- Nezam H Afdhal, MD, FRCPI
Nezam H Afdhal, MD, FRCPI
- Senior Physician in Hepatology
- Beth Israel Deaconess Medical Center
- Section Editors
- Sanjiv Chopra, MD, MACP
Sanjiv Chopra, MD, MACP
- Editor-in-Chief — Gastroenterology and Hepatology
- Section Editor — General Hepatology; Gallbladder and Biliary Tract Disease
- Professor of Medicine
- Harvard Medical School
- Senior Consultant in Hepatology
- James Tullis Firm Chief
- Beth Israel Deaconess Medical Center
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It is also referred to as ascending cholangitis. Cholangitis was first described by Charcot as a serious and life-threatening illness; however, it is now recognized that the severity can range from mild to life-threatening .
This topic will review the clinical features, diagnosis, and management of acute cholangitis. The approach to patients with primary sclerosing cholangitis, the management of common bile duct stones, and the endoscopic management of malignant biliary obstructions are discussed in detail elsewhere. (See "Primary sclerosing cholangitis in adults: Clinical manifestations and diagnosis" and "Primary sclerosing cholangitis in adults: Management" and "Endoscopic management of bile duct stones: Standard techniques and mechanical lithotripsy" and "Endoscopic stenting for malignant pancreaticobiliary obstruction".)
Acute cholangitis is caused primarily by bacterial infection in a patient with biliary obstruction. The organisms typically ascend from the duodenum; hematogenous spread from the portal vein is a rare source of infection .
The most important predisposing factor for acute cholangitis is biliary obstruction and stasis. The most common causes of biliary obstruction in patients with acute cholangitis without bile duct stents are biliary calculi (28 to 70 percent), benign stenosis (5 to 28 percent), and malignancy (10 to 57 percent) . In addition, acute cholangitis is a common complication of stent placement for malignant biliary obstruction (18 percent in one series) .
Mechanism of bacterial entry into the biliary tract — Bacteria are able to enter the biliary tract when the normal barrier mechanisms are disrupted. This may result in translocation of bacteria from the portal system or duodenum into the biliary tree.
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- Mechanism of bacterial entry into the biliary tract
- CLINICAL MANIFESTATIONS
- Symptoms and examination findings
- Laboratory tests
- DIFFERENTIAL DIAGNOSIS
- Managing sepsis
- Biliary drainage
- - Endoscopic retrograde cholangiopancreatography
- - Percutaneous approaches
- - Surgery
- Patients who are pregnant
- PREVENTING RECURRENCE
- SUMMARY AND RECOMMENDATIONS