Cholangitis

Cholangitis is a topic covered in the 5-Minute Emergency Consult.

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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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