https://wikem.org/w/index.php?action=history&feed=atom&title=Ascending_cholangitis%2FenAscending cholangitis/en - Revision history2026-04-19T15:01:28ZRevision history for this page on the wikiMediaWiki 1.38.2https://wikem.org/w/index.php?title=Ascending_cholangitis/en&diff=379991&oldid=prevFuzzyBot: Updating to match new version of source page2026-01-06T21:12:13Z<p>Updating to match new version of source page</p>
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==Background==<br />
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*Also known as "acute cholangitis" or simply "cholangitis"<br />
*Requires the presence of biliary obstruction and infected biliary tract<br />
**Biliary obstruction leads to cholestasis, leading to bacterial ascent from duodenum<br />
**Bacteria can enter systemic circulation via hepatic sinusoids and lead to septic picture; this can occur rapidly<br />
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{{Gallbladder background}}<br />
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{{Gallbladder disease types}}<br />
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===Causes===<br />
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*[[Special:MyLanguage/Choledocholithiasis|Choledocholithiasis]]<br />
*Biliary tract stricture<br />
**Congenital strictures, or due to past biliary instrumentation, or due to [[Special:MyLanguage/Primary sclerosing cholangitis|Primary sclerosing cholangitis]]<br />
*Compression by malignant disease<br />
**Most commonly pancreatic head cancer or cholangiocarcinoma<br />
*Less commonly, parasitic obstruction from Ascaris spp or Clonorchis spp may lead to cholangitis<br />
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==Clinical Features==<br />
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*Charcot's Triad: [[Special:MyLanguage/Fever|Fever]] + [[Special:MyLanguage/jaundice|jaundice]] + [[Special:MyLanguage/RUQ pain|RUQ pain]]<br />
**Occurs in ~50%<br />
*Reynold's Pentad: The triad + [[Special:MyLanguage/altered mental status|altered mental status]] + [[Special:MyLanguage/hypotension|hypotension]]<br />
**Occurs in <5%<br />
**[[Special:MyLanguage/Hypotension|Hypotension]] or [[Special:MyLanguage/Altered mental status|Altered mental status]] may be the only presenting sign in elderly patients<br />
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==Differential Diagnosis==<br />
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{{DDX RUQ}}<br />
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==Evaluation==<br />
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[[File:CBD stones.jpg|thumb|MRCP image of two stones in the distal common bile duct]]<br />
[[File:Cholangitis.jpg|thumb|Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis.]]<br />
*Tokyo Guidelines for Acute Cholangitis 2018 (See MDCalc)<br />
**Criteria is based on signs/labs and can fit "suspected diagnosis" or "definite diagnosis"<br />
**Grading can guide surgical/endoscopic management<br />
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===Work-up===<br />
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*Labs<br />
**CBC: [[Special:MyLanguage/Leukocytosis|Leukocytosis]] with neutrophil predominance<br />
**[[Special:MyLanguage/LFTs|LFTs]]: Elevated alk phos and conjugated bilirubin<br />
**GGT elevation much more sensitive than alk phos<br />
**Blood cultures<br />
*Imaging<br />
**[[Special:MyLanguage/Biliary ultrasound|RUQ Ultrasound]]<br />
***Dilatation of CBD ( > 6mm) and presence of choledocholithiasis<br />
***May miss small CBD stones and in acute cases CBD may not have had time to dilate<br />
*ERCP<br />
**Should be obtained to confirm the diagnosis and for possible intervention<br />
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==Management==<br />
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*Aggressive [[Special:MyLanguage/sepsis|sepsis]] resuscitation<br />
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===Antibiotics===<br />
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{{Cholangitis antibiotics}}<br />
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===Consultation===<br />
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*Involvement with GI for ERCP and general surgery for acute cholecystectomy is necessary for source control and biliary decompression, sphincterotomy, and/or stenting<br />
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==Disposition==<br />
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*Admit<br />
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==See Also==<br />
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*[[Special:MyLanguage/Gallbladder Disease (Main)|Gallbladder Disease (Main)]]<br />
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==References==<br />
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<References/><br />
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[[Category:GI]]<br />
[[Category:ID]]</div>FuzzyBot