Question 1 of 10

    Ascending Cholangitis

    Ascending or acute cholangitis is a potentially life-threatening bacterial infection of the biliary tree that stems from bile duct obstruction and ascension of bacteria from the intestinal tract. Principal symptoms include abdominal pain, fever, and jaundice, known as the Charcot's triad, but additional clinical signs, as well as imaging studies, are necessary to confirm the diagnosis.

    The disease is related to the following process: infectious.

    Presentation

    Signs and symptoms of ascending cholangitis (also known as acute cholangitis) develop due to the obstruction of the biliary tree (by gallstones or choledocholithiasis, tumors or benign strictures are known as pathogenic mechanisms) and secondary bacterial colonization of the bile ducts from the gastrointestinal tract or the portal venous system [1] [2]. As a result, bacteria are able to reproduce and proliferate in this tight environment (as bile is not capable of flushing them back into the duodenum along its pathway), causing an intense inflammatory reaction and symptoms of abdominal pain, jaundice and fever, known as the Charcot's triad [3] [4] [5]. Although this clinical entity was described more than 100 years ago, most recent guidelines have proposed the exclusion of abdominal pain from constitutive features of acute cholangitis, because of a rather low report rate by patients [5] [6]. Indeed, the presence of a complete Charcot's triad ranges from 15.4–72.0%, which is why fever and jaundice remain the most important features [4]. Ascending cholangitis is life-threatening, with mortality rates being 2.5-3.5%, but in the absence of an early diagnosis, dissemination of bacteria in the systemic circulation and sepsis can occur, in which case mortality rates rise to 84-100% without immediate initiation of directed therapy [3] [5] [7]. In fact, septic encephalopathy is seen in up to 9% of cholangitis patients and is manifested as loss of consciousness and shock in most severe cases [5] [7]. Furthermore, some authors add hypotension and altered mental status to the Charcot triad's to form the Reynold's pentad, another diagnostic tool used to identify patients with ascending cholangitis [3] [8].

