acute cholangitis

• related: GI

• pathogenesis:
  • common bile duct ascending bacterial infection
  • result of choledocholithiasis: disruption of normal bile flow, bacteria ascend biliary tract from duodenum
• cause:
  • E. coli (25 to 50%)
  • Klebsiella pneumonia (15 to 20%)
  • Enterobacter species (5 to 10%)
  • Enterococcus species (10 to 20%)
  • Bacteroides and Clostridia (anaerobes, usually part of a mixed infection)
• sx:
  • charcot triad: RUQ, fever, jaundice
  • reynolds pentad: hypotension, AMS. Indicative of suppurative cholangitis due to septic shock
• labs:
  • leukocytosis
  • cholestatic liver function test
• imaging
  • US RUQ: biliary duct dilation without gas in biliary tree
  • emphysematous cholecystitis: gas in biliary tree
• treatment

  • IVF, blood cultures, abx

    • zosyn or cipro with flagyl

  • biliary drainage with ERCP in 24-48 hours

  • if not possible, percutaneous cholangiography with biliary tube placement

  • Elective cholecystectomy in 2 weeks to prevent future episodes