Ascending cholangitis

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Ascending cholangitis
Synonyms	Acute cholangitis, biliary tract infection
Pronounce
Specialty	Gastroenterology, Hepatology
Symptoms	Fever, jaundice, abdominal pain
Complications	Sepsis, liver abscess, biliary cirrhosis
Onset	Sudden
Duration
Types
Causes	Bile duct obstruction (e.g., gallstones, stricture, tumor)
Risks	Choledocholithiasis, biliary stricture, pancreatic cancer
Diagnosis	Blood culture, liver function tests, ultrasound, ERCP
Differential diagnosis	Cholecystitis, hepatitis, pancreatitis
Prevention
Treatment	Antibiotics, ERCP, surgery
Medication	Ciprofloxacin, metronidazole, piperacillin/tazobactam
Prognosis
Frequency
Deaths

Ascending Cholangitis

Introduction

Ascending Cholangitis, also known as acute cholangitis, is a serious infection of the bile ducts characterized by the presence of bacteria ascending from the small intestine into the biliary system. This condition is a medical emergency that requires prompt diagnosis and treatment to prevent complications such as sepsis and liver damage.

Diagram of the Gallstones and Ascending Cholangitis and biliary system showing the location of the bile ducts.

Causes

Ascending cholangitis is most commonly caused by bacterial infection. The primary risk factor for developing this condition is bile duct obstruction, which can occur due to:

• Gallstones
• Strictures
• Biliary tract surgeries
• Tumors

microscopic image showing gallstones in the bile duct, a common cause of cholangitis.

Pathophysiology

The pathophysiology of ascending cholangitis involves the obstruction of bile flow, leading to increased pressure in the bile ducts and bacterial overgrowth. The bacteria typically ascend from the small intestine, taking advantage of the disrupted bile flow to infect the biliary tract.

Symptoms

Symptoms of ascending cholangitis can include:

• Fever and chills
• Jaundice
• Right upper quadrant abdominal pain
• Nausea and vomiting
• Malaise

Diagnosis

Diagnosis of ascending cholangitis is based on clinical presentation, laboratory tests, and imaging studies. Key diagnostic tools include:

• Blood tests showing elevated white blood cell count and liver enzymes
• Ultrasound or MRCP (Magnetic Resonance Cholangiopancreatography) to visualize obstructions in the bile ducts
• ERCP (Endoscopic Retrograde Cholangiopancreatography) for both diagnosis and treatment

Treatment

Treatment for ascending cholangitis typically involves:

• Antibiotics to combat the infection
• Relief of bile duct obstruction, which may require procedures such as ERCP or surgery
• Supportive care for symptoms and to prevent complications

Prognosis

With prompt and appropriate treatment, the prognosis for ascending cholangitis can be good. However, the condition can be life-threatening if not treated promptly, emphasizing the importance of early detection and intervention.

See Also

• Bile duct
• Sepsis
• Gallstones
• ERCP

References

• "Hepatology: A Textbook of Liver Disease." David Zakim and Thomas D. Boyer, 2012.
• "Oxford Textbook of Medicine." Warrell, Cox, Firth, and Benz, 2010.

External Links

• UpToDate: Acute Cholangitis
• American Gastroenterological Association Guidelines