From the Guidelines
Cholecystitis and cholangitis are two distinct inflammatory conditions affecting different parts of the biliary system, with cholecystitis involving the gallbladder and cholangitis involving the bile ducts, requiring different management approaches to reduce morbidity, mortality, and improve quality of life. The main difference between the two conditions lies in their anatomical location and the resulting clinical presentation and management. Cholecystitis is typically caused by gallstones blocking the cystic duct, leading to right upper quadrant pain, fever, nausea, and a positive Murphy's sign, and treatment includes antibiotics, pain management, and often cholecystectomy (gallbladder removal) 1. On the other hand, cholangitis is usually resulting from obstruction by stones, strictures, or tumors, presenting with Charcot's triad: fever, jaundice, and right upper quadrant pain, and requires prompt antibiotic therapy plus urgent biliary decompression through ERCP, percutaneous drainage, or surgery 1. Some key points to consider in the management of these conditions include:
- The use of ultrasonography as the first imaging technique for suspected acute cholecystitis or cholangitis 1
- The importance of antimicrobial therapy in the treatment of both conditions, with recommendations for specific antibiotic regimens and durations of treatment 1
- The role of biliary decompression in the management of cholangitis, with options including ERCP, percutaneous drainage, and surgery 1
- The consideration of cholecystostomy as an alternative to cholecystectomy in certain patients with acute cholecystitis 1. Overall, the management of cholecystitis and cholangitis requires a comprehensive approach that takes into account the underlying cause, clinical presentation, and individual patient factors to minimize morbidity, mortality, and improve quality of life.
From the Research
Difference between Cholecystitis and Cholangitis
- Cholecystitis is an inflammation of the gallbladder, often caused by gallstones, while cholangitis is an inflammation of the bile ducts, typically caused by a bacterial infection 2, 3.
- The symptoms of cholecystitis include right upper quadrant pain, fever, and leukocytosis, whereas cholangitis is characterized by acute inflammation and infection of the common bile duct, often presenting with fever, jaundice, and abdominal pain 4, 5.
- The management of cholecystitis typically involves supportive care and cholecystectomy, while the treatment of cholangitis includes intravenous fluids, analgesia, intravenous antibiotics, and biliary drainage and decompression 2, 4.
Causes and Risk Factors
- Cholecystitis can be caused by stones in the gallbladder, as well as other factors such as ischemia, chemicals, motility disorders, and infections 3.
- Cholangitis is often caused by bacterial infections, and risk factors include obstruction of the bile ducts, previous bile duct surgery, and certain medical conditions 2, 6.
Treatment and Management
- Empirical therapy for both conditions depends on the knowledge of local microbial epidemiology and patient-specific factors affecting the selection of appropriate agents 6.
- Antibacterial therapy is usually empirical, and initial therapy should cover the Enterobacteriaceae, in particular Escherichia coli 2.
- Relief of biliary obstruction is mandatory, even if there is clinical improvement with conservative therapy, because cholangitis is most likely to recur with continued obstruction 2.