Acute cholangitis

Last reviewed: 30 May 2022
Last updated: 07 Dec 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • right upper quadrant (RUQ)/upper abdominal pain
  • RUQ/upper abdominal tenderness
  • jaundice
  • fever
Full details

Other diagnostic factors

  • pale stools
  • pruritus
  • hypotension
  • mental status changes
Full details

Risk factors

  • age >50 years
  • cholelithiasis
  • benign stricture
  • malignant stricture
  • post-procedure injury of bile ducts
  • history of primary sclerosing cholangitis
  • history of secondary sclerosing cholangitis
  • HIV infection
Full details

Diagnostic investigations

1st investigations to order

  • FBC
  • serum urea
  • serum creatinine
  • ABG analysis
  • serum LFTs
  • CRP
  • serum potassium
  • serum magnesium
  • blood cultures
  • coagulation panel
  • transabdominal ultrasound
  • endoscopic retrograde cholangiopancreatography (ERCP)
Full details

Investigations to consider

  • abdominal CT scan with intravenous contrast
  • magnetic resonance cholangiopancreatography (MRCP)
  • percutaneous trans-hepatic cholangiography (PTC)
  • endoscopic ultrasonography (EUS)
Full details

Treatment algorithm

ACUTE

acutely ill

ONGOING

with choledocholithiasis, PSC, or HIV cholangiopathy

Contributors

Expert advisers

Douglas G. Adler, MD, FACG, AGAF, FASGE

Professor of Medicine

Division of Gastroenterology

Department of Internal Medicine

Huntsman Cancer Institute

University of Utah

Salt Lake City

UT

Disclosures

DGA has consulted for Boston Scientific, Merit Medical, and Olympus, who make endoscopic retrograde cholangio-pancreatography (ERCP) products, and has also consulted for AbbVie Pharmaceuticals. He is an author of references cited in this topic.

Peer reviewers

Christian Macutkiewicz, MD, FHEA, FRCS

Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon

Manchester Royal Infirmary

Manchester

UK

Disclosures

CM declares that he has no competing interests.

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

Disclosures

DJH declares that he has no competing interests.

Todd Baron, MD

Professor of Medicine

Division of Gastroenterology & Hepatology

Mayo Clinic Rochester

Rochester

MN

Disclosures

TB declares that he has no competing interests.

Dennis Freshwater, MB, BS, MD, FRCP

Consultant Hepatologist

The Liver and Hepatobiliary Unit

Queen Elizabeth Medical Care Unit

University Hospitals Birmingham NHS Foundation Trust

Birmingham

UK

Disclosures

DF declares that he has no competing interests.

Bertus Eksteen, MRCP, PhD, MRC

Clinical Scientist

University of Birmingham

Honorary Consultant

Liver Transplant Unit

University Hospitals Birmingham NHS Foundation Trust

Birmingham

UK

Disclosures

BE declares that he has no competing interests.

Editors

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Anna Ellis,

Head of Editorial, BMJ Best Practice

Disclosures

AE declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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