Ascending cholangitis - Revision history

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:57:53Z

Add peer-reviewed references with PMIDs

← Revisión anterior		Revisión del 09:57 22 mar 2026
Línea 74:		Línea 74:
	***Dilatation of CBD ( > 6mm) and presence of choledocholithiasis		***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		***May miss small CBD stones and in acute cases CBD may not have had time to dilate
	*ERCP		*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		**Should be obtained to confirm the diagnosis and for possible intervention

Ostermayer: Marked this version for translation

2026-01-06T20:34:58Z

Marked this version for translation

← Revisión anterior		Revisión del 20:34 6 ene 2026
Línea 3:		Línea 3:


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

			<!--T:2-->
	*Also known as "acute cholangitis" or simply "cholangitis"		*Also known as "acute cholangitis" or simply "cholangitis"
	*Requires the presence of biliary obstruction and infected biliary tract		*Requires the presence of biliary obstruction and infected biliary tract
Línea 19:		Línea 20:


	===Causes===		===Causes=== <!--T:3-->

			<!--T:4-->
	*[[Special:MyLanguage/Choledocholithiasis\|Choledocholithiasis]]		*[[Special:MyLanguage/Choledocholithiasis\|Choledocholithiasis]]
	*Biliary tract stricture		*Biliary tract stricture
Línea 30:		Línea 32:


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

			<!--T:6-->
	*Charcot's Triad: [[Special:MyLanguage/Fever\|Fever]] + [[Special:MyLanguage/jaundice\|jaundice]] + [[Special:MyLanguage/RUQ pain\|RUQ pain]]		*Charcot's Triad: [[Special:MyLanguage/Fever\|Fever]] + [[Special:MyLanguage/jaundice\|jaundice]] + [[Special:MyLanguage/RUQ pain\|RUQ pain]]
	**Occurs in ~50%		**Occurs in ~50%
Línea 40:		Línea 43:


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

	</translate>		</translate>
Línea 48:		Línea 51:


	==Evaluation==		==Evaluation== <!--T:8-->

			<!--T:9-->
	[[File:CBD stones.jpg\|thumb\|MRCP image of two stones in the distal common bile duct]]		[[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.]]		[[File:Cholangitis.jpg\|thumb\|Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis.]]
Línea 58:		Línea 62:


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

			<!--T:11-->
	*Labs		*Labs
	**CBC: [[Special:MyLanguage/Leukocytosis\|Leukocytosis]] with neutrophil predominance		**CBC: [[Special:MyLanguage/Leukocytosis\|Leukocytosis]] with neutrophil predominance
Línea 74:		Línea 79:


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

			<!--T:13-->
	*Aggressive [[Special:MyLanguage/sepsis\|sepsis]] resuscitation		*Aggressive [[Special:MyLanguage/sepsis\|sepsis]] resuscitation



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

	</translate>		</translate>
Línea 88:		Línea 94:


	===Consultation===		===Consultation=== <!--T:15-->

			<!--T:16-->
	*Involvement with GI for ERCP and general surgery for acute cholecystectomy is necessary for source control and biliary decompression, sphincterotomy, and/or stenting		*Involvement with GI for ERCP and general surgery for acute cholecystectomy is necessary for source control and biliary decompression, sphincterotomy, and/or stenting



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

			<!--T:18-->
	*Admit		*Admit



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

			<!--T:20-->
	*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]		*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]



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

			<!--T:22-->
	<References/>		<References/>

			<!--T:23-->
	[[Category:GI]]		[[Category:GI]]
	[[Category:ID]]		[[Category:ID]]

	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:41:47Z

Prepared the page for translation

← Revisión anterior		Revisión del 21:41 4 ene 2026
Línea 1:		Línea 1:
	<languages/>		<languages/>
	<translate>		<translate>


	==Background==		==Background==
Línea 15:		Línea 16:
	{{Gallbladder disease types}}		{{Gallbladder disease types}}
	<translate>		<translate>



Línea 25:		Línea 27:
	**Most commonly pancreatic head cancer or cholangiocarcinoma		**Most commonly pancreatic head cancer or cholangiocarcinoma
	*Less commonly, parasitic obstruction from Ascaris spp or Clonorchis spp may lead to cholangitis		*Less commonly, parasitic obstruction from Ascaris spp or Clonorchis spp may lead to cholangitis



Línea 34:		Línea 37:
	**Occurs in <5%		**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		**[[Special:MyLanguage/Hypotension\|Hypotension]] or [[Special:MyLanguage/Altered mental status\|Altered mental status]] may be the only presenting sign in elderly patients



