Ascending cholangitis

Posted by e-Medical PPT
Ascending cholangitis or acute cholangitis is an infection of the bile duct,usually caused by bacteria  ascending from its junction with the duodenum . It tends to occur if the bile duct is already partially obstructed by gallstones.Cholangitis can be life-threatening, and is regarded as a medical emergency.A person with cholangitis may complain of abdominal pain (particularly in the right upper quadrant  of the abdomen), fever, rigors and malaise. Some may report jaundice.
Physical examination findings typically include jaundice and right upper quadrant tenderness.Charcot's triad is a set of three common findings in cholangitis: abdominal pain, jaundice, and fever.This was assumed in the past to be present in 50–70% of cases, although more recently the frequency has been reported as 15–20%.
Routine blood tests show features of acute inflammation (raised white blood cell  count and elevated C-reactive protein level), and usually abnormal liver function tests (LFTs). In most cases the LFTs will be consistent with obstruction: raised bilirubin, alkaline phosphatase and γ-glutamyl transpeptidase. In the early stages, however, pressure on the liver cells may be the main feature and the tests will resemble those in hepatitis, with elevations in alanine transaminase and aspartate transaminase.
Bile duct obstruction, which is usually present in acute cholangitis, is generally due to gallstones. 10–30% of cases, however, are due to other causes such as benign stricturing , postoperative damage or an altered structure of the bile ducts such as narrowing at the site of an anastomosis and various tumors (cancer of the bile duct, gallbladder cancer, cancer of the ampulla of Vater, pancreatic cancer or cancer of the duodenum).Cholangitis may also complicate medical procedures involving the bile duct, especially ERCP.

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