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Acute Cholangitis

 Syn. Cholangitis acute

Signs & Symptoms

 Abdominal pain #Reynolds_pentad #Charcot_triad
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults] Cecil [ 474] Cecil [ 895]
Diffuse Right upper quadrant pain
Ref: Epocrates [ https://online.epocrates.com/diseases/34531/Acute-cholangitis/Diagnostic-Approach]
Vague pain
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults]
Right upper quadrant pain #Charcot_triad #Reynolds_pentad
Ref: Uptodate [ Diagnostic approach to abdominal pain in adults] Uptodate [ Differential diagnosis of abdominal pain in adults] Cecil [ 895] Epocrates [ https://online.epocrates.com/diseases/34531/Acute-cholangitis/Diagnostic-Approach]

Physical Examination

 Charcots triad #Reynolds_pentad #Charcot_triad
Note: biliary pain, jaundice, and spiking fevers with chills
Ref: Uptodate [ Approach to the patient with suspected choledocholithiasis] Harrison [ 2430] Cecil [ 895]
Jaundice #Charcot_triad #Reynolds_pentad
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults] Harrison [ 2430] Cecil [ 474]
Fever #Charcot_triad #Reynolds_pentad #Criteria
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults] Harrison [ 2430] Cecil [ 474] Epocrates [ https://online.epocrates.com/diseases/34536/Ascending-cholangitis/Diagnostic-Criteria]

Lab / Serology

 Neutrophil predominance
Ref: Uptodate [ Acute cholangitis]
Cholestatic pattern of liver test abnormalities
Ref: Uptodate [ Acute cholangitis]
Elevated gammaglutamyl transpeptidase #Criteria
Ref: Uptodate [ Acute cholangitis]

Imagin Study

 dilated common duct
Ref: Cecil [ 896]
Imaging study show common bile duct stones
Ref: Cecil [ 474]

Complication

 Aminotransferases may be as high as 1000 IU L #liver_microabscess
Note: pattern of acute hepatocyte necrosis, microabscess formation in the liver
Ref: Uptodate [ Acute cholangitis]
Microabscess formation in the liver #liver_microabscess
Note: pattern of acute hepatocyte necrosis, aminotransferases may be as high as 1000 IU L
Ref: Uptodate [ Acute cholangitis]
Septic shock #suppurative_acute_cholangitis #toxicity
Note: due to severe toxicity
Ref: Uptodate [ Acute cholangitis] Cecil [ 474]

Risk Factors

 Age > 50
Ref: Epocrates [ https://online.epocrates.com/diseases/34523/Acute-cholangitis/Epidemiology]
Benign stricture
Ref: Epocrates [ https://online.epocrates.com/diseases/34531/Acute-cholangitis/Diagnostic-Approach]
Primary sclerosing cholangitis
Ref: Epocrates [ https://online.epocrates.com/diseases/34532/Acute-cholangitis/Risk-Factors]

Cause

 Result of choledocholithiasis
Ref: Cecil [ 474]
Caused by partial obstruction to flow of bile
Ref: Harrison [ 2430]
Result of biliary tract infection
Ref: Uptodate [ Differential diagnosis of abdominal pain in adults]

Other