    Skin
    Pruritus
    • [patient.info] Assess for allergic reactions: rash , urticaria, pruritus .[symptoma.com]
    • Other symptoms include the following: Jaundice Fever, chills, and rigors Abdominal pain Pruritus Acholic or hypocholic stools Malaise The patient's medical history may be helpful.[emedicine.medscape.com]
    • The patient may also report acholic (putty-coloured) stools and pruritus.[patient.info]
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  • urogenital
    Dark Urine
    • [accessmedicine.mhmedical.com] Dark urine and clay-colored stools.[symptoma.com]
    • Dark urine and clay-colored stools.[medlineplus.gov]
    • Obstruction of the biliary system can hinder excretion of bilirubin into the gut and simultaneously exceed the processing ability of the kidneys, leading to pale stools and dark urine.[accessmedicine.mhmedical.com]
    • Typically, an attack of colic is followed the next day by fluctuating jaundice, dark urine, pale stools, nausea and vomiting, fever and rigors, and a leucocytosis.[meb.uni-bonn.de]
    • Other symptoms include fever, chills, clay-colored stools, vomiting and nausea, dark urine, and skin yellowing (jaundice).[diethealthclub.com]
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  • cardiovascular
    Hypotension
    • [anaerobicinfections.blogspot.com] Hypotension Characteristics associated with increased mortality include hypotension , acute renal failure, liver abscess, cirrhosis, and IBD.[symptoma.com]
    • […] carcinoma triad: (1) hematuria, (2) flank pain, (3) abdominal mass Note this triad only appears 10% of the time Charcot’s triad for ascending cholangitis: (1) fever (2) RUQ pain (3) Jaundice Reynaud’s pentad for ascending cholangitis: Charcot’s triad hypotension[theweeklymnemonic.wordpress.com]
    • Patients present with altered mental status 10-20% of the time and hypotension approximately 30% of the time.[emedicine.medscape.com]
    • DEFINITIVE TREATMENT OF CAUSE • Cholecystectomy • Stent • Urgent decompression- - Persistent abdo pain - Hypotension despite adequate resus - Fever 39.0*C - Confusion/ delerium 19.[slideshare.net]
    • In the more severe, life-threatening form, known as toxic cholangitis or cholangitis with sepsis, patients have purulent biliary tree contents, as well as evidence of sepsis, hypotension, multi-organ failure, and mental status changes. [1] Boey JH, Way[bestpractice.bmj.com]
    Tachycardia
    • [lifeinthefastlane.com] Physical signs may include fever, right upper quadrant tenderness, jaundice, mental status changes, hypotension and tachycardia .[symptoma.com]
    • Physical examination may reveal the following: Fever (90%), although elderly patients may have no fever RUQ tenderness (65%) Mild hepatomegaly Jaundice (60%) Mental status changes (10-20%) Sepsis Hypotension (30%) Tachycardia Peritonitis (uncommon, and[emedicine.medscape.com]
    • 28%-70%) • Recent cholecystectomy • Endoscopic manipulation or ERCP, cholangiogram • History of cholangitis • Immunocompromised • Malignancy (10-57%) • Sepsis • Hypotension (30%)- has been reported as the only symptom in patients on glucocorticoids • Tachycardia[slideshare.net]
    • […] cholecystectomy ERCP or cholangiogram previous cholangitis immunocompromise malignancy CLINICAL FEATURES History fever ( 80%) abdominal pain (especially RUQ) ( 80%) nausea and vomiting, malaise predisposing factors and history of an underlying cause Examination tachycardia[lifeinthefastlane.com]
    • Physical signs may include fever, right upper quadrant tenderness, jaundice, mental status changes, hypotension and tachycardia.[patient.info]
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  • gastrointestinal
    Abdominal Pain
    • Pain For Additional Reading: Cholangitis: Pearls & Pitfalls Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain [emdocs.net] [www.symptoma.com] more... gastrointestinal Abdominal[symptoma.com]
    • For Additional Reading: Cholangitis: Pearls & Pitfalls Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain Cholangitis: Deadly Cause of Right Upper Quadrant Abdominal Pain[emdocs.net]
    • Abdominal pain and jaundice is thought to occur in 70% and 60% of patients, respectively.[emedicine.medscape.com]
    • Charcot's triad: Fever Abdominal pain Jaundice Reynolds pentad: Fever Abdominal pain Jaundice Confusion Hypotension Charcot described the original triad in 1877 .[derangedphysiology.com]
    • Clinically it is characterized by Charcot's cholangitis triad , consisting of abdominal pain (usually RUQ), high fever , and jaundice , although this last sign is not always present.[amboss.com]
    Nausea
    • [amboss.com] Nausea Clinical findings Right upper quadrant pain that may radiate to the shoulder, variable severity, nausea , vomiting, constipation, episodic chills, fever, slow pulse, Murphy sign, anorexia, weight loss; spontaneous remission is rare[symptoma.com]
    • Clinical findings Right upper quadrant pain that may radiate to the shoulder, variable severity, nausea, vomiting, constipation, episodic chills, fever, slow pulse, Murphy sign, anorexia, weight loss; spontaneous remission is rare.[medical-dictionary.thefreedictionary.com]
    • The pain lasts longer than 6h and is usually associated with nausea/vomiting, fever and right upper quadrant pain.[sketchymedicine.com]
    • Other symptoms include fever, chills, clay-colored stools, vomiting and nausea, dark urine, and skin yellowing (jaundice).[diethealthclub.com]
    Vomiting
    • [emdocs.net] Vomiting Clinical findings Right upper quadrant pain that may radiate to the shoulder, variable severity, nausea, vomiting , constipation, episodic chills, fever, slow pulse, Murphy sign, anorexia, weight loss; spontaneous remission is rare[symptoma.com]
    • Clinical findings Right upper quadrant pain that may radiate to the shoulder, variable severity, nausea, vomiting, constipation, episodic chills, fever, slow pulse, Murphy sign, anorexia, weight loss; spontaneous remission is rare.[medical-dictionary.thefreedictionary.com]
    • The pain lasts longer than 6h and is usually associated with nausea/vomiting, fever and right upper quadrant pain.[sketchymedicine.com]
    • Other symptoms include fever, chills, clay-colored stools, vomiting and nausea, dark urine, and skin yellowing (jaundice).[diethealthclub.com]
    Epigastric Pain
    • C H I E F C O M P L A I N T Patient had fever and complaint of epigastric pain prompting immediately his family members to consult.[scribd.com]
    • […] infection/ RUQ pain/ fever if there will we low grade/ no jaundice since its not obstructing CBD/ murphys sign / first step is USG and if not conclusive HIDA scan choledocholithiasis: stone in CBD/ obstructive jaundice(jaundice is big thing here)/ RUQ or epigastric[usmleforum.com]
