Acute cholangitis

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's triad).

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

The most common causes are choledocholithiasis and benign and 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, multi-organ failure, and potentially death can occur.

Acute cholangitis, previously known as ascending 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]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. https://onlinelibrary.wiley.com/doi/10.1002/jhbp.512 http://www.ncbi.nlm.nih.gov/pubmed/29032610?tool=bestpractice.com ​ 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, multi-organ failure, and mental status changes.​[1]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. https://onlinelibrary.wiley.com/doi/10.1002/jhbp.512 http://www.ncbi.nlm.nih.gov/pubmed/29032610?tool=bestpractice.com [2]Boey JH, Way LW. Acute cholangitis. Ann Surg. 1980 Mar;191(3):264-70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1344694 http://www.ncbi.nlm.nih.gov/pubmed/7362292?tool=bestpractice.com ​​