Línea 41:		Línea 45:
	{{DDX RUQ}}		{{DDX RUQ}}
	<translate>		<translate>



Línea 50:		Línea 55:
	**Criteria is based on signs/labs and can fit "suspected diagnosis" or "definite diagnosis"		**Criteria is based on signs/labs and can fit "suspected diagnosis" or "definite diagnosis"
	**Grading can guide surgical/endoscopic management		**Grading can guide surgical/endoscopic management



Línea 65:		Línea 71:
	*ERCP		*ERCP
	**Should be obtained to confirm the diagnosis and for possible intervention		**Should be obtained to confirm the diagnosis and for possible intervention



Línea 70:		Línea 77:

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



Línea 77:		Línea 85:
	{{Cholangitis antibiotics}}		{{Cholangitis antibiotics}}
	<translate>		<translate>



Línea 82:		Línea 91:

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



Línea 87:		Línea 97:

	*Admit		*Admit



Línea 92:		Línea 103:

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



Línea 100:		Línea 112:
	[[Category:GI]]		[[Category:GI]]
	[[Category:ID]]		[[Category:ID]]

	</translate>		</translate>

Ostermayer: Prepared the page for translation

2026-01-04T21:40:43Z

Prepared the page for translation

← Revisión anterior		Revisión del 21:40 4 ene 2026
Línea 1:		Línea 1:
			<languages/>
			<translate>

	==Background==		==Background==

	*Also known as "acute cholangitis" or simply "cholangitis"		*Also known as "acute cholangitis" or simply "cholangitis"
	*Requires the presence of biliary obstruction and infected biliary tract		*Requires the presence of biliary obstruction and infected biliary tract
Línea 5:		Línea 9:
	**Bacteria can enter systemic circulation via hepatic sinusoids and lead to septic picture; this can occur rapidly		**Bacteria can enter systemic circulation via hepatic sinusoids and lead to septic picture; this can occur rapidly

			</translate>
	{{Gallbladder background}}		{{Gallbladder background}}
			<translate>
			</translate>
	{{Gallbladder disease types}}		{{Gallbladder disease types}}
			<translate>


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


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


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{DDX RUQ}}		{{DDX RUQ}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:CBD stones.jpg\|thumb\|MRCP image of two stones in the distal common bile duct]]		[[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.]]		[[File:Cholangitis.jpg\|thumb\|Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis.]]
Línea 32:		Línea 50:
	**Criteria is based on signs/labs and can fit "suspected diagnosis" or "definite diagnosis"		**Criteria is based on signs/labs and can fit "suspected diagnosis" or "definite diagnosis"
	**Grading can guide surgical/endoscopic management		**Grading can guide surgical/endoscopic management


	===Work-up===		===Work-up===

	*Labs		*Labs
	**CBC: [[Leukocytosis]] with neutrophil predominance		**CBC: [[Special:MyLanguage/Leukocytosis\|Leukocytosis]] with neutrophil predominance
	**[[LFTs]]: Elevated alk phos and conjugated bilirubin		**[[Special:MyLanguage/LFTs\|LFTs]]: Elevated alk phos and conjugated bilirubin
	**GGT elevation much more sensitive than alk phos		**GGT elevation much more sensitive than alk phos
	**Blood cultures		**Blood cultures
	*Imaging		*Imaging
	**[[Biliary ultrasound\|RUQ Ultrasound]]		**[[Special:MyLanguage/Biliary ultrasound\|RUQ Ultrasound]]
	***Dilatation of CBD ( > 6mm) and presence of choledocholithiasis		***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		***May miss small CBD stones and in acute cases CBD may not have had time to dilate
	*ERCP		*ERCP
	**Should be obtained to confirm the diagnosis and for possible intervention		**Should be obtained to confirm the diagnosis and for possible intervention


	==Management==		==Management==
	*Aggressive [[sepsis]] resuscitation
			*Aggressive [[Special:MyLanguage/sepsis\|sepsis]] resuscitation


	===Antibiotics===		===Antibiotics===

			</translate>
	{{Cholangitis antibiotics}}		{{Cholangitis antibiotics}}
			<translate>


	===Consultation===		===Consultation===

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


	==Disposition==		==Disposition==

	*Admit		*Admit


	==See Also==		==See Also==
	*[[Gallbladder Disease (Main)]]
			*[[Special:MyLanguage/Gallbladder Disease (Main)\|Gallbladder Disease (Main)]]