    • Liver, Gall & Pancreas Jaundice : stone in CBD/ obstructive jaundice ( jaundice is big thing here)/ RUQ or epigastric pain/ total and direct bilirubin elevated as well as alkaline phosphatase/ can lead to cholangitis/ usg done but cant proficiently see[symptoma.com]
    • […] diagnosis: One item in all three: A , B and C Additionally, one may list supportive features which are not a part of the diagnostic criteria: Characteristic symptoms of biliary colic are the most common symptom In 72-93%, there is right hypochondrial and/or epigastric[derangedphysiology.com]
    Clay-Colored Stool
    • Dark urine and clay-colored stools.[medlineplus.gov]
    • [accessmedicine.mhmedical.com] Dark urine and clay-colored stools.[symptoma.com]
    • Other symptoms include fever, chills, clay-colored stools, vomiting and nausea, dark urine, and skin yellowing (jaundice).[diethealthclub.com]
    Tenderness in the Right Upper Quadrant
    • On physical exam, he has tenderness in the right upper quadrant and is intermittently confused, often repeating himself.[medbullets.com]
    • A physical examination often reveals signs of jaundice as well as abdominal tenderness in the right upper quadrant area.[medicalsubstance.com]
    Chronic Abdominal Pain
    • Oral intake was not aided by the presence of chronic abdominal pain, which was exacerbated by eating and jejunostomy feeding.[pubmedcentralcanada.ca]
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  • neurologic
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  • Entire body system
    Fever
    • Entire body system Fever Fever and Skin Rash 292 Fever and the Renal Transplant Recipient 301 Fever Following Travel Abroad 306 Hyperpyrexia and Hyperthermia 316 Fever in the Granulocytopenic Patient 319 Fever of Unknown Origin 325 Recurrent Furunculosis[symptoma.com]
    • Fever and Skin Rash 292 Fever and the Renal Transplant Recipient 301 Fever Following Travel Abroad 306 Hyperpyrexia and Hyperthermia 316 Fever in the Granulocytopenic Patient 319 Fever of Unknown Origin 325 Recurrent Furunculosis 333 Postoperative Fever[books.google.com]
    • The answer was ascending cholangitis based on the fact that she had a fever. 10% got it right.[forums.studentdoctor.net]
    • Fever is present in approximately 90% of cases.[emedicine.medscape.com]
    • The main symptoms of ascending cholangitis are fever, jaundice and pain.[diethealthclub.com]
    Chills
    • [diethealthclub.com] Chills Today he presents with fever and chills .[symptoma.com]
    • Today he presents with fever and chills.[medbullets.com]
    • Clinical findings Right upper quadrant pain that may radiate to the shoulder, variable severity, nausea, vomiting, constipation, episodic chills, fever, slow pulse, Murphy sign, anorexia, weight loss; spontaneous remission is rare.[medical-dictionary.thefreedictionary.com]
    • • Males, for cholangitis secondary to malignant obstruction and HIV infection PREDOMINANT AGE: Seventh decade and older; unusual 50 years of age PEAK INCIDENCE: Seventh decade PHYSICAL FINDINGS & CLINICAL PRESENTATION • Usually acute onset of fever, chills[encyclopedia.lubopitko-bg.com]
    • Fever and/or shaking chills - temperature 38 C.[patient.info]
    Rigor
    • [patient.info] Rigor Presentation – rigors , fever, abdominal pain, jaundice Treatment It is a medical emergency.[symptoma.com]
    • Presentation – rigors, fever, abdominal pain, jaundice Treatment It is a medical emergency.[almostadoctor.co.uk]
    • If he is jaundiced, with rigors and spiking fever which fails to respond to antibiotics in 24 hours, operate.[meb.uni-bonn.de]
    • Other symptoms include the following: Jaundice Fever, chills, and rigors Abdominal pain Pruritus Acholic or hypocholic stools Malaise The patient's medical history may be helpful.[emedicine.medscape.com]
    • Ascending Cholangitis Signs and Symptoms AC patients may experience problems like: Abdominal pain Rigors Fever Malaise, or a feeling of uneasiness Jaundice may also be reported in some cases.[medicalsubstance.com]
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  • Liver, Gall & Pancreas
    Jaundice
    • Liver, Gall & Pancreas Jaundice : stone in CBD/ obstructive jaundice ( jaundice is big thing here)/ RUQ or epigastric pain/ total and direct bilirubin elevated as well as alkaline phosphatase/ can lead to cholangitis/ usg done but cant proficiently see[symptoma.com]
    • : stone in CBD/ obstructive jaundice(jaundice is big thing here)/ RUQ or epigastric pain/ total and direct bilirubin elevated as well as alkaline phosphatase/ can lead to cholangitis/ usg done but cant proficiently see CBD so gold standard is ERCP cholangitis[usmleforum.com]
    • The bile flow is stanched and the patient will become jaundiced.[buckeyesurgeon.com]
    • Symptoms include the following: Charcot's triad consists of fever, RUQ pain, and jaundice.[emedicine.medscape.com]
    Biliary Colic
    • That is more representative of biliary colic (even though biliary colic itself is often persistent) and maybe choledocholithiasis.[forums.studentdoctor.net]
    • It’s biliary colic that just doesn’t go away.[sketchymedicine.com]
    • Colic That is more representative of biliary colic (even though biliary colic itself is often persistent) and maybe choledocholithiasis.[symptoma.com]
    • Biliary colic occurs when the ducts become partially obstructed.[merckmanuals.com]
    • Compare & contrast the S & Sx of RUQ P, fever/ WCC, & jaundice in biliary colic, acute cholecystitis, & cholangitis.[goconqr.com]
    Scleral Icterus
    • [emdocs.net] On examination, she was apyrexial with scleral icterus .[symptoma.com]
    • Initial Presentation: Jaundice Abdominal pain Fever Vital Signs: Fever can be present given this is an infectious process Dermatological Exam: Scleral icterus Jaundice Abdominal Exam: Abdominal tenderness: can commonly be in the right upper quadrant.[stepwards.com]
    • She has scleral icterus and jaundice (worsened per family).[emdocs.net]
    • Illustration A represents scleral icterus, a sign of jaundice, and elevated bilirubin.[medbullets.com]
    • On examination, she was apyrexial with scleral icterus.[academic.oup.com]
    Hepatomegaly
    • [medbullets.com] Hepatomegaly Scleral icterus, fever, pruritis, and mild hepatomegaly all help support the diagnosis.[symptoma.com]
    • Physical examination may reveal the following: Fever (90%), although elderly patients may have no fever RUQ tenderness (65%) Mild hepatomegaly Jaundice (60%) Mental status changes (10-20%) Sepsis Hypotension (30%) Tachycardia Peritonitis (uncommon, and[emedicine.medscape.com]
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  • Workup

