Acute bacterial infection of the biliary tree and one of the most severe complication of gallstones
Obstruction of the biliary tree leads to bile stasis and bacterial (usually gram-negative anaerobes) infection.
As time progresses this infection ascends towards the liver
Causes/Factors
- Choledocholithiasis (gallstones)
- Biliary strictures
Symptoms
- Fever
- RUQ pain
- Jaundice
- N&V
Signs
Charcot's triad
- Fever
- RUQ pain
- Jaundice
Reynold’s pentad - Charcot’s triad + altered mental status + hypotension
Investigations
- FBC, CRP - elevated WCC and CRP
- Sepsis screen - thrombocytopenia, coagulopathies and a raised lactate.
- LFTs - obstructive Jaundice (raised ALP and bilirubin)
- USS to looked for a dilated bile duct - if -ve CTA contrast should be requested
Management
Sepsis pathway if septic - broad-spec IV antibiotics and IV fluids
ERCP (Endoscopic retrograde cholangiopancreatography) - diagnostic and used to decompress the biliary tree urgently
Surgery may be necessary for patients with severe or complicated acute cholangitis, such as those with perforation, gangrenous Cholecystitis, or biliary Sepsis.
Analgesia
Lifestyle advice to reduce gallstone recurrence
Complications/red Flags
- pancreatitis: Concomitant inflammation of the pancreas due to biliary obstruction or pancreatic duct involvement.
- Biliary Perforation: Rupture of the bile ducts leading to bile peritonitis, abscess formation, or intra-abdominal Sepsis.
- Hepatic Abscess: Secondary infection and abscess formation within the liver parenchyma due to bacterial seeding from the biliary system.