Acute cholangitis

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 15 Aug 2025

最后更新： 26 Mar 2025

Acute cholangitis is an infection of the biliary tree that requires prompt diagnosis and treatment.

Most patients with acute cholangitis have fever, jaundice, and right upper quadrant pain (Charcot triad).

Cholangitis can quickly become an acute, septic, life-threatening infection that requires rapid evaluation and treatment.

The most common causes are choledocholithiasis and benign or malignant strictures.

Antibiotics alone do not provide sufficient treatment in the majority of patients. Drainage of the biliary tree is the most critical step in management.

If untreated, sepsis with shock, vascular collapse, multiorgan failure, and potentially death can occur.

定义

Ascending cholangitis is the historical term for the condition currently referred to as acute cholangitis or simply as cholangitis.

Acute cholangitis is an infection of the biliary tree, most commonly caused by obstruction. In its less severe form, there is biliary obstruction with inflammation and bacterial seeding and growth in the biliary tree. It is estimated that 50% to 70% of these patients present with right upper quadrant pain, fever, and jaundice.[1] In the more severe, life-threatening form, known as toxic cholangitis or cholangitis with sepsis, patients have purulent biliary tree contents, as well as evidence of sepsis, hypotension, multiorgan failure, and mental status changes.[1][2]

病史和体格检查

关键诊断因素

right upper quadrant (RUQ)/upper abdominal pain
RUQ/upper abdominal tenderness
jaundice
fever

完整详情

其他诊断因素

pale stools
pruritus
hypotension
mental status changes

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

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

完整详情

需考虑的检查

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

完整详情

治疗流程

急症处理

acutely ill

持续性治疗

with choledocholithiasis, PSC, or HIV cholangiopathy

撰稿人

专家顾问

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

Professor of Medicine

Director, Center for Advanced Therapeutic Endoscopy (CATE)

Porter Adventist Hospital, Centura Health

Denver

利益声明

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.

鸣谢

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

利益声明

ASF declares that he has no competing interests.

同行评议者

Christian Macutkiewicz, MD, FHEA, FRCS

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

Manchester Royal Infirmary

Manchester

利益声明

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

利益声明

DJH declares that he has no competing interests.

Todd Baron, MD

Professor of Medicine

Division of Gastroenterology & Hepatology

Mayo Clinic Rochester

Rochester

利益声明

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

Divulgaciones

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

Divulgaciones

BE declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referencias

Nuestros equipos internos de evidencia y editoriales colaboran con colaboradores expertos internacionales y revisores pares para garantizar que brindemos acceso a la información más clínicamente relevante posible.

Artículos principales

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 Resumen

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 Resumen

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 Resumen

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 Resumen

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 Resumen

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales
- Acute cholecystitis
- Peptic ulcer disease
- Acute pancreatitis
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Guidelines
- ACG clinical guideline: diagnosis and management of biliary strictures
- ASGE guideline on the management of cholangitis
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Acute cholangitis

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

acutely ill

with choledocholithiasis, PSC, or HIV cholangiopathy

撰稿人

专家顾问

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

利益声明

鸣谢

利益声明

同行评议者

Christian Macutkiewicz, MD, FHEA, FRCS

利益声明

David J. Hackam, MD, PhD

利益声明

Todd Baron, MD

利益声明

Dennis Freshwater, MB, BS, MD, FRCP

Divulgaciones

Bertus Eksteen, MRCP, PhD, MRC

Divulgaciones

Peer reviewer acknowledgements

Disclosures

Referencias

Artículos principales

Artículos de referencia

Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.

Diferenciales

Guidelines

Videos

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice