Cholangitis

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- 80% have CBD stones causing partial or complete obstruction
- post-op strictures
- stenosis of papilla of Vater
- partial obstruction of bile duct by periampullary diverticulum
- sclerosing cholangitis
- oriental cholangiohepatitis
- late stage AIDS
- most common organisms: E. coli, Klebsiella, Bacteroides, enterococcus, Pseudomonas. In 20% of patients 2 organisms are isolated

Bile is usually sterile but when obstruction to flow occurs it readily becomes infected with enteric organisms. Sepsis can be particularly severe because there is no endothelial lining between the bile canaliculi and the capillary system in the liver and elevated intraductal pressure leads to bacteraemia

- fever
- jaundice
- RUQ pain
- signs of systemic inflammation

- US or CT to demonstrate biliary dilatation
- not all patients with cholangitis have significantly dilated ducts because the obstruction may be partial or sepsis may occur early in the course of the disease prior to duct dilatation
- cholangiography (surgical, percutaneous, or endoscopic) required for definitive anatomic diagnosis)

- IV fluid
- broad spectrum antibiotics
- failure to respond (15% of patients) is an indication for urgent biliary decompression
- endoscopic drainage, insertion of nasobiliary drain ± sphincterotomy + removal of stones is intervention of choice.
- percutaneous transhepatic cholangiography and drainage is a technically easier alternative but it is more difficult to provide definitive treatment than with endoscopy and there are the potential complications of bleeding, bile leak and superinfection as well as the disadvantage of greater patient discomfort

© Charles Gomersall December 1999

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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