Cholangitis
Bacterial infection of biliary tract due to obstruction (partial or
complete); potentially life threatening
Common causes of obstruction:
- Choledocholithiasis (most common)
- Stricture (usually postop)
- Neoplasm (usually ampullary carcinoma)
- Extrinsic compression (pancreatic pseudocyst/pancreatitis)
- Instrumentation (ERCP/PTC)
- Bilary stent
Signs and Sx:
- Charcot's Triad: JEF
- Jaundice
- Epigastric/RUQ pain
- Fever/Chills
- Reynold's Pentad: Charcot's Triad+
- Altered Mental Status
- Shock
Labs: Increased WBC, Alk Phos, +/- Blood Cx
Organisms:
- Gram neg: Kleb, Enterbacter, Serratia, Pseudom, Proteus
- Gram pos: Enterococci
Dx:
- US then contrast study (PTC/ERCP) after 'cooled off' from IV abx.
- Suppurative Cholangitis: "Pus under pressure" severe infection with sepsis
Tx:
- Non-suppurative: IVF and Abx - definitive tx later
- suppurative: IVF, ABX, decompression (ERCP/PTC)
Cholangitis, sclerosing