Table of Contents
Overview – Cholangitis
Cholangitis is a serious, potentially life-threatening infection of the biliary tree, typically caused by obstruction (e.g. choledocholithiasis) and subsequent ascending bacterial infection. Acute cholangitis often presents with classical symptoms such as Charcot’s triad, and can rapidly progress to sepsis if untreated. It is a core condition in hepatobiliary medicine and requires urgent diagnosis, admission, surgical consult, and management, often including endoscopic intervention and broad-spectrum antibiotics.
Definition
Acute cholangitis is an ascending infection of the biliary tract, usually secondary to biliary obstruction and bacterial colonisation.
Aetiology
- Choledocholithiasis (most common cause)
- Bacterial infection:
- Escherichia coli
- Klebsiella
- Less common triggers: biliary strictures, tumours, or parasitic infections
Pathogenesis
- Biliary stasis (due to obstruction, anorexia, or TPN) → allows bacterial ascent from the GI tract
- Most commonly involves gram-negative bacilli
- Infection progresses rapidly and may lead to systemic inflammatory response and sepsis
Clinical Features
Charcot’s Triad:
- Fever
- Jaundice
- Right upper quadrant abdominal pain
Reynold’s Pentad (sign of severe disease/sepsis):
- Hypotension
- Confusion
Investigations
- FBC → Leukocytosis (↑WCC)
- LFTs → Cholestatic pattern (↑ALP, ↑GGT, ↑Bilirubin)
- Amylase ↑ → Suggests concurrent pancreatitis
- Blood cultures → Identify causative organism
- Abdominal USS → Biliary duct dilation or gallstones
- MRCP/ERCP → Imaging and potential therapeutic intervention
Management
- ERCP / MRCP → Confirm diagnosis and treat by:
- Biliary decompression
- Stenting or stone extraction
- IV antibiotics:
- Ampicillin
- Gentamicin
- Metronidazole (triple therapy “AGM”)
- IV fluids and supportive care
- Cholecystectomy (considered once acute infection resolves)
Complications
- Sepsis and septic shock
- Hepatic abscess
- Multi-organ failure
- Biliary cirrhosis (in chronic/recurrent cases)
Summary – Cholangitis
Cholangitis is an acute bacterial infection of the biliary tree, most commonly due to choledocholithiasis. Classic presentation includes Charcot’s triad or Reynold’s pentad in more severe cases. Timely investigation with bloods, imaging, and ERCP is critical. Management involves urgent antibiotics and biliary decompression. For related hepatobiliary topics, visit our Gastrointestinal Overview page.