II. Epidemiology
-
Incidence rare under age 40 years
- However can occur in children with risk factors
III. Risk Factors
- Choledocolithiasis
- Biliary atresia or Biliary tract stricture
- Surgical anastomotic stricture
- Extrinsic compression from malignancy
- Liver transplant history
- Roux-en-Y Bypass Surgery
IV. Pathophysiology
- Reflux of Bacteria into the lymphatics, hepatitic veins
- Results in systemic spread
- Complete biliary obstruction in presence of Bacteria (Gram Negative Bacteria, Anaerobic Bacteria)
- E. coli (25-50%)
- Klebsiella (15-20%)
- Enterobacter (5-10%)
- Enterococcus (10-20%)
- Bacteroides
- Clostridium
- Pseudomonas
V. Symptoms
- See Acute Cholecystitis
- See Biliary Colic
- Nausea or Vomiting
VI. Signs
- Charcot's Triad (seen in only 25% of patients)
- Reynold's Pentad (seen in only 14% of patients)
- Charcot's Triad and
- Hypotension (Shock) and
- Altered Mental Status
- Other findings
- Toxic appearance
- Hepatomegaly (with tender liver edge)
- Splenomegaly
VII. Labs
- Complete Blood Count
-
Liver Function Tests abnormal
- Bilirubin elevated in urine and plasma (40% of cases)
- Serum alkaline phsophatase elevated
- Blood Cultures (positive in 50% of cases)
VIII. Differential Diagnosis
- Acute Cholecystitis
- Post-op status (esp. Laparoscopic Cholecystectomy) Bile Duct Injury with Biliary Leak
- Acute Pancreatitis
- Liver Abscess
IX. Prognosis
- Mortality 100% if missed or incorrectly treated
X. Management
- See Acute Cholecystitis
- See Cholecystectomy
- Broad spectrum parenteral antibiotics
- Initial antibiotic regimen
- Piperacillin-Tazobactam 4.5 g IV q8 hours OR
- Ertapenem 1 g IV every 24 hours OR
- Initial antibiotic regimen for life threatening infection
- Imipenem 0.5 g IV every 6 hours OR
- Meropenem 1 g IV every 8 hours OR
- Doripenem 500 mg IV every 8 hours
- Initial antibiotic regimen for mild to moderate community acquired infection
- Alternative antibiotic regimens
- Metronidazole 1 g IV load, then 500 mg IV every 6 hours AND
- Ceftriaxone 2 g IV OR (Moxifloxacin 400 IV q24h or Ciprofloxacin 400 mg IV q12 h)
- Risk of Fluoroquinolone resistance
- Additional antibiotics
- Vancomycin
- Added to regimen if Healthcare Associated Infection
- Vancomycin
- References
- (2019) Acute Cholangitis, Sanford Guide, accessed 3/29/2019
- (2019) Acute Cholangitis, UpToDate, accessed 3/29/2019
- Initial antibiotic regimen
-
Sepsis management
- See Septic Shock
- Volume Resuscitation
- Vasopressor support as needed
- Rapid decompression of biliary tree
- Endoscopy with ERCP and sphincterotomy
- May be preferred as initial intervention
- Open common bile duct exploration
- High mortality and morbidity
- Endoscopy with ERCP and sphincterotomy
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Related Studies
| Definition (MSHCZE) | Zánět žlučových cest, zejm. intrahepatálních. Velmi často vzniká po neléčeném uzávěru (obstrukci) žlučových cest kaménkem (srov. choledocholitiáza, cholestáza). V akutním stadiu se projeví bolestmi v pravém podžebří, horečkami, třesavkou, žloutenkou (Charcotova triáda). Méně nápadný je obraz chronického zánětu. Onemocnění je nutné intenzivně léčit (antibiotiky, chirurgickým zákrokem) jinak hrozí i přechod k závažnějšímu jaternímu poškození až cirhóze (sekundární biliární cirhóza). Některé typy ch. vznikají na autoimunitním podkladě např. primární biliární cirhóza. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI) | An acute or chronic inflammatory process affecting the biliary tract. |
| Definition (NCI_CTCAE) | A disorder characterized by an infectious process involving the biliary tract. |
