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{{CMG}} {{AE}} {{FH}}
 
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{{Cholangitis}}
{{Cholangitis}}
==Overview==
==Overview==
Cholangitis is commonly caused by [[bacterial infection]]s, which can occur when the [[common bile duct]] (CBD) is obstructed.
Cholangitis is usually caused by a [[bacterial infection]], which can occur when there is blockage in the [[bile duct]], such as a [[gallstone]] or [[tumor]]. The [[infection]] causing this condition may also spread to the [[liver]].


==Causes==
==Causes==
===Common Causes===
===Life-threatening causes===
The most common causes of biliary obstruction are [[Gallstone|biliary calculi]], benign stricture or malignant [[neoplasms]]. Benign strictures are caused by primary [[Sclerotherapy|sclerosing]] cholangitis, [[ischemic]] cholangitis, [[iatrogenic]] [[biliary tract]] injury, [[congenital disease]] and [[infection]].  Chronic inflammation predisposed to the development of cholangiocarcinoma.  Extraluminal obstruction can occur from [[pancreatic cancer]] or [[pseudocyst]], [[lymphoma]], [[hepatoma]], [[metastatic]] disease or ampullary cancer. Any condition in the CBD that leads to [[stasis]], including benign or malignant [[stricture]], parasitic infection, or extrinsic compression by the [[pancreas]] can result in bacterial infection and cholangitis. There is a higher rate of infection due to partial obstruction of the CBD compared to a complete obstruction.<ref> Acute Cholangitis Clinical Presentation. MedScape (2016). http://emedicine.medscape.com/article/774245-clinical#b5  Accessed on April 1, 2016</ref>
Acute suppurative cholangitis is a life-threatening cause of cholangitis.
 
===Other Causes===
Bile duct obstructions are generally due to [[gallstones]]. 10-30% of cases are due to other causes, such as:<ref "name=246"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Causes  Accessed on April 1, 2016</ref>
*[[Benign stricture]]: narrowing of the bile duct without an underlying tumor
* Postoperative damage or altered structure of bile duct, such as narrowing at site of an [[anastomosis]]
*Various tumors (cancer of the bile duct, [[gallbladder]], [[ampulla of Vater]], [[pancreas]], or [[duodenum]]).
*Anaerobic organisms such as [[Clostridium]] and [[Bacteroides]]


Parasites can infect the liver and bile ducts, which can also cause cholangitis. These include:<ref "name=246"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Causes  Accessed on April 1, 2016</ref>
===Common causes===
*Roundworm [[Ascaris lumbricoides]]
Cholangitis is usually caused by [[bile]] stasis. It is the ascending infection of the [[bile duct]] by [[bacteria]], and/or [[parasites]].
*Liver flukes [[Clonorchis sinensis]]
*[[Opisthorchis viverrini]]
*[[Opisthorchis felineus]]


In people with AIDS, a large number of opportunistic organisms has been known to cause AIDS cholangiopathy, but the risk has rapidly diminished since the introduction of effective AIDS treatment.<ref "name=246"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Causes  Accessed on April 1, 2016</ref>
Cholangitis may be caused by:
* [[Bile]] stasis
**[[Choledocholithiasis]]/dislodged [[gallstones]] ([[cholelithiasis]]) 
**Biliary [[Stricture|strictures]]
*[[Bacterial]] infection
**[[Escherichia coli]] 
**[[Klebsiella]]
**[[Enterococcus]]
**[[Enterobacter]]
**[[Bacteroides]]
**[[Clostridia]]
* [[Malignancy]]
**[[Pancreatic cancer|Cancer of the pancreatic head]]
**[[Cholangiocarcinoma]]
*[[Endoscopic retrograde cholangiopancreatography]] ([[ERCP]])
*[[Biliary tract]] surgery with [[common bile duct]] implantment<ref>{{Cite web|url=https://books.google.com/books?id=Z67nCAAAQBAJ&pg=PA16&lpg=PA16&dq=paralytic+ileus+and+cholangitis&source=bl&ots=EN_c_A_D4F&sig=tzVoAltXsoltCH6_KkdcTi_qaiU&hl=en&sa=X&ved=0ahUKEwiywPaJu4zXAhVp5IMKHWZzB7AQ6AEIRjAG#v=onepage&q=paralytic%20ileus%20and%20cholangitis&f=false|title=|last=|first=|date=|website=|publisher=|access-date=}}</ref>e.g. resection of the [[carcinoma]] of [[ampulla of Vater]]


