Ascending cholangitis natural history, complications and prognosis

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

Natural History

Ascending Cholangitis, also known as acute cholangitis is a systemic disease caused by the inflammation and infection of the biliary tree most commonly following an obstruction in the biliary tract. It is characterized by a triad (Charcot's Triad) of fever, jaundice and right upper quadrant pain. A pentad (also known as Reynold's pentad) can also be seen in which altered mental status and sepsis are present in addition to usual findings. The severity of disease range anywhere from mild infection to life-threatening sepsis by the translocation of bacteria into the bloodstream. If left untreated, patients with ascending cholangitis may progress to develop severe sepsis and multiorgan failure leading to death

Complications

Some complications of ascending cholangitis include;

• Sepsis - Gram negative bacteremia
• Hepatic abcesses
• Liver failure
• Renal Failure
• Pancreatitis

Other complications that are seen in ascending cholangitis patients can occur following the treatment . Post-operative complications may include;

• Pneumonia
• Respiratory failure
• Heart failure
• Cardiac arrythmias
• Cardiac ischemia
• Gastrointestinal Bleeding
• Bile leaking into peritoneum or abdomen
• Renal abcess
• Fistulae
• Wound infection
• Wound dehiscence
• Disseminated intravascular coagulation (DIC)

Prognosis

• Acute cholangitis bears a significant risk of death, with the leading cause being irreversible shock with multiple organ failure (which could have multiple possible complications of severe infections). Modern improvements in diagnosis and treatment have led to a reduction in mortality.
• Before 1980, the mortality rate was greater than 50%; However, in the past thirty years, it has decreased to 10-30%. Mortality rate after the year 2000 was found to be 2700-10,000 per 100,000. These differences in mortality can likely be attributed to improvements in early diagnosis and supportive treatment.
• Patients with signs of multiple organ failure have a high mortality risk and need urgent biliary drainage and treatment with systemic antibiotics. Other causes of death following severe cholangitis include heart failure and pneumonia.

• Prognosis is good in patients who have quick and adequate drainage where there is improvement in hemodynamic and inflammatory parameters.
• Poor outcomes are seen if urgent surgery is required for drainage.

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.

Natural History, Complications, and Prognosis Natural History The symptoms of (disease name) usually develop in the first/ second/ third decade of life, and start with symptoms such as ___. The symptoms of (disease name) typically develop ___ years after exposure to ___. If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3]. Complications Common complications of [disease name] include: [Complication 1] [Complication 2] [Complication 3] Prognosis Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [--]%. Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent. The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy]. [Subtype of disease/malignancy] is associated with the most favorable prognosis. The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis. References