From the Guidelines
Cholangitis is defined as an infectious disease characterized by acute inflammation and infection in the bile ducts resulting from a combination of biliary obstruction and bacterial growth in bile. This condition typically occurs when bile flow becomes obstructed, allowing bacteria to grow and cause infection, with the most common cause being choledocholithiasis 1. The key elements of cholangitis include acute inflammation, infection, and biliary obstruction, which can lead to severe complications if not treated promptly.
Causes and Risk Factors
The causes of cholangitis include:
- Choledocholithiasis, which is the most common cause 1
- Biliary obstruction due to strictures, tumors, or other procedures like endoscopic retrograde cholangiopancreatography (ERCP)
- Bacterial growth in bile, which can occur due to ascent from the intestine or through the portal venous system 1
Symptoms and Diagnosis
Symptoms of cholangitis include:
- Fever
- Abdominal pain, particularly in the right upper quadrant
- Jaundice, which is the yellowing of skin and eyes
- Sometimes, confusion or low blood pressure in severe cases, which is known as Reynolds' pentad when hypotension and altered mental status are present
Treatment and Management
Treatment of cholangitis requires:
- Prompt antibiotic therapy, typically with broad-spectrum antibiotics 1
- Relieving the biliary obstruction, often through ERCP, percutaneous drainage, or surgery 1
- Endoscopic retrograde cholangiopancreatography (ERCP) plays a central role in the management of biliary obstruction in patients with acute cholangitis, and is the treatment of choice for biliary decompression in patients with moderate/severe acute cholangitis 1. Percutaneous biliary drainage (PTBD) should be reserved for patients in whom ERCP fails, and open drainage should only be used in patients for whom endoscopic or percutaneous trans-hepatic drainage is contraindicated or those in whom it has been unsuccessfully performed 1.
From the Research
Definition of Cholangitis
- Cholangitis is a life-threatening infection of the biliary tract 2.
- It is a potentially life-threatening systemic disease resulting from a combination of infection and obstruction of the biliary tree, secondary to different underlying etiologies 3.
- Cholangitis can be categorized as primary sclerosing (PSC), secondary (acute) cholangitis, and a recently characterized form, known as IgG4-associated cholangitis (IAC) 4.
- Acute cholangitis is a potentially life-threatening bacterial infection of the intra and/or extrahepatic bile ducts 5.
Key Characteristics
- Cholangitis is a serious life-threatening situation affecting the hepatobiliary system 4.
- It is associated with mortality rates of up to 15%, despite advances in broad-spectrum antimicrobial therapy and improved access to emergency biliary tract decompression procedures 5.
- Bacterial infections are known as the most common cause for acute cholangitis 4.
- Increased biliary pressure leads to biliovenous reflux of bacteria and purulent bile into the circulation leading to systemic inflammation and sepsis with subsequent organ dysfunction 6.