| Definition (MSH) | Inflammation of the biliary ductal system (BILE DUCTS); intrahepatic, extrahepatic, or both. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D002761 |
| ICD9 | 576.1 |
| ICD10 | K83.0 |
| SnomedCT | 155831003, 197445007, 82403002 |
| English | Cholangitides, CHOLANGITIS, Cholangitis NOS, Inflammation bile duct, Cholangitis [Disease/Finding], Cholangitis, bile duct inflammation, cholangitis, cholangeitis, cholangitis (diagnosis), Cholangitis NOS (disorder), Biliary tract infection, Cholangitis (disorder), bile duct; inflammation, inflammation; bile duct, Cholangitis, NOS |
| Portuguese | COLANGITE, Colangite NE, Inflamação de canal biliar, Colangite |
| Dutch | cholangitis NAO, galwegontsteking, galweg; ontsteking, ontsteking; galweg, cholangitis, Cholangitis |
| French | Inflammation des canaux biliaires, Angiocholite SAI, CHOLANGITE, Angiocholite, Cholangite |
| German | Entzuendung des Gallengangs, Cholangitis NNB, Cholangiitis, Cholangitis, Gallengangsentzündung |
| Italian | Colangite NAS, Infiammazione di dotto biliare, Colangite |
| Spanish | Colangitis NEOM, Inflamación de conductos biliares, colangitis, SAI (trastorno), colangitis, SAI, colangitis (trastorno), colangitis, Colangitis |
| Japanese | 胆管炎, 胆管の炎症, 胆管炎ＮＯＳ, ﾀﾝｶﾝｴﾝNOS, ﾀﾝｶﾝｴﾝ, ﾀﾝｶﾝﾉｴﾝｼｮｳ |
| Swedish | Gallvägsinflammation |
| Czech | žlučové cesty - zánět, cholangitida, cholangoitida, zánět žlučových cest, Cholangitida NOS, Zánět žlučových cest, Cholangitida |
| Finnish | Sappitietulehdus |
| Russian | KHOLANGIT, ХОЛАНГИТ |
| Korean | 담관염 |
| Croatian | KOLANGITIS |
| Polish | Zapalenie dróg żółciowych, Zapalenie przewodów żółciowych |
| Hungarian | Cholangitis, epevezeték-gyulladás, Cholangitis k.m.n. |
| Norwegian | Gallegangsbetennelse, Kolangitt |
Ontology: Suppurative cholangitis (C0267924)
| Concepts | Disease or Syndrome (T047) |
| ICD10 | K83.0 |
| SnomedCT | 197437002, 69850007 |
| English | Cholangitis suppurative, suppurative cholangitis (diagnosis), suppurative cholangitis, Septic cholangitis, Suppurative cholangitis, Suppurative cholangitis (disorder), Suppurative Cholangitis |
| Italian | Colangite suppurativa, Colangite settica |
| Dutch | septische cholangitis, cholangitis etterend |
| French | Cholangite septique, Cholangite suppurée |
| German | septische Cholangitis, Cholangitis eitrig |
| Portuguese | Colangite séptica, Colangite supurativa |
| Spanish | Colangitis séptica, colangitis supurativa (trastorno), colangitis supurativa, Colangitis supurativa |
| Japanese | 敗血症性胆管炎, 化膿性胆管炎, ﾊｲｹﾂｼｮｳｾｲﾀﾝｶﾝｴﾝ, ｶﾉｳｾｲﾀﾝｶﾝｴﾝ |
| Czech | Septická cholangitida, Hnisavá cholangitida |
| Hungarian | Septicus cholangitis, cholangitis suppurativa |
Ontology: Ascending cholangitis (C0311273)
| Definition (NCI) | Acute infection of the bile ducts caused by bacteria ascending from the small intestine. |
| Concepts | Disease or Syndrome (T047) |
| ICD10 | K83.0 |
| SnomedCT | 26918003 |
| English | ASCENDING CHOLANGITIS, Cholangitis lenta, Ascending cholangitis, ascending cholangitis, ascending cholangitis (diagnosis), Ascending cholangitis (disorder), Ascending Cholangitis |
| Dutch | opstijgende cholangitis |
| French | Cholangite ascendante |
| German | aufsteigende Cholangitis |
| Italian | Colangite ascendente |
| Portuguese | Colangite ascendente |
| Spanish | Colangitis ascendente, colangitis ascendente (trastorno), colangitis ascendente |
| Japanese | 上行性胆管炎, ｼﾞｮｳｺｳｾｲﾀﾝｶﾝｴﾝ |
| Czech | Ascendentní cholangitida |
| Hungarian | ascendáló cholangitis |
