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]

Mirizzi’s syndrome can present with RUQ pain, jaundice and fever. [cancertherapyadvisor.com]

Death was uncommon but when it occurred was often caused by septic shock within 48 h of presentation. [ncbi.nlm.nih.gov]

• Fever

  The term hepatic fever was used for the first time by Charcot in his report published in 1887. Intermittent fever accompanied by chills, right upper quadrant abdominal pain, and jaundice have been established as Charcot's triad. [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]

  RUQ pain and jaundice (neither sensitive nor specific) Symptoms Fever/chills Nausea/vomiting Abdominal pain Physical Exam RUQ tenderness to palpation Peritoneal signs are variable Jaundice Frank sepsis (fever, tachycardia, hypotension, tachypnea) is [coreem.net]

  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]

• Sepsis

  *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]

  Sepsis was more common in ESBL-positive strains, but did not reach statistical significance (23.8 % for ESBL-positive strains and 9.4 % for ESBL-negative strains, P = 0.066). [ncbi.nlm.nih.gov]

  A pentad may also be seen, in which mental status changes and sepsis are added to the triad. A spectrum of cholangitis exists, ranging from mild symptoms to fulminant overwhelming sepsis. [emedicine.com]

  Complications Patients with severe sepsis can develop liver abscesses and liver failure, bacteraemia and Gram-negative sepsis. [patient.info]

• Weight Loss

  A patient with gallhbladder cancer may present with signs and symptoms that include, but are not limited to abdominal pain, particularly in the right upper quadrant (RUQ), and bloating, as well as fever, nausea, unintentional weight loss, loss of appetite [news-medical.net]

  History of bile duct cancer and recent biliary surgery Injury from a gallbladder surgery Obesity Rapid weight loss Key Symptoms Patients suffering from biliary obstruction due to the presence of calculus in the biliary tract typically notice various physical [docdoc.com.sg]

  Other cholangiocarcinoma symptoms may include weight loss, loss of appetite, weakness, loss of energy, and easy bruising or bleeding (factors that clot the blood are manufactured in the liver and loss of liver function may decrease the clotting factors [medicinenet.com]

  Risk factors for gallstones include birth control pills, pregnancy, a family history of gallstones, obesity, diabetes, liver disease, or rapid weight loss. The bile components that form gallstones include cholesterol, bile salts, and bilirubin. [play.google.com]

  Loss of appetite/weight loss People with bile duct cancer may not feel hungry and may lose weight without trying to do so. Fever Some people with bile duct cancer develop fevers. [cancer.org]

• Chills

  The classical features of this syndrome are jaundice, chills, fever, and pain in the right upper quadrant of the abdomen. 1 To these, Reynolds and Dargan 2 added delirium and shock as the identifying features of this disease. [dx.doi.org]

  Fever and chills. Dark urine and clay-colored stools. Nausea and vomiting. Yellowing of the skin (jaundice), which may come and go. Quick diagnosis and treatment are very important. [nlm.nih.gov]

  Intermittent fever accompanied by chills, right upper quadrant abdominal pain, and jaundice have been established as Charcot's triad. [patient.info]

• Rigor

  On examination, patients may have pyrexia (in 90% of cases), rigors, jaundice, right upper quadrant tenderness, confusion, hypotension, and tachycardia may be present. [teachmesurgery.com]

  Signs and symptoms[edit] A person with cholangitis may complain of abdominal pain (particularly in the right upper quadrant of the abdomen), fever, rigors (uncontrollable shaking) and a feeling of uneasiness (malaise). [en.wikipedia.org]

• Loss of Appetite

  They include consumption of large amounts of alcohol, loss of appetite, nausea, and vomiting. [msdmanuals.com]

  Loss of appetite/weight loss People with bile duct cancer may not feel hungry and may lose weight without trying to do so. Fever Some people with bile duct cancer develop fevers. [cancer.org]

  Other less common signs and symptoms of cholestasis of pregnancy may include: Yellowing of the skin and whites of the eyes (jaundice) Nausea Loss of appetite When to see a doctor Contact your pregnancy care provider immediately if you begin to feel persistent [mayoclinic.org]

  A patient with gallhbladder cancer may present with signs and symptoms that include, but are not limited to abdominal pain, particularly in the right upper quadrant (RUQ), and bloating, as well as fever, nausea, unintentional weight loss, loss of appetite [news-medical.net]

