Acute Cholangitis

Cholangitis is infection of the biliary tree, often with obstruction. Most commonly due to Gram-negative bacteria that become trapped in the bile (ex: E. coli). Charcot's triad – severe RUQ tenderness, fever, jaundice; they are also likely to have abnormal lab results.

• Some authors add altered mental status and sepsis (Reynolds pentad).

Be aware that many patients do not present with all classic signs and symptoms. Increased leukocytes (particularly neutrophils) and c-reactive protein. Evidence of liver dysfunction (hyperbilirubinemia with increased alkaline phosphatase (ALP) and gamma-glutamyl transverse (GGT)). Identify the cause of obstruction (gallbladder stones, strictures). Primary sclerosing cholangitis & primary biliary cholangitis Cholangiocarcinoma