Cholangitis

Basics

Partial or complete obstruction of the common bile duct lead to increased intraluminal pressure in biliary tree
Purulent infection of biliary tree, which may involve the liver and gallbladder (GB) due to bacterial multiplication:
- Typically leads to bacteremia and sepsis

Acute biliary obstruction (more often partial than complete)
- Common bile duct (CBD) stones 65%
- Malignant stenosis 24%
- Benign stenosis 4%
- Sclerosing cholangitis 3%
- Mirizzi syndrome: Extrinsic compression of CBD by GB stones in cystic duct or GB neck
Bacterial sources of infection include:
- Ascending duodenal source
- Gallbladder infection
- Portal venous seeding
- Hematogenous spread with hepatic secretion
- Lymphatic spread
Bacterial organisms include:
- Anaerobes (Bacteroides and Clostridium species)
- Intestinal coliform (Escherichia coli, Klebsiella)
- Enterococcus
- Frequently polymicrobial
AIDS sclerosing cholangitis characterized by:
- Papillary stenosis or sclerosing cholangitis leading to extrahepatic biliary obstruction
- Cytomegalovirus (CMV), Cryptosporidium, and microsporidia isolated, but causal role not established

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