Ascending cholangitis 

Acute cholangitis

• mechanism: obstruction of CBD leading to biliary stasis, bacterial overgrowth, suppuration, and biliary sepsis – life threatening
• etiology
  • choledocholithiasis (60%) 
  • post-operative stricture
  • pancreatic or biliary neoplasms
  •  organisms: E. coli, Klebsiella, Pseudomonas, Enterococci, B. fragilis, Proteus
• signs and symptoms
  • Charcot’s triad (50-70% of cases): fever, jaundice, RUQ pain – Not every patient has all 3
  • Reynold’s pentad: Charcot’s triad + mental confusion + hypotension leading to renal failure
  • If severe may have hypotension, mental status changes
• Investigation
  • Raised bilirubin
  • Raised CRP
  • USS – Dilated bile duct > 6mm
• Treatment
  • Medical emergency
  • IV fluids
  • IV Abx
  • Biliary decompression – ?ERCP
  • Will need cholecystectomy eventually

Courvoisier’s Law: Palpable gallbladder + obstructive jaundice 🡪 NOT STONE 

because thickened GB wall cannot dilate to become palpable

Cholangitis (inflammation of bile duct)

• Choledocholithiasis*
• Stricture
• Extrinsic compression (tumours, pancreatic pseudocyst, pancreatitis)
• Instrumentation (PTC, ERCP, stent)