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Cholangoitis

Cholangitis (sometimes referred to as cholangoitis) is an inflammation of primarily the intrahepatic bile ducts. It is almost always associated with partial or complete obstruction of the bile ducts. The cause of obstruction may be choledocholithiasis, biliary strictures, primary sclerosing cholangoitis, congenital malformations or tumor obstruction of the bile ducts. Bile that stagnates in the ducts may then be infected with intestinal microorganisms (E. coli) and the process can then proceed intraparenchymatously, leading to multiple microabscesses in the liver and generalized sepsis, which is a life-threatening condition.

Author: Jan Hudec, Klára Fabiánková, Nhat Linh Ngo, Kristína Slobodová

Institution: Faculty of Medicine at Masaryk University in Brno

Medical discipline: Emergency Medicine

Keywords: cholangoitida | sepse | ERCP

Educational evel: Undergraduate level | Graduate

Cholangitis (sometimes referred to as cholangoitis) is an inflammation of primarily the intrahepatic bile ducts. It is almost always associated with partial or complete obstruction of the bile ducts. The cause of obstruction may be choledocholithiasis, biliary strictures, primary sclerosing cholangoitis, congenital malformations or tumor obstruction of the bile ducts. Bile that stagnates in the ducts may then be infected with intestinal microorganisms (E. coli) and the process can then proceed intraparenchymatously, leading to multiple microabscesses in the liver and generalized sepsis, which is a life-threatening condition.


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Review

Cholangoitis is a serious life-threatening condition that almost always occurs in the field of partial or complete obstruction of the bile ducts, when the bile is congested and infected by microbes from the intestine. The most common cause of obstruction is choledocholithiasis (very often secondary to cholecystolithiasis), which corresponds to the high prevalence of cholelithiasis in the population. In the presented algorithm, a typical patient is very well described, it emphasize the need for quality history and physical examination in combination with the correct evaluation of laboratory results and findings of imaging methods for rapid diagnosis. The therapeutic process points to the importance of early causal treatment (administration of broad-spectrum antibiotics and biliary drainage) to prevent severe local (liver abscesses) and systemic complications (MODS), while emphasizing the initial assessment of the patient´s clinical condition and therefore considering hospitalization in intensive care to ensure vital functions. Finally, a possible complication of the performed endoscopic examination and its solution is described. The authors were able to squeeze a huge amount of important information into a simple algorithm, which in this (very fun and attractive) form will certainly help to quickly understand the issue and transfer theoretical knowledge into practice.

publikováno: 9.8.2021 | last modified on: 1.10.2021