Cholangitis

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Ascending 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 is mostly due to gallstones; however, 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's triad: Right upper Quadrant pain, Jaundice and Fever

Reynod's pentad: Charoct's triad + hypotension and mental status change (coma, anxiety or delirium)

investigations

CBC: leucocytosis

LFT: derranged LFT with obstructive picture

Amylase: elevated in pancreatitis

Blood culture

Ultrasound

Treatment

IV fluid

antibiotcs: choice mainly broad spectrum antibiotics. About 90 % of patient will be responsive to conservative management with antibiotics and other supportive treatment.

ERCP

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