Acute Cholangitis

4 Nov

OVERVIEW:
Acute cholangitis is a clinical syndrome resulting from stasis and infection in the biliary tract. 
–The most important predisposing factor for acute cholangitis is biliary obstruction and stasis, generally secondary to biliary calculi or a stricture.

CHARCOT’S TRIAD
–Fever (90%), RUQ pain (70%), and Jaundice (60%)
–As a whole only 50%-70% of cases possess all three

REYNOLD’S PENTAD:
–Same as above (fever, jaundince, RUQ pain) + AMS (10-20%) and hypotension (~30%)
–occurs in suppurative cholangitis, a more severe form of cholangitis with higher morbidity/mortality.

BACTERIA:
–E. coli, Enterococcus, Klebsiella, Enterobacter, and Anaerobes.

DIAGNOSIS:
-Charcot’s triad
–2/3 of Charcot’s triad + elevated liver enzymes + biliary dilatation based on the Tokyo Guidelines for diagnosis.

IMAGING:
–CBD dilatation is a common finding; RUQ ultrasound is the recommended first imaging test.
–After RUQ u/s, ERCP or MRCP to confirm diagnosis and intervene therapeutically with sphincterotomy, stone extraction, or stent insertion.




ANTIBIOTICS:

Zosyn OR Ancef
Meropenam
Ceftriaxone AND Flagyl
Ciprofloxacin AND Flagyl –80% of patients respond to conservative therapy with antibiotic therapy. Biliary drainage is emergently required in the remaining 20% (ERCP/MRCP).

10-SECOND RECAP:
–Acute cholangitis: biliary tract infection, usually 2/2 obstruction
–Charcot’s Triad: fever, jaundice, RUQ pain
–Reynold’s Pentad: charcot’s + AMS, hypotension
–Diagnosis: hx, labs/LFTs, RUQ u/s, ERCP/MRCP
–Treatment: antibiotics, ERCP/MRCP

Submitted by J. Grover.

Reference(s): Yusoff IF, Barkun JS, et al. “Diagnosis and management of cholecystitis and cholangitis.” Gastroenterol Clin N Am 32 (2003) 1145–1168, Uptodate. “Acute Cholangitis,” image

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