• 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]

• Failure to Thrive

  Failure to Thrive One of the major clinical effects of cholestasis, particularly chronic cholestasis, is failure to thrive. [emedicine.medscape.com]

  Its prevalence varies with geographic location, ranging from 1 in 6,000 to 1 in 19,000, with the highest prevalence in Taiwan. 3 Biliary atresia usually presents within the first few weeks of life, with progressive cholestasis leading to failure to thrive [mdedge.com]

• Jaundice

  Coagulation studies were done on 78 consecutive cases of obstructive jaundice with or without biliary tract infection. [ncbi.nlm.nih.gov]

  Conclusion: For patients with malignant obstructive jaundice, biliary stent could improve cholestasis by increasing the proportion of CD4+/CD8+ T lymphocytes, which can improve immune system, function for patients with malignant obstructive jaundice. [alliedacademies.org]

  Intermittent fever accompanied by chills, right upper quadrant abdominal pain, and jaundice have been established as Charcot's triad. [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]

• 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]

  However, gallstones may block the flow of bile from the gallbladder, causing pain (biliary colic) or inflammation. [msdmanuals.com]

• Hypotension

  Other six cases developed diffuse bleeding tendency in addition to the signs of hypotension and multiorgan dysfunction such as oliguria, respiratory distress and mental confusion. [ncbi.nlm.nih.gov]

  Factors which increase the mortality rate include delayed diagnosis, liver failure, cirrhosis, CKD, hypotension, female gender, and >50yrs. [teachmesurgery.com]

  Physical signs may include fever, right upper quadrant tenderness, jaundice, mental status changes, hypotension and tachycardia. Peritonism is an unusual sign and should stimulate the search for an alternative diagnosis. [patient.info]

  Presentation Charcot’s Triad: Fever, RUQ pain and jaundice (neither sensitive nor specific) Symptoms Fever/chills Nausea/vomiting Abdominal pain Physical Exam RUQ tenderness to palpation Peritoneal signs are variable Jaundice Frank sepsis (fever, tachycardia, hypotension [coreem.net]

• 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]

• Flushing

  The continuous flushing action of bile and the bacteriostatic effects of bile salts keeps the biliary tract sterile under normal conditions. [ncbi.nlm.nih.gov]

  […] due to increased intra-biliary pressures as a result of obstruction translocation of pathogenic micro-organisms from the duodenum up the biliary tree and into the bloodstream infection overcomes normal barriers: mucosal barriers, continuous biliary flushing [litfl.com]

  Centola et al. [ 32 ] in 1981 described a patient in whom they performed a percutaneous papillary balloon dilatation to flush a small stone into the duodenum. [doi.org]

• Confusion

  Other six cases developed diffuse bleeding tendency in addition to the signs of hypotension and multiorgan dysfunction such as oliguria, respiratory distress and mental confusion. [ncbi.nlm.nih.gov]

  Introduction[1] Acute obstructive cholangitis was defined by Reynolds and Dargan in 1959 as a syndrome consisting of lethargy or mental confusion and shock, as well as fever, jaundice, and abdominal pain caused by biliary obstruction. [patient.info]

  On examination, patients may have pyrexia (in 90% of cases), rigors, jaundice, right upper quadrant tenderness, confusion, hypotension, and tachycardia may be present. [teachmesurgery.com]

  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]

• Hypercholesterolemia

  The proper approach to treating hypercholesterolemia in cholestatic liver disease is to treat the liver disease itself. Xanthomas Xanthomas may result from the deposition of cholesterol into the dermis. [emedicine.medscape.com]

• Gram-Positive Bacteria

  Common infecting organisms include gram-negative bacteria (eg, Escherichia coli,Klebsiella sp, Enterobacter sp); less common are gram-positive bacteria (eg, Enterococcus sp) and mixed anaerobes (eg, Bacteroides sp, Clostridia sp). [merckmanuals.com]

  Bacteria ascend from the duodenum into the common bile duct (CBD) causing infection. Gram-negative bacteria (e.g. Escherichia coli, Klebsiella, Enterobacter), gram-positive bacteria (e.g. [cancertherapyadvisor.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]

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]

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]

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]

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

Image Credit: Designua / Shutterstock Pathophysiology of Acute Cholangitis One of the important pathological reasons of acute cholangitis is biliary obstruction. [news-medical.net]

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]