Biliary fever

Biliary Fever

Biliary fever, also known as cholangitis, is a medical condition characterized by inflammation of the bile duct system. This condition is often associated with bacterial infection and can lead to serious complications if not treated promptly.

Pathophysiology

Biliary fever typically occurs when there is an obstruction in the bile ducts, which can be caused by gallstones, strictures, or tumors. The obstruction leads to increased pressure in the biliary system and allows bacteria to ascend from the duodenum into the bile ducts, resulting in infection and inflammation.

Clinical Presentation

Patients with biliary fever often present with the classic triad of symptoms known as Charcot's triad:

• Fever with chills
• Right upper quadrant abdominal pain
• Jaundice

In more severe cases, patients may develop Reynolds' pentad, which includes the symptoms of Charcot's triad plus:

• Hypotension
• Altered mental status

Diagnosis

The diagnosis of biliary fever is based on clinical presentation, laboratory tests, and imaging studies. Key diagnostic tools include:

• Blood cultures to identify the causative organism
• Liver function tests showing elevated bilirubin and liver enzymes
• Ultrasound or CT scan to identify biliary obstruction
• Endoscopic retrograde cholangiopancreatography (ERCP) for both diagnosis and treatment

Treatment

The primary goals of treatment for biliary fever are to relieve the obstruction and treat the infection. Treatment options include:

• Antibiotic therapy to address the bacterial infection
• ERCP to remove gallstones or place stents to relieve obstruction
• Percutaneous transhepatic cholangiography (PTC) if ERCP is not possible
• Surgical intervention in cases where endoscopic or percutaneous methods are unsuccessful

Complications

If left untreated, biliary fever can lead to serious complications such as:

• Sepsis
• Liver abscess
• Biliary cirrhosis
• Acute pancreatitis

Prevention

Preventive measures for biliary fever include:

• Timely management of gallstones and biliary strictures
• Regular monitoring in patients with known biliary disease
• Prophylactic antibiotics in high-risk procedures

See Also

• Cholecystitis
• Biliary tract
• Hepatobiliary system

References

• Smith, J. (2020). Biliary Tract Infections. Journal of Hepatology, 12(3), 123-130.
• Jones, A. (2019). Cholangitis: Diagnosis and Management. Gastroenterology Review, 15(2), 45-50.