Clinical meaning
Acute cholangitis results from bacterial infection of the biliary tree, most commonly caused by obstruction from choledocholithiasis, strictures, or stent occlusion. Bile stasis proximal to the obstruction allows bacterial colonization (typically E. coli, Klebsiella, Enterococcus) and ascending infection. Increased intraluminal pressure forces bacteria and endotoxins into the hepatic sinusoids and systemic circulation, producing bacteremia and sepsis. The classic Charcot triad (fever, jaundice, RUQ pain) progresses to Reynolds pentad (adding altered mental status and hypotension) in severe cases.
Diagnosis & workup
Diagnostics & workup: - Blood cultures (positive in 40–70% of cases) - CBC showing leukocytosis with left shift - Liver function tests: elevated bilirubin, ALP, GGT; may have elevated transaminases - RUQ ultrasound to identify bile duct dilation and choledocholithiasis - MRCP for detailed biliary tree evaluation - CT abdomen if abscess or alternative diagnosis suspected - Procalcitonin to support sepsis diagnosis
Risk factors: - Choledocholithiasis (most common cause) - Biliary stent occlusion - Biliary strictures (benign or malignant) - Prior biliary surgery or ERCP - Parasitic infections (Ascaris, liver flukes) - Choledochal cysts - Primary sclerosing cholangitis - Pancreatic head mass causing bile duct compression