Ver el código de «Ascending cholangitis»

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==Background== <!--T:1-->

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*Also known as "acute cholangitis" or simply "cholangitis"
*Requires the presence of biliary obstruction and infected biliary tract
**Biliary obstruction leads to cholestasis, leading to bacterial ascent from duodenum
**Bacteria can enter systemic circulation via hepatic sinusoids and lead to septic picture; this can occur rapidly

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{{Gallbladder background}}
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{{Gallbladder disease types}}
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===Causes=== <!--T:3-->

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*[[Special:MyLanguage/Choledocholithiasis|Choledocholithiasis]]
*Biliary tract stricture
**Congenital strictures, or due to past biliary instrumentation, or due to [[Special:MyLanguage/Primary sclerosing cholangitis|Primary sclerosing cholangitis]]
*Compression by malignant disease
**Most commonly pancreatic head cancer or cholangiocarcinoma
*Less commonly, parasitic obstruction from Ascaris spp or Clonorchis spp may lead to cholangitis



==Clinical Features== <!--T:5-->

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*Charcot's Triad: [[Special:MyLanguage/Fever|Fever]] + [[Special:MyLanguage/jaundice|jaundice]] + [[Special:MyLanguage/RUQ pain|RUQ pain]]
**Occurs in ~50%
*Reynold's Pentad: The triad + [[Special:MyLanguage/altered mental status|altered mental status]] + [[Special:MyLanguage/hypotension|hypotension]]
**Occurs in <5%
**[[Special:MyLanguage/Hypotension|Hypotension]] or [[Special:MyLanguage/Altered mental status|Altered mental status]] may be the only presenting sign in elderly patients



==Differential Diagnosis== <!--T:7-->

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{{DDX RUQ}}
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==Evaluation== <!--T:8-->

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[[File:CBD stones.jpg|thumb|MRCP image of two stones in the distal common bile duct]]
[[File:Cholangitis.jpg|thumb|Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis.]]
*Tokyo Guidelines for Acute Cholangitis 2018 (See MDCalc)
**Criteria is based on signs/labs and can fit "suspected diagnosis" or "definite diagnosis"
**Grading can guide surgical/endoscopic management



===Work-up=== <!--T:10-->

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*Labs
**CBC: [[Special:MyLanguage/Leukocytosis|Leukocytosis]] with neutrophil predominance
**[[Special:MyLanguage/LFTs|LFTs]]: Elevated alk phos and conjugated bilirubin
**GGT elevation much more sensitive than alk phos
**Blood cultures
*Imaging
**[[Special:MyLanguage/Biliary ultrasound|RUQ Ultrasound]]
***Dilatation of CBD ( > 6mm) and presence of choledocholithiasis
***May miss small CBD stones and in acute cases CBD may not have had time to dilate
*ERCP<ref>Miura F, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):47-54. PMID 23307007</ref>
**Should be obtained to confirm the diagnosis and for possible intervention



==Management== <!--T:12-->

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*Aggressive [[Special:MyLanguage/sepsis|sepsis]] resuscitation



===Antibiotics=== <!--T:14-->

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{{Cholangitis antibiotics}}
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===Consultation=== <!--T:15-->

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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



==Disposition== <!--T:17-->

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*Admit



==See Also== <!--T:19-->

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*[[Special:MyLanguage/Gallbladder Disease (Main)|Gallbladder Disease (Main)]]



==References== <!--T:21-->

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<References/>

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[[Category:GI]]
[[Category:ID]]

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