Ascending Cholangitis

Ascending Cholangitis

Cholelithiasis: Presence of gallstones within the gallbladder

Choledocholithiasis: Presence of gallstones within the bile ducts

Cholecystitis: Inflammation of the gallbladder

Cholangitis: Inflammation of the bile duct system

Clinical Signs of Ascending Cholangitis

Charcot’s Triad

• Fever
• Jaundice
• Right Upper Quadrant Abdominal Pain

Reynold’s Pentad

• The 3 Symptoms of Charcot’s Triad
• Hypotension
• Confusion

Causes of Biliary Obstruction

Intraluminal:

• Choledocholithiasis
• Biliary Strictures (Post-Infectious, autoimmune, congenital)
• Malignancy (i.e. cholangiocarcinoma)

Extraluminal:

• Malignancy (pancreatic or duodenal carcinoma)
• Pancreatitis (from oedema from surrounding pancreatic tissue)
• Mirizzi Syndrome (Obstruction of the biliary tree through gallstone impacted in the cystic duct) 
• Lemmel Syndrome (Obstruction of the biliary tree through duodenal diverticula)

Risk Factors for Biliary Stone Formation

Fair – more common in Caucasian patients

Fat  – patients who are obese (BMI >30) or hyperlipidaemia

Female 

Fertile – for women who have had one or more children

Forty – Age > 40