Talk:Ascending cholangitis/GA1

GA Review

I am currently reviewing "Ascending cholangitis" for "Good article" status. Axl (talk) 17:53, 2 July 2008 (UTC)[reply]

The journal titles in the references section are inconsistently formatted. Some have full stops (periods) after the abbreviations while others don't. Axl (talk) 18:19, 2 July 2008 (UTC)[reply]

From "Signs and symptoms": "Reynolds' pentad includes the findings of Charcot's triad with the presence of septic shock and mental confusion." What is the frequency of Reynolds' pentad? Axl (talk) 18:29, 2 July 2008 (UTC)[reply]

From "Diagnosis", "Blood tests": "In the early stages, however, pressure on the liver cells may be the main feature and the tests will resemble those in hepatitis, with elevations in alanine transaminase and aspartate transaminase." Is this really true? I'm reading "Oxford Textbook of Clinical Hepatology" and there's no mention of this. Unfortunately my hospital library doesn't stock "Gastrointestinal clinics of North America". Axl (talk) 18:25, 2 July 2008 (UTC)[reply]

From "Diagnosis", "Medical imaging": "Compared to ERCP (see below), this modality may show dilation of the bile duct and identifies 38% of bile duct stones; it is relatively poor at identifying stones further down the bile duct." This sentence is rather awkward and should be split.The first part of the sentence: "Compared to ERCP, this modality may show dilation..." doesn't really make sense. Axl (talk) 18:51, 2 July 2008 (UTC)[reply]

From "Diagnosis", "Medical imaging": "If other causes rather than gallstones are suspected, such as tumors, computed tomography and endoscopic ultrasound...." When I first read this, it seemed that CT and EUS are causes of cholangitis. Axl (talk) 18:58, 2 July 2008 (UTC)[reply]

The "Causes" section is inadequate. "Postoperative damage" is mentioned. However there should be more information about iatrogenic causes. As well as biliary surgery, ERCP and PTC themselves can cause cholangitis. There should also be some discussion about the use of prophylactic antibiotics. Axl (talk) 19:08, 2 July 2008 (UTC)[reply]

From "Pathogenesis": "The duodenum is relatively rich in bacteria also found in the large intestine." It is? The Oxford textbook states "The duodenum and jejunum contain only scant Gram-positive organisms under normal circumstances." Similarly from Gorbach & Taqabchali. Axl (talk) 19:34, 2 July 2008 (UTC)[reply]

~~In "Pathogenesis", the pressure in the biliary system isn't mentioned. Huang discussed it: "The significance of biliary pressure in cholangitis", pmid: 4888283. Axl (talk) 19:44, 2 July 2008 (UTC)~~[reply]

Correction: The importance of the biliary pressure should be emphasized more, perhaps by placing the paragraph higher up. Also, the values of the pressure should be mentioned, as per Huang. [I can do this if necessary.] Axl (talk) 20:29, 2 July 2008 (UTC)[reply]

In "Pathogenesis": "It is important in this mode of proposed pathogenesis that the obstruction be partial, and not complete as the latter would not allow the bacteria to ascend upward and contaminate the biliary tree." Reference 1 is quoted. Is there actually any evidence for this? Axl (talk) 19:51, 2 July 2008 (UTC)[reply]

In "Pathogenesis": "systemic inflammatory response syndrome (SIRS) comprising fever, rigors, low blood pressure, and increased respiratory rate." SIRS comprises two of four features: fever (or low temperature), tachycardia, tachypnoea and extreme white cell count. Axl (talk) 20:32, 2 July 2008 (UTC)[reply]

The caption for the picture in "Medical imaging" mentions a "nasobiliary drain". I can guess what this means, although I've never heard of it before. Axl (talk) 21:01, 2 July 2008 (UTC)[reply]