    Acute deterioration of patients that present with jaundice and fever (as well as abdominal pain) must raise clinical suspicion of an inflammatory process in the biliary tree, especially if loss of consciousness or an altered mental state is also present [3]. After obtaining a detailed patient history (if patients are unconscious, friends or family who bring the patient to the hospital can provide valuable information). Conducting a thorough physical examination and a complete laboratory workup is mandatory. A complete blood count (CBC) will almost always show leukocytosis [5], whereas inflammatory parameters - C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen will all be elevated depending on the duration and severity of the infection. Alkaline phosphatase (ALP), bilirubin, and pancreatic amylase levels may be elevated in severe cases [8]. At the same time, blood cultures should be drawn, and they are likely to be positive in the majority of the cases [5]. Bacterial pathogens that cause ascending cholangitis are principally gram-negative Enterobacteriaceae (Escherichia coli, Enterobacter spp, and Klebsiella spp), while gram-positive microorganisms (eg. Enterococcus sp) and anaerobes (Bacteroides spp, Clostridia, and Fusobacterium spp) are less common [8]. On the other hand, imaging studies must be performed early on, including ultrasonography and computed tomography (CT), which is recommended as a first-line procedure [4]. Multidetector CT (MDCT) has shown even greater specificity and sensitivity and should be performed whenever possible, while magnetic resonance cholangiopancreatography (MRCP) is also mentioned as a reliable method to diagnose the condition [3] [4].

