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 owing to gallstones, tumor, cyst, or stricture
  • Increased intraluminal pressure in biliary tree
  • Bacterial multiplication results in bacteremia and sepsis.
  • Purulent infection of biliary tree, which may involve the liver and gallbladder
  • Mirizzi syndrome is defined as common bile duct obstruction owing to extrinsic compression from gallbladder or cystic duct edema or stones.

Etiology

  • 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)
    • Enterococcus
  • AIDS sclerosing cholangitis characterized by:
    • Papillary stenosis
    • Sclerosing cholangitis
    • Extrahepatic biliary obstruction
    • Cytomegalovirus (CMV), Cryptosporidium, and microsporidia isolated, but causal role not established

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