Acute cholangitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Acute cholangitis is an infection of the biliary tree that requires prompt diagnosis and treatment.
Most patients with acute cholangitis have fever, jaundice, and right upper quadrant pain (Charcot triad).
Cholangitis can quickly become an acute, septic, life-threatening infection that requires rapid evaluation and treatment.
The most common causes are choledocholithiasis and benign and malignant strictures.
Antibiotics alone do not provide sufficient treatment in the majority of patients. Drainage of the biliary tree is the most critical step in management.

Endoscopic retrograde cholangiopancreatography reveals a large common bile duct (CBD) stone (arrow) in the mid-common bile duct

From the collection of Douglas G. Adler; used with permission

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Endoscopic retrograde cholangiopancreatography reveals a large common bile duct (CBD) stone (arrow) in the mid-common bile duct
Endoscopic photo of same patient following removal of large common bile duct (CBD) stone; note copious pus draining through the ampulla

Citations

Key Articles

Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30.[Abstract][Full Text]
Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):31-40. [Abstract][Full Text]
Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16. [Abstract][Full Text]
Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):96-100. [Abstract][Full Text]
Mukai S, Itoi T, Baron TH, et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017 Oct;24(10):537-49.[Abstract][Full Text]

Referenced Articles

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31. Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16. [Abstract][Full Text]
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