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Cholangitis, Acute

David C. Krulak, MD, MPH, MBA Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Acute infection due to partial or complete obstruction of the biliary tree, most commonly by gallstones migrating into the common bile duct (CBD); also by endoscopic retrograde chola...

DIAGNOSIS

HISTORY

  • Presentation often nonspecific. Classic findings:

    • Clinical triad of fever, jaundice, and RUQ pain (Charcot triad)

  • Reynolds pentad of fever, jaundice, RUQ pain, mental status changes, an...

TREATMENT

  • Monitor airway, breathing, hydration, circulation, and resuscitate as needed; IV crystalloid

  • NPO; nasogastric tube for vomiting

  • Medical treatment is effective in 80% for symptom control. Opera...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patients with recurrent symptoms of cholangitis may require maintenance antibiotics and more advanced imaging to exclude liver abscess or residual stones. 

DIET

NPO...

REFERENCES

1
Weber A, Schneider J, Wagenpfeil S, et al. Spectrum of pathogens in acute cholangitis in patients with and without biliary endoprosthesis. J Infect.  2013;67(2):111–121. {L-End} [Vie...

SEE ALSO

Cholelithiasis 

CODES

ICD10

K83.0 Cholangitis 

ICD9

576.1 Cholangitis 

SNOMED

6215006 Acute cholangitis 

CLINICAL PEARLS

  • Charcot triad (fever, jaundice, and RUQ pain) is seen in <25% of cases and has low sensitivity but high specificity for ascending cholangitis.

  • An isolated elevation of alkaline phosp...

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