Ascending cholangitis: Difference between revisions
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'''Ascending cholangitis''' is an [[infection]] of the [[bile duct]] ([[cholangitis]]), usually caused by [[bacteria]] ascending from [[Ampulla of Vater|its junction]] with the [[duodenum]] (first part of the small intestine). Characteristic symptoms, are [[jaundice]], [[fever]] and [[abdominal pain]], [[hypotension|low blood pressure]] and [[mental confusion|confusion]]. Initial treatment is with [[antibiotic]]s, but as there is often an underlying problem (such as [[gallstone]]s or [[biliary stricture|narrowed areas]] in the bile duct) for which further tests and treatments may be necessary. |
'''Ascending cholangitis''' or '''acute cholangitis''' is an [[infection]] of the [[bile duct]] ([[cholangitis]]), usually caused by [[bacteria]] ascending from [[Ampulla of Vater|its junction]] with the [[duodenum]] (first part of the small intestine). Characteristic symptoms, are [[jaundice]], [[fever]] and [[abdominal pain]], [[hypotension|low blood pressure]] and [[mental confusion|confusion]]. Initial treatment is with [[antibiotic]]s, but as there is often an underlying problem (such as [[gallstone]]s or [[biliary stricture|narrowed areas]] in the bile duct) for which further tests and treatments may be necessary. |
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==Signs and symptoms== |
==Signs and symptoms== |
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Revision as of 21:33, 12 June 2008
| Ascending cholangitis | |
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| Specialty | Gastroenterology  |
Ascending cholangitis or acute cholangitis is an infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). Characteristic symptoms, are jaundice, fever and abdominal pain, low blood pressure and confusion. Initial treatment is with antibiotics, but as there is often an underlying problem (such as gallstones or narrowed areas in the bile duct) for which further tests and treatments may be necessary.
Signs and symptoms
The clinical symptoms of ascending cholangitis are pain, jaundice, and fever (Charcot's triad). In addition, the presence of hypotension and mental confusion (Reynold's pentad) is suggestive of severe septicemia. The typical clinical picture is present in only 50% of cases.
Causes
The infecting organisms are usually gram-negative bacilli (eg, E. coli, Klebsiella, Pseudomonas, and Enterococcus).
Diagnosis
Blood sample
Anaerobes may be cultured in 15% of cases. Laboratory studies show cholestasis, variable transaminase levels, leukocytosis, and positive blood cultures.
Ultrasound
Findings on ultrasound examination are the same as those for choledocholithiasis.
Treatment
When acute ascending cholangitis is suspected, the patient should be hospitalized. Fluid resuscitation and antibiotics are the key interventions, and antibiotic treatment should be targeted against gram-negative organisms and, possibly, anaerobes. Commonly used drugs include ampicillin, gentamicin sulfate (Garamycin) and metronidazole (Flagyl, Metro IV, Protostat), or ciprofloxacin (Cipro) with or without metronidazole.
The mainstay of therapy, however, is the establishment of biliary drainage, which can be accomplished endoscopically or percutaneously. Timing of the procedure depends on severity of the clinical presentation. Endoscopic retrograde cholangiopancreatography (ERCP) is used primarily. However, if the patient's condition is too unstable for ERCP, percutaneous transhepatic drainage can tide the patient over the acute crisis until definitive therapy can be planned. In all other cases, ERCP to determine the cause of the obstruction and provide drainage should be performed as soon as possible.
Prognosis
Ascending cholangitis can be life-threatening if untreated.
References
External links
- . GPnotebook https://www.gpnotebook.co.uk/simplepage.cfm?ID=1624244226.
{{cite web}}: Missing or empty|title=(help)
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