Ver el código de «Ascending cholangitis/en»

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==Background==

*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

{{Gallbladder background}}

{{Gallbladder disease types}}



===Causes===

*[[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==

*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==

{{DDX RUQ}}



==Evaluation==

[[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===

*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
**Should be obtained to confirm the diagnosis and for possible intervention



==Management==

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



===Antibiotics===

{{Cholangitis antibiotics}}



===Consultation===

*Involvement with GI for ERCP and general surgery for acute cholecystectomy is necessary for source control and biliary decompression, sphincterotomy, and/or stenting



==Disposition==

*Admit



==See Also==

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



==References==

<References/>

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