ascending cholangitis (cholangitis lenta)

Etiology

• bacterial infection of the biliary tract
  • sometimes a cause of fever of unknown origin
  • organisms:
    • Enterococci (40%)
    • E coli (17%)
    • Klebsiella (10%)
• choledocholithiasis

Pathology

• biliary obstruction & stasis
• hepatitis
• bacterial infection ascending from duodenum
• shock

Clinical manifestations

• Charcot's triad
  • right upper quadrant pain
  • fever
  • jaundice

Diagnostic procedures

• abdominal ultrasound (right upper quadrant)
  • dilated bile duct
  • liver generally appears normal

Management

• broad-spectrum antimicrobials
  • ampicillin plus an aminoglycoside is usually adequate
• anaerobic coverage is occasionally necessary
• drainage of the biliary tree
  • ERCP: sphincterotomy, stone removal, placement of naso- biliary cannula
  • surgical drainage

More general terms

• cholangitis

Additional terms

• Charcot's triad for ascending cholangitis