cholangitis

Definition & etiologies

(World J Gasrointest Pathophysiol 2018:9:1)

• Bile duct obstruction causes stasis → infection proximal to the obstruction
• Etiologies: BD stone (~85%); malignant (biliary, pancreatic) or benign stricture; infection w/ fluke (Clonorchis sinensis, Opisthorchis viverrini); recurrent pyrogenic cholangitis

Clinical manifestations

• Charcot’s triad: RUQ pain, jaundice, fever/chills; present in ~70% of Pts
• Reynolds’ pentad: Charcot’s triad + shock and Δ MS; present in ~15% of Pts

Diagnostic studies

• RUQ U/S: often demonstrates dilation of bile ducts
• Labs: ↑ WBC (with left shift), bilirubin, Aφ, amylase; may see ⊕ BCx
• ERCP; percutaneous transhepatic cholangiogram if ERCP unsuccessful

Treatment-cholangitis