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{{Infobox_Disease |
__NOTOC__
  Name          = {{PAGENAME}} |
{| class="infobox" style="float:right;"
  Image          = Recurrent_pyogenic_cholangitis_MRI_105.jpg|
|-
  Caption        = Recurrent pyogenic cholangitis. <br> ([http://www.radswiki.net Image courtesy of RadsWiki])|
| [[File:Siren.gif|link=Cholangitis resident survival guide|41x41px]]|| <br> || <br>
  DiseasesDB    = 2514 |
| [[Cholangitis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
  ICD10          = {{ICD10|K|83|0|k|80}} |
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  ICD9          = {{ICD9|576.1}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 2665 |
  eMedicine_mult = {{eMedicine2|emerg|96}} |  
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{{Cholangitis}}
{{Cholangitis}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''


{{CMG}}
{{CMG}} '''Assosciate Editor(s)-In-Chief:''' {{ADS}}, [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]], {{FH}}


{{Editor Help}}
{{SK}} Cholangitis; bile duct infection; bile duct inflammation; common bile duct inflammation; common bile duct infection


==[[Cholangitis overview|Overview]]==
==[[Cholangitis overview|Overview]]==


==[[Cholangitis historical perspective|Historical Perspective]]==
==[[Cholangitis historical perspective|Historical Perspective]]==
==[[Cholangitis classification|Classification]]==


==[[Cholangitis pathophysiology|Pathophysiology]]==
==[[Cholangitis pathophysiology|Pathophysiology]]==


==[[Cholangitis epidemiology and demographics|Epidemiology & Demographics]]==
==[[Cholangitis causes|Causes]]==
==[[Cholangitis differential diagnosis|Differentiating Cholangitis from other Diseases]]==
 
==[[Cholangitis epidemiology and demographics|Epidemiology and Demographics]]==


==[[Cholangitis risk factors|Risk Factors]]==
==[[Cholangitis risk factors|Risk Factors]]==
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==[[Cholangitis screening|Screening]]==
==[[Cholangitis screening|Screening]]==


==[[Cholangitis causes|Causes]]==
==[[Cholangitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
==[[Cholangitis differential diagnosis|Differentiating Cholangitis]]==
 
==[[Cholangitis natural history|Complications & Prognosis]]==


==Diagnosis==
==Diagnosis==
[[Cholangitis history and symptoms|History and Symptoms]] | [[Cholangitis physical examination|Physical Examination]] | [[Cholangitis staging|Staging]] | [[Cholangitis laboratory tests|Laboratory tests]] | [[Cholangitis electrocardiogram|Electrocardiogram]]  | [[Cholangitis x ray|X Rays]] | [[Cholangitis CT|CT]] | [[Cholangitis MRI|MRI]] [[Cholangitis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cholangitis other imaging findings|Other images]] | [[Cholangitis other diagnostic studies|Alternative diagnostics]]
[[Cholangitis history and symptoms|History and Symptoms]] | [[Cholangitis physical examination|Physical Examination]] | [[Cholangitis laboratory findings|Laboratory findings]] | [[Cholangitis x ray|X Ray]] | [[Cholangitis CT|CT]] | [[Cholangitis MRI|MRI]] | [[Cholangitis ultrasound|Ultrasound]] | [[Cholangitis other imaging findings|Other Imaging Findings]] | [[Cholangitis other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
[[Cholangitis medical therapy|Medical therapy]] | [[Cholangitis surgery|Surgical options]] | [[Cholangitis primary prevention|Primary prevention]]  | [[Cholangitis secondary prevention|Secondary prevention]] | [[Cholangitis cost-effectiveness of therapy|Financial costs]] | [[Cholangitis future or investigational therapies|Future therapies]]
[[Cholangitis medical therapy|Medical Therapy]] | [[Cholangitis surgery|Surgery]] | [[Cholangitis primary prevention|Primary Prevention]] | [[Cholangitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Cholangitis future or investigational therapies|Future or Investigational Therapies]]
 
== Diagnosis ==
 
50-60% of patients will have all three of Charcot’s triad.  95% will have fever, 66% [[abdominal pain]], jaundice is noted in 80% (When [[bilirubin]] >2.5).  Nonobstructive stones are more likely to present without pain or fever.  Elderly patients may present only with [[hypotension]].  Dark urine is noted and acholia can be seen.
 
