Cholangitis
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Basics
Description
- 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
Etiology
- 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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Basics
Description
- 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
Etiology
- 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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