HWN Suggests

Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain

Around 10-15% of patients worldwide have gallstones, with the majority experiencing little to no symptoms. Out of these patients, only 2-3% will experience obstructive complications, which includes pancreatitis, cholecystitis, and cholangitis. Acute or ascending cholangitis is a rare disease characterized by an infection of the common bile duct (CBD). It can be life-threatening if not treated appropriately. Although biliary stone disease is the most common etiology, there are other causes of cholangitis including previous biliary tree instrumentation, biliary stenosis, helminthic infections, and neoplastic disease. The prevalence of cholangitis is equal between both genders and occurs more…

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Featured

 Early ERCP for severe cholangitis? Of course!

Although the surgical management of severe cholangitis had improved in the 1960s and 1970s, with decreasing mortality, the overall outcome was still unacceptable. The universally accepted treatment for cholangitis remained surgical until ERCP became widely available in the late 1970s, when an endoscopic approach was proposed as a realistic alternative despite the commonly held unscientific belief that cholangitis was a contraindication to endoscopy.

 EM@3AM – Ascending Cholangitis

Initiate antibiotic therapy directed towards enteric gram-negative and gram-positive aerobes and anaerobes...

Articles of Interest

Gareth’s story

On 4 August 2016 (a week later) I went back to hospital to get the results and discuss the gallbladder operation. I was on my own as we thought it would be a routine appointment but this was not the case...I was told by the surgeon that the good news was there wasn’t a stone in my bile duct but the bad news was they suspected I had a rare liver disease which was the actual cause of my symptoms, called Primary Sclerosing Cholangitis (PSC). I was to be referred to a consultant who specialises in PSC.

Cholangitis: Pearls & Pitfalls

Cholangitis is a result of biliary obstruction and bacterial growth in the bile. Bacteria, primarily E. coli, Klebsiella species, and Enterococcus species, are thought to ascend from the duodenum into the common hepatopancreatic duct in the setting of ductal obstruction.

Cholangitis: Pearls & Pitfalls

Cholangitis is a result of biliary obstruction and bacterial growth in the bile. Bacteria, primarily E. coli, Klebsiella species, and Enterococcus species, are thought to ascend from the duodenum into the common hepatopancreatic duct in the setting of ductal obstruction.

Resources

Living with Primary Sclerosing Cholangitis (PSC)

Hi, I am Jason and I found out I had Primary Sclerosing Cholangitis (PSC) about 10 years before I became symptomatic and subsequently required a Liver transplant in 2017. This blog shares my Journey before, during and after transplant to help people going through the same experience.

Core EM

Imaging is helpful in supporting the diagnosis and aids in identifying the cause. Many patients will have concomitant acute cholecystitis that will be identified on imaging

Geeky Medics

Acute cholangitis (a.k.a. ascending cholangitis) is an infection of the biliary tree caused by a combination of both biliary outflow obstruction and biliary infection.

Life in the Fastlane

Definitive diagnosis involves (1) a history of biliary disease, (2) the clinical manifestations, (3) laboratory data that indicate the presence of inflammation and biliary obstruction, and (4) imaging findings that indicate biliary obstruction.

WikEM

Hypotension may be the only presenting sign in elderly patients...

Cholangitis and Early Goal Directed Therapy

CHOLANGITIS: biliary tract infection (primary etiologies: CBD stones or medical interventions).

ClinicianRevision

Any and all causes of biliary tree strictures can lead to infections. The most common cause is choledocholithiasis, where a stone becomes dislodged from the gallbladder and obstructs the biliary tree downstream. It can also be caused iatrogenically from previous cholecystectomy or endoscopic retrograde cholangiopancreatogram (ERCP) which scars the lumen of the biliary tree and causes a benign stricture.

EMed

Biliary obstruction (in the lumen, in the wall or external) plus infection (presumed ascending from duodenum). Patients often confused / septic (>30% develop bacteraemia)

Life with PBC Blog

Living with a chronic disease requires regular engagement in healthcare but all too often the focus is on treating the diagnosis and physical symptoms, with little attention paid to someone’s emotional and mental well-being.

PAINE Podcast and Medical Blog

The first physician to describe acute cholangitis was Dr. Jean-Martin Charcot and has the eponomyous Charcot’s Triad named after him for right upper quadrant pain, fever, and jaundice. Fever and abdominal pain is more common (80%), than is jaundice (60%) and only 50-75% of patients have the classic triad.

Patient

The 2013 Tokyo guidelines furthermore acknowledged that determining severity against criteria could create some difficulty in reality. They advised that emergency biliary drainage should be carried out at any time when the condition becomes severe...

StatPearls

Acute cholangitis, also known as ascending cholangitis, is a life-threatening condition caused by an ascending bacterial infection of the biliary tree. Choledocholithiasis is the most common cause, with infection-causing stones in the common bile duct leading to partial or complete obstruction of the biliary system