The combination of [[hyperbilirubinemia]], elevated [[white blood cell]] (WBC) count with bandemia, [[aspartate aminotransferase]] (AST), [[alanine aminotransferase]] (ALT) and [[alkaline phosphatase]] elevations all suggest the diagnosis.  Alkaline phosphatase and bilirubin are significantly higher inpatients with [[malignant]] rather than [[benign]] obstruction.  In benign obstruction, the bilirubin rarely exceeds 12.  [[Gamma-glutamyltransferase]] (GGT) and 5’-nucleotidase confirm a biliary origin of the alkaline phosphatase.  The [[prothrombin]] time is often elevated.  AST and ALT may be as high as 1000, especially if microabcesses form.
 
=== [[MRI]] and [[CT]] ===
 
CT has a higher sensitivity (63%) and is better to localize the site of obstruction.
 
===MRI===
 
([http://www.radswiki.net Images courtesy of RadsWiki])
 
<gallery>
Image:Recurrent_pyogenic_cholangitis_MRI_101.jpg|Recurrent pyogenic cholangitis
Image:Recurrent_pyogenic_cholangitis_MRI_102.jpg|Recurrent pyogenic cholangitis
</gallery>
 
<gallery>
Image:Recurrent_pyogenic_cholangitis_MRI_103.jpg|Recurrent pyogenic cholangitis
Image:Recurrent_pyogenic_cholangitis_MRI_104.jpg|Recurrent pyogenic cholangitis
</gallery>
 
<gallery>
Image:Recurrent_pyogenic_cholangitis_MRI_105.jpg|Recurrent pyogenic cholangitis
Image:Recurrent_pyogenic_cholangitis_MRI_106.jpg|Recurrent pyogenic cholangitis
</gallery>
 
=== Other Imaging Findings ===
 
*[[Ultrasound]]: Diagnostic evaluation should proceed first with ultrasound which has an 55-85% sensitivity.  Small stones in the common bile duct may be missed.  The CBD may not be enlarged early or if the stones has passed.  The ducts may be totally normal in PSC.
 
== Treatment ==
 
80% of patients with acute cholangitis will respond to conservative therapy and elective drainage.  In 15-20%, the cholangitis will progress requiring emergent drainage.  Markers for these people are persistent abdominal pain, hypotensive, fever >102, and confusion.
 
Patients should be kept [[Nil per os|NPO]], given [[IVF]], broad spectrum ABX, [[Vitamin K]] and be drained.  Choices for drainage are [[ERCP]] with stone removal and [[sphincterotomy]]/[[stent]] placement, surgically drainage or percutaneous drainage. Intra[[hepatic]] stones cannot be removed via ERCP and should be drained [[percutaneously]].  [[Clinical trial#Design|Randomized trial]]s comparing ERCP and [[surgery]] showed [[morbidity]] and [[mortality]] benefit for ERCP (4.7-10% versus 10-50%).  A nasobiliary catheter can be placed if ERCP is impossible (<5%) either because of [[coagulopathy]] precluding sphincterotomy, too large a stone (>2cm) etc.  Next step should be percutaneous drainage as a bridge to elective surgery since emergent surgery has an up to 40% mortality.


== References ==
==Case Studies==
{{Reflist|2}}
[[Cholangitis case study one|Case #1]]


{{Gastroenterology}}
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Surgery]]

Latest revision as of 03:10, 1 December 2020
Resident
Survival
Guide

Cholangitis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cholangitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Amandeep Singh M.D.[2], Prashanth Saddala M.B.B.S, Farwa Haideri [3]

Synonyms and keywords: Cholangitis; bile duct infection; bile duct inflammation; common bile duct inflammation; common bile duct infection

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cholangitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory findings | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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