Acute cholangitis

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Last reviewed: 14 Jul 2025
Last updated: 26 Mar 2025

Summary

Definition

History and exam

Key diagnostic 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

  • older age
  • cholelithiasis
  • benign stricture
  • malignant stricture
  • postprocedure injury of bile ducts
  • history of primary sclerosing cholangitis
  • history of secondary sclerosing cholangitis
  • HIV infection
  • use of immune checkpoint inhibitors
  • immunoglobulin (Ig) G4-related digestive disease
Full details

Diagnostic tests

1st tests to order

  • CBC
  • serum BUN
  • serum creatinine
  • blood gas analysis
  • serum LFTs
  • CRP
  • serum potassium
  • serum magnesium
  • blood cultures
  • coagulation panel
  • transabdominal ultrasound
Full details

Tests to consider

  • endoscopic retrograde cholangiopancreatography (ERCP)
  • abdominal CT scan with intravenous contrast
  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasonography (EUS)
  • surgical approaches
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

Director, Center for Advanced Therapeutic Endoscopy (CATE)

Porter Adventist Hospital, Centura Health

Denver

CO

Disclosures

DGA has provided consulting and speaking services for Abbvie, Boston Scientific Olympus America, and Cook Endoscopy, some of which make products relevant to this topic. He is also an author of references cited in this topic.

Acknowledgements

Dr Douglas G. Adler would like to gratefully acknowledge Dr Andrew S. Fedoravicius, a previous contributor to this topic.

Disclosures

ASF declares that he has no competing interests.

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 is an author of a reference cited in this topic.

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

Declarações

BE declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30.Texto completo  Resumo

Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):31-40.Texto completo  Resumo

Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16.Texto completo  Resumo

Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):96-100.Texto completo  Resumo

Mukai S, Itoi T, Baron TH, et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017 Oct;24(10):537-49.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Acute cholangitis images
  • Diagnósticos diferenciais

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    • Peptic ulcer disease
    • Acute pancreatitis
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  • Diretrizes

    • ACG clinical guideline: diagnosis and management of biliary strictures
    • ASGE guideline on the management of cholangitis
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  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Peripheral intravascular catheter: animated demonstration

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  • Folhetos informativos para os pacientes

    Gallstones

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