Diagnosis and Management of Acute Cholangitis

Abstract

Acute cholangitis is a potentially life-threatening systemic disease resulting from a combination of infection and obstruction of the biliary tree, secondary to different underlying etiologies. Common causes of cholangitis (eg, gallstones, benign and malignant biliary strictures) are well known. However, others (eg, immunoglobulin-G subclass-4-related sclerosing cholangitis) have been described only recently, are still under evaluation, and need to gain broader attention from clinicians. The diagnosis of acute cholangitis is based on clinical presentation and laboratory data indicating systemic infection, as well as diagnostic imaging modalities revealing signs of biliary obstruction and possibly an underlying etiology. The clinical presentation varies, and initial risk stratification is important to guide further management. Early medical therapy, including fluid resuscitation and appropriate antibiotic coverage, is of major importance in all cases, followed by a biliary drainage procedure and, if possible, definitive therapy of the underlying etiology. The type and timing of biliary drainage should be based on the severity of the clinical presentation, and the availability and feasibility of drainage techniques, such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), and open surgical drainage. ERCP plays a central role in the management of biliary obstruction in patients with acute cholangitis. Endoscopic ultrasound-guided biliary drainage recently emerged as a possible alternative to PTC for second-line therapy if ERCP fails or is not possible.

Transplantation in autosomal recessive polycystic kidney disease: liver and/or kidney?

“…Patients with Caroli's disease are at risk for acute bacterial cholangitis leading to septicemia and biliary tract calculi from stasis. Gram-negative organisms and occasionally Gram-positive anaerobes and fungi are implicated in acute cholangitis requiring broad-spectrum antibiotic coverage [17]. Fever, right upper quadrant pain, icterus, and abnormal transaminases could indicate cholangitis but often the presentation can be subtle.…”

Comparison of acute cholangitis with or without common bile duct dilatation

“…Patients at the National Hospital Organization Shimoshizu Hospital were diagnosed with acute cholangitis using the clinical Charcot's triad criteria (Table I) (8) or the criteria for 'suspected' or 'definite' acute cholangitis according to the Tokyo guidelines (TG13) (9). Briefly, patients were diagnosed with acute cholangitis when they had the following Charcot's triad: Fever, jaundice and abdominal pain.…”

“…Based on CBD measurements, enrolled patients were divided into the following two groups: A CBDdil(-) group for patients with a CBD diameter of ≤7.0 mm and a CBDdil(+) group for patients with a CBD diameter of >7.0 mm. Previous studies indicate that the upper Patients were diagnosed with acute cholangitis if they met the Charcot's triad criteria (8). If patients did not meet the Charcot's triad criteria, they were diagnosed with acute cholangitis if they met the criteria for suspected (one item in A + one item in either B or C) or definite (one item in each of A, B and C) acute cholangitis according to the TG13 (9).…”

“…Age and laboratory test variables of CBDdil(-) and CBDdil(+) patients were compared. CRP levels are presented as mg/dl, as described previously (8). Data are presented as the mean ± standard deviation.…”

“…Acute cholangitis may progress to sepsis, which in some cases is fatal, as the bacteria are able to translocate to the blood (5,6). In the clinical management of acute cholangitis, biliary drainage is generally performed (7) by endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiodrainage and endoscopic ultrasound-guided drainage (8). For prompt treatment of patients with acute cholangitis, accurate diagnosis is necessary.…”