	==References==		==References==

	<References/>		<References/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:ID]]		[[Category:ID]]
			</translate>

Patricklin at 01:36, 21 November 2023

2023-11-21T01:36:02Z

← Revisión anterior		Revisión del 01:36 21 nov 2023
Línea 2:		Línea 2:
	*Also known as "acute cholangitis" or simply "cholangitis"		*Also known as "acute cholangitis" or simply "cholangitis"
	*Requires the presence of biliary obstruction and infected biliary tract		*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 background}}
Línea 9:		Línea 11:
	*[[Choledocholithiasis]]		*[[Choledocholithiasis]]
	*Biliary tract stricture		*Biliary tract stricture
			**Congenital strictures, or due to past biliary instrumentation, or due to [[Primary sclerosing cholangitis]]
	*Compression by malignant disease		*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==		==Clinical Features==
Línea 16:		Línea 21:
	*Reynold's Pentad: The triad + [[altered mental status]] + [[hypotension]]		*Reynold's Pentad: The triad + [[altered mental status]] + [[hypotension]]
	**Occurs in <5%		**Occurs in <5%
	**[[Hypotension]] may be the only presenting sign in elderly patients		**[[Hypotension]] or [[Altered mental status]] may be the only presenting sign in elderly patients

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 24:		Línea 29:
	[[File:CBD stones.jpg\|thumb\|MRCP image of two stones in the distal common bile duct]]		[[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.]]		[[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===		===Work-up===
	*Labs		*Labs
Línea 44:		Línea 53:

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

	==Disposition==		==Disposition==

Rossdonaldson1: /* Evaluation */

2020-05-02T13:13:04Z

Evaluation

← Revisión anterior		Revisión del 13:13 2 may 2020
Línea 23:		Línea 23:
	==Evaluation==		==Evaluation==
	[[File:CBD stones.jpg\|thumb\|MRCP image of two stones in the distal common bile duct]]		[[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.]]
	===Work-up===		===Work-up===
	*Labs		*Labs

Rossdonaldson1: /* Background */

2020-05-02T12:24:33Z

Background

← Revisión anterior		Revisión del 12:24 2 may 2020
Línea 1:		Línea 1:
	==Background==		==Background==
	*Also known as "~~ascending~~ cholangitis"		*Also known as "acute cholangitis" or simply "cholangitis"
	*Requires the presence of biliary obstruction and infected biliary tract		*Requires the presence of biliary obstruction and infected biliary tract

Rossdonaldson1: Rossdonaldson1 moved page Cholangitis to Ascending cholangitis

2020-05-02T12:23:57Z

Rossdonaldson1 moved page Cholangitis to Ascending cholangitis

← Revisión anterior	Revisión del 12:23 2 may 2020
(Sin diferencias)

Rossdonaldson1 at 12:21, 2 May 2020

2020-05-02T12:21:32Z

← Revisión anterior		Revisión del 12:21 2 may 2020
Línea 53:		Línea 53:
	==References==		==References==
	<References/>		<References/>


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

ClaireLewis at 19:47, 29 September 2019

2019-09-29T19:47:59Z

← Revisión anterior		Revisión del 19:47 29 sep 2019
Línea 7:		Línea 7:

	===Causes===		===Causes===
	*Choledocholithiasis		*[[Choledocholithiasis]]
	*Biliary tract stricture		*Biliary tract stricture
	*Compression by malignant disease		*Compression by malignant disease
Línea 25:		Línea 25:
	===Work-up===		===Work-up===
	*Labs		*Labs
	**Leukocytosis with neutrophil predominance		**CBC: [[Leukocytosis]] with neutrophil predominance
	**Elevated alk phos and conjugated bilirubin		**[[LFTs]]: Elevated alk phos and conjugated bilirubin
	**GGT elevation much more sensitive than alk phos		**GGT elevation much more sensitive than alk phos
	**Blood cultures		**Blood cultures
Línea 38:		Línea 38:
	==Management==		==Management==
	*Aggressive [[sepsis]] resuscitation		*Aggressive [[sepsis]] resuscitation

	===Antibiotics===		===Antibiotics===
	{{Cholangitis antibiotics}}		{{Cholangitis antibiotics}}

	===Consultation===		===Consultation===
	Involvement with GI for ERCP and general surgery for acute cholecystectomy is necessary for source control and biliary decompression		*Involvement with GI for ERCP and general surgery for acute cholecystectomy is necessary for source control and biliary decompression

	==Disposition==		==Disposition==