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   Name          = Ascending cholangitis |
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{{Ascending cholangitis}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
 
{{CMG}}; {{AE}} {{AHS}},''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]]


{{CMG}}
{{SK}} Acute cholangitis; bile duct inflammation
==[[Ascending cholangitis overview|Overview]]==
==[[Ascending cholangitis pathophysiology|Pathophysiology]]==


{{Editor Help}}
==[[Ascending cholangitis causes|Causes]]==


==Overview==
==[[Ascending cholangitis differential diagnosis|Differentiating Ascending cholangitis from other Diseases]]==
'''Ascending cholangitis''' is a [[cholangitis]] caused by bacterial infection. Cholangitis, in turn, is an inflammation of the [[bile duct]]<ref>[http://www.gpnotebook.co.uk/cache/1624244226.htm gpnotebook]</ref>.


==Symptoms==
==[[Ascending cholangitis epidemiology and demographics|Epidemiology and Demographics]]==
The clinical symptoms of ascending cholangitis are pain, [[jaundice]], and fever ([[Charcot's triad]]). In addition, the presence of hypotension and mental confusion (Reynold's pentad) is suggestive of severe [[septicemia]]. The typical clinical picture is present in only 50% of cases.


==Cause==
==[[Ascending cholangitis risk factors|Risk Factors]]==
It results from bile stasis due to chronic obstruction, usually by [[gallstones]] ([[choledocholithiasis]]). This facilitates a bacterial infection.


The infecting organisms are usually gram-negative bacilli (eg, [[E. coli]], [[Klebsiella]], [[Pseudomonas]], and [[Enterococcus]]).
==[[Ascending cholangitis natural history|Natural History, Complications and Prognosis]]==


==Diagnosis==
==Diagnosis==
===Blood sample===
[[Ascending cholangitis history and symptoms|History and Symptoms]] | [[Ascending cholangitis physical examination|Physical Examination]] | [[Ascending cholangitis laboratory findings|Laboratory Findings]] | [[Ascending cholangitis x ray|X Ray]] | [[Ascending cholangitis CT|CT]] | [[Ascending cholangitis MRI|MRI]] | [[Ascending cholangitis ultrasound|Ultrasound]] | [[Ascending cholangitis other imaging findings|Other Imaging Findings]] | [[Ascending cholangitis other diagnostic studies|Other Diagnostic Studies]]
Anaerobes may be cultured in 15% of cases.
Laboratory studies show cholestasis, variable transaminase levels, [[leukocytosis]], and positive blood cultures.
 
===Ultrasound===
Findings on [[ultrasound]] examination are the same as those for [[choledocholithiasis]].
 
==Differential Diagnosis of Causes of Ascending cholangitis==
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |  
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Gallstones]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|}


==Treatment==
==Treatment==
[[Ascending cholangitis medical therapy|Medical Therapy]] | [[Ascending cholangitis surgery|Surgery]] | [[Ascending cholangitis primary prevention|Primary Prevention]] | [[Ascending cholangitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Ascending cholangitis future or investigational therapies|Future or Investigational Therapies]]


When acute ascending cholangitis is suspected, the patient should be hospitalized. Fluid resuscitation and antibiotics are the key interventions, and antibiotic treatment should be targeted against gram-negative organisms and, possibly, anaerobes. Commonly used drugs include ampicillin, gentamicin sulfate (Garamycin) and metronidazole (Flagyl, Metro IV, Protostat), or ciprofloxacin (Cipro) with or without metronidazole.
==Case Studies==


The mainstay of therapy, however, is the establishment of biliary drainage, which can be accomplished endoscopically or percutaneously. Timing of the procedure depends on severity of the clinical presentation. [[Endoscopic retrograde cholangiopancreatography]] (ERCP) is used primarily. However, if the patient's condition is too unstable for ERCP, percutaneous transhepatic drainage can tide the patient over the acute crisis until definitive therapy can be planned. In all other cases, ERCP to determine the cause of the obstruction and provide drainage should be performed as soon as possible.
:[[Ascending cholangitis case study one|Case #1]]


==Prognosis==
Ascending cholangitis can be life-threatening if untreated.
==References==
<references/>
==External links==
* {{GPnotebook|1624244226}}
{{SIB}}
{{Gastroenterology}}
{{Gastroenterology}}


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Inflammations]]
[[Category:Inflammations]]
[[Category:Disease]]


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Latest revision as of 18:27, 9 October 2018

Ascending cholangitis
Duodenoscopy image of pus extruding from Ampulla of Vater, indicative of cholangitis
ICD-10 K83.9
ICD-9 576.1

Ascending cholangitis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2], Prashanth Saddala M.B.B.S

Synonyms and keywords: Acute cholangitis; bile duct inflammation

Overview

Pathophysiology

Causes

Differentiating Ascending cholangitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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