    Pathology

    Biopsy
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  • Laboratory

    Serum
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  • Microbiology
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  • Imaging

    X-ray
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  • Angiography
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  • Treatment

    Prognosis

    Complications

    Obstructive Jaundice
    • : stone in cystic duct/this is inflammation and not infection/ RUQ pain/ fever if there will we low grade/ no jaundice since its not obstructing CBD/ murphys sign / first step is USG and if not conclusive HIDA scan choledocholithiasis: stone in CBD/ obstructive[usmleforum.com]
    • [malacards.org] LFTs: typically show pattern of obstructive jaundice .[symptoma.com]
    • Obstructive jaundice promotes bacterial translocation in human .[nature.com]
    • Parasitic infestation can cause obstructive jaundice with intrahepatic ductal inflammation, proximal stasis, stone formation, and cholangitis.[merckmanuals.com]
    • LFTs: typically show pattern of obstructive jaundice.[patient.info]
    Fever
    • Entire body system Fever Fever and Skin Rash 292 Fever and the Renal Transplant Recipient 301 Fever Following Travel Abroad 306 Hyperpyrexia and Hyperthermia 316 Fever in the Granulocytopenic Patient 319 Fever of Unknown Origin 325 Recurrent Furunculosis[symptoma.com]
    • Fever and Skin Rash 292 Fever and the Renal Transplant Recipient 301 Fever Following Travel Abroad 306 Hyperpyrexia and Hyperthermia 316 Fever in the Granulocytopenic Patient 319 Fever of Unknown Origin 325 Recurrent Furunculosis 333 Postoperative Fever[books.google.com]
    • The answer was ascending cholangitis based on the fact that she had a fever. 10% got it right.[forums.studentdoctor.net]
    • Fever is present in approximately 90% of cases.[emedicine.medscape.com]
    • The main symptoms of ascending cholangitis are fever, jaundice and pain.[diethealthclub.com]
    Acute Pancreatitis
    • The 2 major complications are 1) Cholangitis and 2) Acute pancreatitis.[sketchymedicine.com]
    • [diethealthclub.com] Acute Pancreatitis The 2 major complications are 1) Cholangitis and 2) Acute pancreatitis .[symptoma.com]
    • pancreatitis K85.00 …… without necrosis or infection Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.[icd10data.com]
    • Pancreatitis Chronic Pancreatits Pancreatic Pseudocyst Acute Bowel Disorders Diarrhea Lower GI Bleed Volvulus Appendicitis Ischemic Colitis Mesenteric Ischemia Small Bowel Obstruction Large Bowel Obstruction Ogilvie's Syndrome Paralytic/Adynamic Ileus[medbullets.com]
    • Over ten years, 15–26% will suffer one or more episodes of biliary colic (abdominal pain due to the passage of gallstones through the bile duct into the digestive tract), and 2–3% will develop complications of obstruction: acute pancreatitis , cholecystitis[en.wikipedia.org]
    Shock
    • Other causes of septic shock.[patient.info]
    • […] altered mental state jaundice (60-70%) Eponymous findings Charcot’s triad (50-75% of cases): fever, RUQ pain and jaundice Reynold’s pentad ( 5% of cases): Charcot’s triad plus altered mental state and shock INVESTIGATIONS Bedside blood gas including[lifeinthefastlane.com]
    • Sepsis and septic shock may develop as a complication of acute cholangitis.[amboss.com]
    • Reynolds’ pentad includes mental confusion and septic shock – two more symptoms apart from the three common with Charcot’s triad.[medicalsubstance.com]
    • If untreated, sepsis with shock, vascular collapse, multiorgan failure, and potentially death can occur.[blood-test.biz]
    Liver Abscess
    • abscess ( A06.4 ) cholangitis without liver abscess ( K83.0 ) pylephlebitis without liver abscess ( K75.1 ) Type 2 Excludes acute or subacute hepatitis NOS ( B17.9 ) acute or subacute non-viral hepatitis ( K72.0 ) chronic hepatitis NEC ( K73.8 ) Angiocholitis[icd10data.com]
    • […] wall thickening with hyperenhancement Intraductal purulent bile or pus: High density on CT, intermediate to low signal on T1 and T2WI MR Heterogeneous liver enhancement, which can be wedge-shaped, peribiliary, patchy, or diffuse Can be associated with liver[clinicalgate.com]
    • We report a case where ascending cholangitis was associated with pyogenic liver abscess formation and a gastric fistula.[journals.lww.com]
    • [blood-test.biz] Liver Abscess abscess ( A06.4 ) cholangitis without liver abscess ( K83.0 ) pylephlebitis without liver abscess ( K75.1 ) Type 2 Excludes acute or subacute hepatitis NOS ( B17.9 ) acute or subacute non-viral hepatitis ( K72.0 ) chronic[symptoma.com]
    • Obtain blood cultures Differential Pancreatic cancer, cholangiocarcinoma, carcinoma of the bile ducts, metastatic carcinoma, primary biliary cirrhosis, cholecystitis, pancreatitis, sepsis, liver abscess.[medbullets.com]
    Jaundice
    • Liver, Gall & Pancreas Jaundice : stone in CBD/ obstructive jaundice ( jaundice is big thing here)/ RUQ or epigastric pain/ total and direct bilirubin elevated as well as alkaline phosphatase/ can lead to cholangitis/ usg done but cant proficiently see[symptoma.com]
    • : stone in CBD/ obstructive jaundice(jaundice is big thing here)/ RUQ or epigastric pain/ total and direct bilirubin elevated as well as alkaline phosphatase/ can lead to cholangitis/ usg done but cant proficiently see CBD so gold standard is ERCP cholangitis[usmleforum.com]
    • The bile flow is stanched and the patient will become jaundiced.[buckeyesurgeon.com]
    • Symptoms include the following: Charcot's triad consists of fever, RUQ pain, and jaundice.[emedicine.medscape.com]
    Acute Cholecystitis
    • S & Sx of acute cholecystitis.[goconqr.com]
