Acute cholangitis is a condition of acute inflammation and infection in the common bile duct. The bile is normally sterile in nature. Stasis of bile from obstruction of the common bile duct from a stone, stent, parasites, or cancer promotes bacterial growth that then spreads and ascends to the biliary duct, resulting in acute ascending cholangitis.
Demographics and risk factors of cholangitis and acute cholecystitis:
Sex – Women are more likely to develop gallstones because of higher estrogen levels. For the same reason, pregnancy and hormone replacement therapy increase the risk of gallstones. Approximately 25% of women older than 60 have gallstones.
Age – Gallstones are unusual in children. In cases when they occur, they are commonly pigment stones. The following conditions put children at a higher risk of having gallstones:
- Spinal injury
- History of abdominal surgery
- Sickle cell disease
- Impaired immunity
- Intravenous nutrition
Obesity and weight changes – In obesity, the liver overproduces cholesterol, which increases the risk of gallstone formation. Rapid weight loss is also a risk factor for the development of cholesterol gallstones.
Pregnancy – Increase in cholesterol saturation of bile and impaired gallbladder contraction during pregnancy predispose to formation of cholesterol stones or biliary sludge.
Genetics – Having a family member with gallstones increases one's risk. Mutation of gene ABCG8 increases the risk of gallstone formation.
AIDS – Biliary disease occurs via 2 mechanisms in patients with AIDS:
- AIDS cholangiopathy (commonly due to Cryptosporidium or cytomegalovirus)
- Acute acalculous cholecystitis
Ascariasis – This is a geographical risk factor in regions such as China and Southeast Asia. It can cause cholecystitis, cholangitis or hepatic abscess, or even pancreatitis.
Other parasites – In Asia, Clonorchis sinensis, Opisthorchis felineus, Opisthorchis viverrini, and Fasciola hepatica are associated with acute and relapsing cholangitis. Clonorchis and Opisthorchis parasitic infections are known causes of cholangiocarcinoma in Asia.
Clinical manifestations of cholangitis:
Signs and symptoms include Charcot's triad and Reynolds' pentad.
- Acute cholangitis was first described by Charcot in 1877 as hepatic fever.
- Typical signs and symptoms of acute cholangitis include intermittent fever with chills, right-upper-quadrant (RUQ) pain, and jaundice.
- Fever and abdominal pain are seen in 80% of patients, while jaundice is seen less frequently, in 60%-70% of cases.
- Described by B. M. Reynolds in 1959.
- In addition to components of Charcot's triad, patients also have hypotension and confusion / altered mental status.