Ascending cholangitis

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**Ascending cholangitis**
*Classification & external resources*
ICD-10	K 83.9
ICD-9	576.1

"Cholangitis" redirects here. For the chronic autoimmune version of this disease, see primary sclerosing cholangitis. For other conditions causing bile duct sclerosis, see secondary sclerosing cholangitis.

Cholangitis is one of a number of problems associated with the bile duct. Cholangitis is bacterial infection of the biliary tract. It results from bile stasis due to chronic obstruction, usually by stones. It is a common, life-threatening complication of choledocholithiasis. It is a consequence of bacterial infection superimposed on an obstructed biliary system. The infecting organisms are usually gram-negative bacilli (eg, E coli, Klebsiella, Pseudomonas, and Enterococcus). Anaerobes may be cultured in 15% of cases. The clinical syndrome of cholangitis is characterized by 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. Laboratory studies show cholestasis, variable transaminase levels, leukocytosis, and positive blood cultures. Findings on ultrasound examination are the same as those for choledocholithiasis. When acute 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. 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. 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.