Cholangitis=bacterial infection in patient with biliary obstruction and stasis (eg: stones-most common, stenosis, malignancy)- high mortality if not treated!

What is Charcot’s Triad and Reynolds’ Pentad?

Charcot’s Triad: Fever, RUQ, Jaundice, ~50-75 % of patients
Reynold’s Pentad: Fever, RUQ, Jaundice, AND hypotension, AMS

Workup

Abdominal ultrasound/MRCP to evaluate for biliary dilation
Blood cultures
CBC (elevated leukocytosis), LFT (cholestatic pattern of injury)

What is a normal CBD diameter?

~4-6 mm,normal range can slightly increase in later decades of life

Most common etiologies of cholangitis

1)E.coli (25-50 %)
2)Klebsiella (15-20 %)
3)Enterobacter (5-10 %)
4)Enterococcus (10-20 %)
5)Anaerobes (usually mixed)

Treatment

1)Empiric antibiotics choices

a)Beta lactam/Beta Lactamase inhibitor (eg: Zosyn)
b)CTX/Flagyl
c)Cipro/Flagyl
d)Carabapenem

2) ERCP within 24-48 hours for endoscopic sphincterotomy with stone extraction and/or stent insertion- can be both diagnostic and therapeutic!