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ascending cholangitis (cholangitis lenta)
Etiology:
1) bacterial infection of the biliary tract
a) sometimes a cause of fever of unknown origin [1]
b) organisms:
- Enterococci (40%)
- E coli (17%)
- Klebsiella (10%)
2) choledocholithiasis
Pathology:
1) biliary obstruction & stasis
2) hepatitis
3) bacterial infection ascending from duodenum
4) shock
Clinical manifestations:
- Charcot's triad [2]
a) right upper quadrant pain
b) fever
c) jaundice
Special laboratory:
- abdominal ultrasound (right upper quadrant)
- dilated bile duct
- liver generally appears normal
Management:
1) broad-spectrum antimicrobials
- ampicillin plus an aminoglycoside is usually adequate
2) anaerobic coverage is occasionally necessary
3) drainage of the biliary tree
a) ERCP: sphincterotomy, stone removal, placement of naso- biliary cannula
b) surgical drainage
Related
Charcot's triad for ascending cholangitis
General
cholangitis
References
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995,
pg 363
- Primary Sclerosing Cholangitis
https://www.niddk.nih.gov/health-information/liver-disease/primary-sclerosing-cholangitis