===Causes by Organ System===
===Less common causes===
{|style="width:80%; height:100px" border="1"
Less common causes of [[cholangitis]] include:
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
*[[Parasitic]] infections:
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
**[[Ascaris lumbricoides]] 
**[[Clonorchis sinensis]]
**[[Opisthorchis viverrini]]
**Ogatpisthorchis felineus
**[[Taenia saginata]]
* [[Malignancy]]
**[[Hepatoma]]<ref name="Serradilla MartinPalomares Cano2016">{{cite journal|last1=Serradilla Martin|first1=M.|last2=Palomares Cano|first2=A.|last3=Dabán Collado|first3=E.|last4=Medina Cuadros|first4=M.|title=Acute cholangitis secondary to main bile duct thrombi for hepatocellular carcinoma|journal=HPB|volume=18|year=2016|pages=e745–e746|issn=1365182X|doi=10.1016/j.hpb.2016.01.225}}</ref>
**[[Lymphoma]]
**[[Metastasis]] to [[bile duct]]
===Causes by organ system===
{| style="width:80%; height:100px" border="1"
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" |'''Cardiovascular'''
| style="width:75%" bgcolor="Beige" ; border="1" | No underlying causes
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
| bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|  [[Cidofovir]], [[Sorafenib]], [[Teduglutide]]
| bgcolor="Beige" |  [[Cidofovir]], [[Sorafenib]], [[Teduglutide]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Cholelithiasis]], Biliary [[stricture]], [[Pancreatic cancer]], [[Primary sclerosing cholangitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Endoscopic retrograde cholangiopancreatography]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Escherichia coli]], [[Klebsiella]], [[Enterococcus]], [[Enterobacter]], [[Bacteroides]], [[Clostridia]], [[Ascaris lumbricoides]], [[Clonorchis sinensis]], ''[[Opisthorchis viverrini]], [[Opisthorchis felineus]], [[Taenia saginata]]''
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Pancreatic cancer|Cancer of the pancreatic head]], [[Cholangiocarcinoma]], [[Lymphoma]], [[Hepatoma]], [[Metastasis]] to [[bile duct]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|}
|}
===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Cidofovir]]
*[[Sorafenib]]
{{col-break|width=33%}}
{{col-break|width=33%}}
{{col-end}}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 20:54, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Farwa Haideri [3]

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Overview

Cholangitis is usually caused by a bacterial infection, which can occur when there is blockage in the bile duct, such as a gallstone or tumor. The infection causing this condition may also spread to the liver.

Causes

Life-threatening causes

Acute suppurative cholangitis is a life-threatening cause of cholangitis.

Common causes

Cholangitis is usually caused by bile stasis. It is the ascending infection of the bile duct by bacteria, and/or parasites.

Cholangitis may be caused by:

Less common causes

Less common causes of cholangitis include:

Causes by organ system

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cidofovir, Sorafenib, Teduglutide
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Cholelithiasis, Biliary stricture, Pancreatic cancer, Primary sclerosing cholangitis
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Endoscopic retrograde cholangiopancreatography
Infectious Disease Escherichia coli, Klebsiella, Enterococcus, Enterobacter, Bacteroides, Clostridia, Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, Taenia saginata
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Cancer of the pancreatic head, Cholangiocarcinoma, Lymphoma, Hepatoma, Metastasis to bile duct
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

References

  1. ↑ https://books.google.com/books?id=Z67nCAAAQBAJ&pg=PA16&lpg=PA16&dq=paralytic+ileus+and+cholangitis&source=bl&ots=EN_c_A_D4F&sig=tzVoAltXsoltCH6_KkdcTi_qaiU&hl=en&sa=X&ved=0ahUKEwiywPaJu4zXAhVp5IMKHWZzB7AQ6AEIRjAG#v=onepage&q=paralytic%20ileus%20and%20cholangitis&f=false. Missing or empty |title= (help)
  2. ↑ Serradilla Martin, M.; Palomares Cano, A.; Dabán Collado, E.; Medina Cuadros, M. (2016). "Acute cholangitis secondary to main bile duct thrombi for hepatocellular carcinoma". HPB. 18: e745–e746. doi:10.1016/j.hpb.2016.01.225. ISSN 1365-182X.


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