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CHOLANGITIS

Cholangitis refers to an acute infection of the biliary tree, and has the potential to cause significant morbidity and mortality. It occurs secondary to stasis or obstruction of bile compounded by the presence of bacteria. Choledocholithiasis (stones in the common bile duct) has long been the most common cause of obstruction, however, strictures, tumors, or manipulation of the common bile duct may cause bile stasis, leading to the predisposition to bacterial infection of the biliary tree. The most common organisms associated with Cholangitis are those found in the gut (E Coli, Klebsiella, Enterobacter, Enterococci, and Group D Streptococci). . | CHOLANGITIS General - Cholangitis refers to an acute infection of the biliary tree and has the potential to cause significant morbidity and mortality. It occurs secondary to stasis or obstruction of bile compounded by the presence of bacteria. Choledocholithiasis stones in the common bile duct has long been the most common cause of obstruction however strictures tumors or manipulation of the common bile duct may cause bile stasis leading to the predisposition to bacterial infection of the biliary tree. The most common organisms associated with Cholangitis are those found in the gut E Coli Klebsiella Enterobacter Enterococci and Group D Streptococci . - Charcot recognized cholangitis in 1877 when he described what has come to be known as Charcot s Triad Fever Jaundice RUQ pain . Reynolds and Dargon in 1959 described a more severe form of the illness which included Charcot s Triad plus the addition of hypotension septic shock and mental status changes thus coining the term Reynold s Pentad. Charcot s Triad Fever Jaundice RUQ Pain Reynold s Pentad Fever Jaundice RUQ Pain Hypotension Mental Status Changes - Cholangitis occurs relatively infrequently in the US and as it most commonly associated with gallstones the risk factors for development are essentially the same. Importantly however although the risk of gallstones is higher in women than in men cholangitis occurs equally in both sexes. Untreated the mortality of cholangitis is high 13-88 . Characteristics associated with increased mortality include hypotension acute renal failure liver abscess cirrhosis and IBD. Clinical Presentation - Scleral icterus of jaundice - A spectrum of cholangitis exists from mild illness to fulminant overwhelming sepsis. Charcot s Triad of fever jaundice and RUQ pain classically occur in up to 70 of patients presenting with illness however some patients particularly the elderly are too ill to localize the infection. A past medical history of gallstones recent cholecystectomy ERCP or .