Acute cholangitis

Acute Cholangitis is a serious, potentially life-threatening infection of the biliary tract that is often caused by obstruction and subsequent bacterial infection. It is characterized by the classic triad of Charcot's triad: jaundice, fever, and right upper quadrant pain.

Etiology

The most common cause of acute cholangitis is biliary obstruction due to gallstones. Other causes include strictures, tumors, or iatrogenic causes such as endoscopic retrograde cholangiopancreatography (ERCP). The obstruction allows for bacterial overgrowth and infection within the biliary tract.

Pathophysiology

The obstruction in the biliary tract causes an increase in pressure, leading to bile leakage into the liver and systemic circulation. This results in systemic inflammation and potential sepsis. The most common organisms involved are gram-negative bacteria, including Escherichia coli and Klebsiella species.

Clinical Presentation

Patients with acute cholangitis often present with the classic Charcot's triad of jaundice, fever, and right upper quadrant pain. In severe cases, patients may also exhibit Reynolds' pentad, which includes the additional symptoms of altered mental status and shock.

Diagnosis

Diagnosis of acute cholangitis is typically made based on clinical presentation and laboratory findings, including leukocytosis and abnormal liver function tests. Imaging studies, such as ultrasound or CT, can also be useful in confirming the diagnosis and identifying the cause of biliary obstruction.

Treatment

The mainstay of treatment for acute cholangitis is antibiotic therapy and biliary drainage. This can be achieved through ERCP, percutaneous transhepatic cholangiography (PTC), or surgical intervention.

Prognosis

With prompt diagnosis and treatment, the prognosis for acute cholangitis is generally good. However, if left untreated, it can progress to sepsis and be life-threatening.