Cholangitis

Cholangitis

Duodenoscopy image of ampulla of Vater with pus extruding from it, indicative of cholangitis

Cholangitis: bacterial infection superimposed on an obstructed biliary tree. Cholangitis mostly due to gallstones. The other causes include strictures, tumor (pancreatic head tumor, ampullary tumor, or bile duct tumor, following recent procedures (ERCP, cholecystectomy), etc.

Presentation

The classic triad of cholangitis is Charcot' triad: Right upper Quadrant pain, Jaudince and Fever Reynod's pentad: Charoct's triad + hypotension and mental status change (coma, anxiety or delirium)

Types of cholangitis

Ascending cholangitis

Main article: Ascending cholangitis

Ascending cholangitis is caused by bacteria, and causes pain, jaundice, and fever. The bacteria usually originate from a preceding choledocholithiasis and is ascending from the intestines. Typical bacteria is; - Aerobic: E. Coli, Klebsiella, Pseudomonas (post ERCP), streptococcus faecalis and Enterobacter - Anaerobic: Bacteroides fragilis, Clostridium perfringens. Both aerobic and anaerobic infection can be present at the same time. Gallstones obstructing the common bile duct are a risk factor for developing ascending cholangitis.

Primary sclerosing cholangitis

Main article: Primary sclerosing cholangitis

Primary sclerosing cholangitis is a cholangitis with autoimmune origin.

Secondary sclerosing cholangitis

Secondary sclerosing cholangitis is a cholangitis with other causes.

Recurrent pyogenic cholangitis

Main article: Recurrent pyogenic cholangitis

Recurrent pyogenic cholangitis is a cholangitis usually associated with gallstones which recurs. It is also known as cholangiohepatitis.