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Acute Gallstone CholangitisAka: Ascending Cholangitis, Cholangitis, Charcot's Triad, Reynold's Pentad
- Epidemiology
- Incidence rare under age 40 years
- Causes
- Choledocolithiasis
- Biliary tract stricture
- Surgical anastomotic stricture
- Extrinsic compression from malignancy
- Pathophysiology
- Complete biliary obstruction in presence of bacteria
- Gram Negative Bacteria
- Enterococci
- Anaerobic bascteria
- Reflux of bacteria into the lymphatics, hepatitic veins
- Results in systemic spread
- Symptoms and Signs
- Charcot's Triad (seen in only 25% of patients)
- Fever
- Jaundice
- Right Upper Quadrant pain
- Reynold's Pentad (seen in only 14% of patients)
- Charcot's Triad and
- Shock and
- Altered mental status
- Other symptoms and signs
- Nausea or Vomiting
- Hepatomegaly (with tender liver edge)
- Splenomegaly
- Labs
- Complete Blood Count
- Leukocytosis
- Liver Function Tests abnormal
- Bilirubin elevated in urine and plasma (40% of cases)
- Serum alkaline phsophatase elevated
- Blood Cultures (positive in 50% of cases)
- Prognosis
- Mortality 100% if missed or incorrectly treated
- Management
- Volume Resuscitation
- Vasopressor support as needed
- Broad spectrum parenteral antibiotics
- Rapid decompression of biliary tree
- Endoscopy with ERCP and sphincterotomy
- May be preferred as initial intervention
- Open common bile duct exploration
- High mortality and morbidity
- References
- Poon (2001) Arch Surg 136:11
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| Definition (MSH) | Inflammation of the biliary ductal system (BILE DUCTS); intrahepatic, extrahepatic, or both. |
| Concepts | Disease or Syndrome (T047)
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| ICD9 | 576.1 |
| English | cholangeitis, Cholangitides, Cholangitis, Form of cholangitis, INFLAMMATION BILE DUCT |
| French | Cholangite |
| Italian | Colangite |
| Spanish | colangitis, forma de colangitis |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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