emDocs - December 19, 2016 - Author: Ely R - Edited by: Koyfman A and Long B
"Cholangitis is a life-threatening infection of the biliary tract. It was first described in 1877, and for many decades the mortality secondary to cholangitis approached 100%. Identification and treatment of cholangitis has significantly improved over the last century, however there is still progress to be made. Challenges include not only early recognition of biliary infection, but also identification of those patients requiring emergent versus urgent biliary decompression. With these advances in identification and management, mortality has been cut to approximately 10%.
For another great case and background on cholangitis, please see: http://www.emdocs.net/cholangitis-deadly-cause-of-right-upper-quadrant-abdominal-pain/
Pearls & Takeaways
- Cholangitis can be subtle and only rarely presents with the classic triad of fever, jaundice, and right upper quadrant pain
- While ultrasound can be useful, CT is often required to support the diagnosis and can often identify the source of obstruction
- While early antibiotics are important, most patients require biliary decompression
- Consult gastroenterology early, and the patient may require ICU-level care
- The Tokyo Guidelines (TG13) may help support your working diagnosis in subtle cases, and can also help to stratify severity of disease. In the future, we may be able to use this severity stratification to guide urgency of biliary decompression."