Doctors should look out for acute cholangitis, says DTB

Up to one in 11 patients admitted to hospital with gallstone disease has acute cholangitis (an infection of the biliary tree) which can quickly lead to septicaemia, shock and death. Drug and Therapeutics Bulletin (DTB) reviews the diagnosis and subsequent management of patients with this condition.
(I-Newswire) - In acute cholangitis, normally sterile bile becomes obstructed ( typically by gallstones ), leading to infection in the biliary tree. The classic symptoms are fever, abdominal pain and jaundice. However, less than a third of patients display all three of these features ( which are known as Charcot's triad ). Most of the patients have fever but there is often no jaundice and pain ( if present ) might be mild. In particular, clinicians should have high suspicion for acute cholangitis in older patients with unexplained fever and abnormal liver function tests, whether or not they have pain and jaundice. Acute cholangitis is potentially fatal and requires emergency hospital admission. And prompt resuscitation and broad-spectrum antibacterial therapy directed at likely bacterial causes are essential. Patients also need biliary drainage. In general, this is best done using endoscopic or radiological techniques rather than by surgery, which is associated with a higher mortality and morbidity rate.Endoscopic retrograde cholangiopancreatography with bile duct drainage or clearance is the method of choice. Dr Ike Iheanacho, DTB editor: “Acute cholangitis is a medical emergency and needs to be spotted and dealt with quickly. Doctors need to consider it as a possibility even in patients who do not have all the classical features of the disease.”