Cholangitis overview
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Cholangitis is a clinically defined syndrome of fever, right upper quadrant pain and jaundice caused by infection of bile and inflammation of the biliary tree, usually due to obstruction and stasis.
Historical Perspective
Cholangitis was first described as a life-threatening disorder in 1877 by Charcot. In 1955, Reynolds and Dargan recognized that septic shock and mental status changes portended a poor outcome. (Reynolds’s Pentad). [1] [2] [3] [4]
Causes
Cholangitis is usually caused by a bacterial infection, which can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver.
Epidemiology and Demographics
Parasites are commonly associated with cholangitis outside of the United States. Parasites associated with cholangitis include the Ascaris, Opisthorchis, Clonorchis, Fasciola and Echinococcus. Ascaris is thought to be the etiologic agent of recurrent pyogenic cholangitis (Oriental cholangiohepatitis) found in Hong Kong, Southeast Asia, Columbia, Italy and South Africa. As they migrate to the biliary tree, they bring gut flora with them predisposing to bacterial infection. Dying worms lead to inflammation, granulomatous scarring and fibrosis which may lead to biliary cirrhosis. Opisthorchis and Clonorchis are transmitted by raw fish in Asia, Europe and Siberia and “frequently” lead to the development of cholangiocarcinoma. Fasciola is transmitted by colonized watercress and does not predispose to cholangiocarcinoma.
Diagnosis
History and Symptoms
The classical clinical manifestation of Cholangitis is described by Charcot's triad and includes fever, right upper quadrant pain, and jaundice. In suppurative cholangitis hypotension, and confusion can occur. The pentad of presentation is then called as Reynold's pentad. Reynold's pentad is associated with significant morbidity, and mortality.
Laboratory Findings
Laboratory tests provide useful clues in the diagnosis of cholangitis. Some commonly conducted tests are complete blood count, basic metabolic panel, liver function tests, blood culture, and other body fluid culture.
CT
CT has a higher sensitivity (63%) and is better to localize the site of obstruction.
Diagnosis
Primary Prevention
Treatment of gallstones, tumors, and infestations of parasites may reduce the risk for some people. A metal or plastic stents within the bile system may be needed to prevent recurrence.
References
- ↑ Kadakia S. Biliary Tract Emergencies. Med Clin North Amer. 1993, 77(5) 1015-1036. PMID 8371614
- ↑ Carpenter H. Bacterial and Parasitic Cholangitis. May Clin Proc. 1998, 73:473-478. PMID 9581592
- ↑ Leese T, Neoptolemos JP, Baker AR. Management of acute cholangitis and the impact of endoscopic sphincterotomy. Br J Surg. 1986, 73:988. PMID 3790964
- ↑ Lai ECS, Mok FPT, Tan ESY. Endoscopic biliary drainage for severe acute cholangitis. NEJM 1992, 326:1582-6. PMID 1584258