Presentation 50-70% of patients present with classic Charcot's triad of jaundice, fever and right upper quadrant pain. In elderly patients, the abdominal pain may be poorly localised. [patient.info]

A biliary colic will present with a colicky RUQ pain yet without fever, leucocytosis, or jaundice. Cholecystitis will present with RUQ pain and fever yet jaundice will be absent. [teachmesurgery.com]

A cause of the development of bleeding tendency in obstructive jaundice presently observed may likely to be due to the occurrence of disseminated intravascular coagulation (DIC), i.e. hypercoagulability caused by the biliary tract infection is responsible [ncbi.nlm.nih.gov]

• Upper Abdominal Pain

  Result of FA test was related to clinical findings such as fever and leucocytosis, but was not to upper abdominal pain, jaundice, liver function test abnormality and the presence of gallstones. [ncbi.nlm.nih.gov]

  Parameters: (1) local symptoms (upper abdominal pain and tenderness, other) (2) body temperature and fever (3) erythrocyte sedimentation rate (ESR) (4) white blood cell (WBC) count (5) serum ALT (6) serum AST (7) serum conjugated bilirubin in µmol/L [meducator3.net]

  Sudden severe upper abdominal pain RUQ tenderness and guarding Low grade fever Jaundice is usually absent Complications ◦ Early Acute suppurative cholangitis Hepatic ascariasis Acute pancreatitis ◦ Late- calculi and strictures 37. [slideshare.net]

  Ninety percent of the patients complain of upper abdominal pain and have enlarged intra- and extrahepatic bile ducts on abdominal ultrasonography. [doi.org]

• Biliary Colic

  […] the ingestion of fatty meals is classic for biliary colic. [cdemcurriculum.com]

  These stones cause biliary colic, biliary obstruction, gallstone pancreatitis, or cholangitis (bile duct infection and inflammation). Cholangitis, in turn, can lead to strictures, stasis, and choledocholithiasis. [merckmanuals.com]

  *Antibiotics are not required in: Biliary colic without sepsis Mild diverticulitis without sepsis and with no evidence of perforation on CT scan Acute pancreatitis unless there is co-existent cholangitis, suggested by jaundice and sepsis (see SIRS criteria [handbook.ggcmedicines.org.uk]

  When a gallstone blocks the bile duct, a crampy pain in the right upper part of the abdomen, known as biliary colic (gallbladder attack) can result. This happens in 1–4% of those with gallstones each year. [play.google.com]

• Chest Pain

  Gallstone attacks can produce chest pain that may feel like a heart attack. If a pain is new and different than other pains the symptoms should be discussed with a physician. [patients.gi.org]

• Haemophilus Parainfluenzae

  Abstract Haemophilus parainfluenzae was isolated from a bile specimen of a 56-year-old patient with elevated liver enzymes and chronic cholecystitis. [ncbi.nlm.nih.gov]

Whereas less severe cases with appropriate treatment have very good prognosis, severe cases with delayed treatment may result in grave complications such as sepsis or kidney failure Addressing issues of biliary tract obstruction in a timely manner may [dovemed.com]

Both groups received comparable accompanying endoscopic antiobstructive treatment. [ncbi.nlm.nih.gov]

Quick diagnosis and treatment are very important. Antibiotics to cure infection are the first treatment done in most cases. ERCP or other surgical procedure is done when the person is stable. [nlm.nih.gov]

In severe cases of Cholangitis, endoscopic decompression may be required to drain the pus from the biliary tract The prognosis of Cholangitis depends upon the provision of timely treatment. [dovemed.com]

Treatment and prognosis Treatment involves appropriate antibiotic therapy and biliary tree decompression (usually either via ERCP or PTC). Mortality rates are between 50-90% for severe acute cholangitis 5,6. [radiopaedia.org]

Prognosis The prognosis depends on several factors, including the following [6] : Early recognition and treatment of cholangitis Response to therapy Underlying medical conditions of the patient Mortality rate ranges from 5-10%, with a higher mortality [emedicine.com]

Prognosis Prognosis after liver transplantation is generally good, however, in a proportion of patients PSC may recur in the transplanted liver, with recurrence rates varying from 10-37%. [orpha.net]

Liver Biopsy Helpful in intrahepatic cholestasis to evaluate for various possible underlying etiologies. Treatment / Management Management of cholestatic jaundice widely depends upon underlying etiology and type of cholestasis. [ncbi.nlm.nih.gov]

Etiology The precise etiology of PSC has not yet been established, but it is believed to be multifactorial. [orpha.net]

There are two other etiologies of acute cholangitis; Mirizzi syndrome and lemmel syndrome. [doi.org]

Poor prognostic factors Various factors from literature to suggest poor prognosis 10,12,13,14 high fever >39°C shock organ dysfunction advanced age >75 years mental confusion malignancy as etiology medical comorbidities hyperbilirubinemia ≥2.2 mg/dL reduced [radiopaedia.org]

OBJECTIVES: To determine the epidemiology of bacteraemia due to biliary tract infection (BTI) and to identify independent predictors of mortality. [ncbi.nlm.nih.gov]

Specifically, it will serve as a single-source reference on the current knowledge base for the multidisciplinary management of such cancers and thus covers epidemiological, surgical, radiotherapy, and chemotherapy approaches. [books.google.com]

Epidemiology, pathogenesis, and classification of cholangiocarcinoma. Available online: http://www.uptodate.com/contents/epidemiology-pathogenesis-and-classification-of-cholangiocarcinoma Bergquist A, von Seth E. Epidemiology of cholangiocarcinoma. [cco.amegroups.com]

An epidemiological study of primary liver carcinomas in Pusan area with special reference to clonorchiasis. Korean J Pathol 1976;10:33–46. 34. Shin HR, Lee CU, Park HJ, Seol SY, Chung JM, Choi HC, et al. [kjronline.org]

FASCIOLIASIS Etiology: Zoonosis caused by trematode ◦ Fasciola hepatica ◦ Fasciola gigantica Epidemiology F. hepatica – temperate zones F. gigantica – tropical zones Now has become global in distribution 4. [slideshare.net]

For related pathophysiology, please see the Cholelithiasis and Cholecystitis and Biliary Colic articles. [emedicine.com]

Mortality rate 5-10% Hepatobiliary Tract Anatomy Pathophysiology Bile duct develops an obstruction Obstruction may be incomplete (more common) or complete Causes: Gallstones (most common), malignancy, benign stricture, iatrogenic (i.e. [coreem.net]

Pathophysiology and Natural History Most gallstones are composed primarily of cholesterol, with smaller amounts of mucus, calcium bilirubinate, and protein. [clevelandclinicmeded.com]

Conversely, Kupffer cells and the tight junctions between hepatocytes help prevent bacteria and toxic metabolites from entering the hepatobiliary system from the portal circulation. [ncbi.nlm.nih.gov]

For most benign strictures, the authors prefer a straight stent with internal and external flaps to prevent stent migration. [clinicalgate.com]

On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher. [books.google.com]

Prevention In some cases, preventing cholangitis might not be possible. However, as most cases are caused by gallstones blocking the bile ducts, preventing gallstones may help. [verywellhealth.com]