsis causes serious complications like multi-organ failure. Hepatobiliary sepsis can be diagnosed by physical examination, medical history of the patient, and investigations. The following methods help diagnose hepatobiliary sepsis:

• Physical Examination - A doctor can feel tenderness in the liver or abdomen on physical examination. Doctors can check for signs of jaundice, such as yellowing of skin, eyes, mucosa, and nails. The doctor can check for vitals to detect the location of the infection. The signs of sepsis can be found by examining vitals such as the patient's blood pressure, heart rate, and oxygen level.

• Medical History - The patient should be quizzed thoroughly on medical history and surgery as it could provide vital information regarding exposure to bacteria, a list of medications, or any habit or practice responsible for worsening the condition. Adequate attention should be paid to risk factors for human immunodeficiency virus (HIV), exposure to tuberculosis, and underlying immune status, which helps diagnose sepsis's cause while eliciting medical history.

• Blood Tests - A routine blood test helps diagnose the infection. The white blood cells count increases in case of an infection. Elevation in serum bilirubin level indicates jaundice, a common feature of liver disease.

• Urine Test - Urine culture can also help in detecting the infection. Low urine output is a common symptom seen in sepsis.

• Ultrasound - This technique allows visualization of the organ in the abdomen. Ultrasound can help measure the liver's size and help assess the adjacent organs affected by hepatomegaly.

• Computed Tomography Scan (CT Scan) - A CT scan of the chest and the abdomen with contrast is a high-yield test for sepsis. CT scan can help in detecting the course and location of the infection.

• Magnetic Resonance Imaging (MRI) - This technique helps obtain higher-resolution images of the abdomen.

How Is Hepatobiliary Sepsis Treated?

The treatment of hepatobiliary sepsis depends upon the underlying cause of sepsis and the history of prior infection. The treatment aims to control sepsis as it results in the deterioration of the patient's quality of life. The treatment is dependent upon hemorrhage or low cardiac output.

The following general measures should be taken to control sepsis:

• Early resuscitation can be done by following the sepsis six rule-

  • Deliver high-flow oxygen.
  • Take blood culture.
  • Start intravenous fluid replacement.
  • Administer intravenous antibiotics.
  • Measure serum lactate and send full blood count.
  • Note the accurate measurement of urine output.

• Red cell transfusion should be done to increase hemoglobin concentration in the patient.

• Early intubation (artificial ventilation) is recommended to reduce oxygen demand in severe cases.

• Broad-spectrum antibiotics should be administered immediately after suspected sepsis. The choice of antibiotic depends upon the patient's resistance, source of infection, and risk factors. First and second-generation cephalosporins (Cephalothin, Cephazolin, Cefamandole) can be administered.

• Medicines such as Dobutamine or Adrenaline can improve cardiac output in severe cases.

• Calcium should be replaced if ionized calcium is low.

Conclusion

Hepatobiliary sepsis is a critical condition requiring urgent medical attention. Early source control of sepsis is recommended as soon as physiological stability is established. Early source control requires accurate diagnosis, urgent investigation, and proper treatment. A broad-spectrum antibiotic should be administered as soon as possible without delay, as treatment is associated with a five to ten percent increase in mortality rate. Hepatobiliary sepsis could progress to a life-threatening condition if not diagnosed earlier. However, drainage of sepsis with good medical therapy can help improve this condition in one to three days with an eventual positive resolution.