    • acute cholecystitis: stone in cystic duct/this is inflammation and not infection/ RUQ pain/ fever if there will we low grade/ no jaundice since its not obstructing CBD/ murphys sign / first step is USG and if not conclusive HIDA scan choledocholithiasis[usmleforum.com]
    • Cholecystitis S & Sx of acute cholecystitis .[symptoma.com]
    • Infection can also flow in a retrograde direction up the CBD as a result of acute cholecystitis or instrumentation such as endoscopic retrograde cholangiopancreatography (ERCP).[patient.info]
    • Even patients with acute cholecystitis can be cooled down for 24-48 hours with fluids and IV antibiotics prior to definitive surgery.[buckeyesurgeon.com]
    Septicemia
    Hypotension
    • [anaerobicinfections.blogspot.com] Hypotension Characteristics associated with increased mortality include hypotension , acute renal failure, liver abscess, cirrhosis, and IBD.[symptoma.com]
    • […] carcinoma triad: (1) hematuria, (2) flank pain, (3) abdominal mass Note this triad only appears 10% of the time Charcot’s triad for ascending cholangitis: (1) fever (2) RUQ pain (3) Jaundice Reynaud’s pentad for ascending cholangitis: Charcot’s triad hypotension[theweeklymnemonic.wordpress.com]
    • Patients present with altered mental status 10-20% of the time and hypotension approximately 30% of the time.[emedicine.medscape.com]
    • DEFINITIVE TREATMENT OF CAUSE • Cholecystectomy • Stent • Urgent decompression- - Persistent abdo pain - Hypotension despite adequate resus - Fever 39.0*C - Confusion/ delerium 19.[slideshare.net]
    • In the more severe, life-threatening form, known as toxic cholangitis or cholangitis with sepsis, patients have purulent biliary tree contents, as well as evidence of sepsis, hypotension, multi-organ failure, and mental status changes. [1] Boey JH, Way[bestpractice.bmj.com]
    Bacterial Endocarditis
    Pelvic Inflammatory Disease
    Cholestasis
    • Institute of Diabetes and Digestive and Kidney Diseases ALP - blood test (Medical Encyclopedia) Bile duct obstruction (Medical Encyclopedia) Biliary atresia (Medical Encyclopedia) Biliary stricture (Medical Encyclopedia) Cholangitis (Medical Encyclopedia) Cholestasis[icdlist.com]
    • Acute cholangiolitis is associated not only with bile duct obstruction but may also be seen in any liver disease related to prominent cholestasis that also involves the periportal zones.[humpath.com]
    • Abdominal pain (most commonly RUQ) High fever Jaundice (less common) Reynolds pentad : Charcot cholangitis triad hypotension and mental status changes seen in severe cholangitis Possible septic shock References: [3] Diagnostics Leukocytosis , CRP Signs of cholestasis[amboss.com]
    • [icdlist.com] Acute cholangiolitis is associated not only with bile duct obstruction but may also be seen in any liver disease related to prominent cholestasis that also involves the periportal zones.[symptoma.com]
    Renal Amyloidosis
    • - R Marley, A Suddle - Clinical Dilemmas in Inflammatory Bowel , 2008 - books.google.com Adult celiac disease and its malignant complications - HJ Freeman - Gut and liver, 2009 - synapse.koreamed.org A clinicopathological study of renal amyloidosis in[symptoma.com]
    Viral Hepatitis
    • […] abscess Pylephlebitic hepatic abscess Type 1 Excludes amebic liver abscess ( A06.4 ) cholangitis without liver abscess ( K83.0 ) pylephlebitis without liver abscess ( K75.1 ) Type 2 Excludes acute or subacute hepatitis NOS ( B17.9 ) acute or subacute non-viral[icd10data.com]
    • Hepatitis - eg, viral hepatitis , drug-induced hepatitis .[patient.info]
    • […] or subacute non- viral [icd10data.com] Hepatitis - eg, viral hepatitis , drug-induced hepatitis .[symptoma.com]
    Septic Shock
    Primary Biliary Cirrhosis
    • biliary cirrhosis (Medical Encyclopedia) [ Read More ][icdlist.com]
    • Obtain blood cultures Differential Pancreatic cancer, cholangiocarcinoma, carcinoma of the bile ducts, metastatic carcinoma, primary biliary cirrhosis, cholecystitis, pancreatitis, sepsis, liver abscess.[medbullets.com]
    • [patient.info] Primary Biliary Cirrhosis biliary cirrhosis (Medical Encyclopedia) [ Read More ] [icdlist.com] Obtain blood cultures Differential Pancreatic cancer, cholangiocarcinoma, carcinoma of the bile ducts, metastatic carcinoma, primary biliary[symptoma.com]
    • biliary cirrhosis 2016 2017 2018 Billable/Specific Code Applicable To Chronic nonsuppurative destructive cholangitis K74.3 ) The following code(s) above K83.0 contain annotation back-references Annotation Back-References In this context, annotation back-references[icd10data.com]
    Secondary Sclerosing Cholangitis
    • The third type of cholangitis is secondary sclerosing cholangitis, and this is caused due to some other reasons.[diethealthclub.com]
    Perforated Peptic Ulcer
    Leukocytosis
    • [forums.studentdoctor.net] [www.symptoma.com] Leukocytosis A complete blood count (CBC) will almost always show leukocytosis , whereas inflammatory parameters - C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen will all be[symptoma.com]
    • The idea was that it presented exactly like stones (since that can be an aetiology of AC), but that one needs to be aware of the fever and/or leukocytosis.[forums.studentdoctor.net]
    • There is usually a leukocytosis, and the alkaline phosphatase and bilirubin levels are generally elevated.[ncbi.nlm.nih.gov]
    • Charcot cholangitis triad Abdominal pain (most commonly RUQ) High fever Jaundice (less common) Reynolds pentad : Charcot cholangitis triad hypotension and mental status changes seen in severe cholangitis Possible septic shock References: [3] Diagnostics Leukocytosis[amboss.com]
    • […] biliary malignancy History of biliary reconstruction or endoscopic biliary duct manipulation stricture/indwelling stent occlusion Evaluation: Labs: LFTs: conjugated hyperbilirubinemia, transaminitis, elevated alkaline phosphatase, elevated GGT CBC: leukocytosis[emdocs.net]

