Acute Cholangitis

Inflammation of the bile duct system, typically caused by bacterial infection and often associated with bile duct obstruction.

• Obstruction: Most commonly due to gallstones. Other causes include strictures, tumours, and parasitic infections.

• Organisms: E. coli, Klebsiella, Enterococcus, and other enteric bacteria are the predominant pathogens.

• Charcot’s Triad: Fever, right upper quadrant (RUQ) pain and jaundice.

• Reynold’s Pentad (seen in severe cases): Includes the above three, plus hypotension and altered mental status.

• Blood tests: Raised white cell count (leukocytosis), elevated bilirubin, elevated alkaline phosphatase, and elevated liver transaminases.

• Imaging: Ultrasound of the abdomen is the first-line imaging test. It assesses for gallstones, dilated bile ducts, and other causes of obstruction.

• Magnetic resonance cholangiopancreatography (MRCP): Non-invasive imaging technique used to visualise the biliary and pancreatic ducts.

• Endoscopic retrograde cholangiopancreatography (ERCP): Diagnostic and therapeutic procedure which can also be used to relieve obstruction.

• Antibiotics: Broad-spectrum initially, tailored to culture results when available.

• Biliary drainage: Often via ERCP, especially if there’s complete obstruction or patient doesn’t respond to antibiotics alone.

• Supportive care: Hydration, pain management.

• Cholecystectomy: Might be needed if gallstones are the primary cause.

• Septic shock
• Multiple organ failure
• Abscess formation
• Recurrent cholangitis