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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = Ascending cholangitis |
   Name          = Ascending cholangitis |
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{{Ascending cholangitis}}
{{Ascending cholangitis}}
{{CMG}}
{{CMG}}
==Overview==
==[[Ascending cholangitis overview|Overview]]==
'''Ascending cholangitis''' is a [[cholangitis]] caused by bacterial infection. Cholangitis, in turn, is an inflammation of the [[bile duct]]<ref>[http://www.gpnotebook.co.uk/cache/1624244226.htm gpnotebook]</ref>.


==Symptoms==
==[[Ascending cholangitis historical perspective|Historical Perspective]]==
The clinical symptoms of ascending cholangitis are pain, [[jaundice]], and fever ([[Charcot's triad]]). In addition, the presence of hypotension and mental confusion (Reynold's pentad) is suggestive of severe [[septicemia]]. The typical clinical picture is present in only 50% of cases.


==Cause==
==[[Ascending cholangitis pathophysiology|Pathophysiology]]==
It results from bile stasis due to chronic obstruction, usually by [[gallstones]] ([[choledocholithiasis]]). This facilitates a bacterial infection.


The infecting organisms are usually gram-negative bacilli (eg, [[E. coli]], [[Klebsiella]], [[Pseudomonas]], and [[Enterococcus]]).
==[[Ascending cholangitis epidemiology and demographics|Epidemiology & Demographics]]==


==Diagnosis==
==[[Ascending cholangitis risk factors|Risk Factors]]==
===Blood sample===
 
Anaerobes may be cultured in 15% of cases.
==[[Ascending cholangitis screening|Screening]]==
Laboratory studies show cholestasis, variable transaminase levels, [[leukocytosis]], and positive blood cultures.


===Ultrasound===
==[[Ascending cholangitis causes|Causes]]==
Findings on [[ultrasound]] examination are the same as those for [[choledocholithiasis]].


==Differential Diagnosis of Causes of Ascending cholangitis==
==[[Ascending cholangitis differential diagnosis|Differentiating Ascending cholangitis]]==
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Gastroenterologic'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Gallstones]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[E. coli]], [[Klebsiella]], [[Pseudomonas]], and [[Enterococcus]]
|-
|}


==Treatment==
==[[Ascending cholangitis natural history|Complications & Prognosis]]==


When acute ascending cholangitis is suspected, the patient should be hospitalized. Fluid resuscitation and antibiotics are the key interventions, and antibiotic treatment should be targeted against gram-negative organisms and, possibly, anaerobes. Commonly used drugs include ampicillin, gentamicin sulfate (Garamycin) and metronidazole (Flagyl, Metro IV, Protostat), or ciprofloxacin (Cipro) with or without metronidazole.
==Diagnosis==
[[Ascending cholangitis history and symptoms|History and Symptoms]] | [[Ascending cholangitis physical examination|Physical Examination]] | [[Ascending cholangitis laboratory tests|Laboratory tests]] | [[Ascending cholangitis electrocardiogram|Electrocardiogram]]  | [[Ascending cholangitis chest x ray|X Rays]] | [[Ascending cholangitis CT|CT]] | [[Ascending cholangitis MRI|MRI]] | [[Ascending cholangitis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Ascending cholangitis other imaging findings|Other images]] | [[Ascending cholangitis other diagnostic studies|Alternative diagnostics]]


The mainstay of therapy, however, is the establishment of biliary drainage, which can be accomplished endoscopically or percutaneously. Timing of the procedure depends on severity of the clinical presentation. [[Endoscopic retrograde cholangiopancreatography]] (ERCP) is used primarily. However, if the patient's condition is too unstable for ERCP, percutaneous transhepatic drainage can tide the patient over the acute crisis until definitive therapy can be planned. In all other cases, ERCP to determine the cause of the obstruction and provide drainage should be performed as soon as possible.
==Treatment==
[[Ascending cholangitis medical therapy|Medical therapy]] | [[Ascending cholangitis surgery|Surgical options]] | [[Ascending cholangitis primary prevention|Primary prevention]]  | [[Ascending cholangitis secondary prevention|Secondary prevention]] | [[Ascending cholangitis cost-effectiveness of therapy|Financial costs]] | [[Ascending cholangitis future or investigational therapies|Future therapies]]


==Prognosis==
==Case Studies==
Ascending cholangitis can be life-threatening if untreated.


==References==
==References==

Revision as of 15:47, 25 January 2012

For patient information click here

Ascending cholangitis
Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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