    Etiology

    Causes

    Epidemiology

    Sex distribution
    Age distribution

    Pathophysiology

    Prevention

    Summary

    Patient Information

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    References

    1. Mosler P. Diagnosis and management of acute cholangitis. Curr Gastroenterol Rep. 2011;13(2):166-172.
    2. Kiriyama S, Takada T, Strasberg SM, et al. New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo guidelines. J Hepatobiliary Pancreat Sci. 2012;19(5):548-556.
    3. Schneider J, Hapfelmeier A, Thöres S, et al. Mortality Risk for Acute Cholangitis (MAC): a risk prediction model for in-hospital mortality in patients with acute cholangitis. BMC Gastroenterol 2016;16:15.
    4. Yamamoto K Gotoda T, Kusano C, Liu J, Yasuda T, Itoi T, Moriyasu F. Severe Acute Cholangitis with Complications of Bacterial Meningitis Associated with Hearing Loss. Intern Med. 2015;54(14):1757-1760.
    5. Qin YS, Li QY, Yang FC, Zheng SS. Risk factors and incidence of acute pyogenic cholangitis. Hepatobiliary Pancreat Dis Int. 2012;11(6):650-654.
    6. Kim SW, Shin HC, Kim HC, Hong MJ, Kim IY. Diagnostic performance of multidetector CT for acute cholangitis: evaluation of a CT scoring method. Br J Radiol. 2012;85(1014):770-777.
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