Gastrointestinal System >
“Infection due to obstruction of the biliary tree”
- Recent biliary tract procedure or previous cholangitis.
- Medication e.g. COCP, fibrates.
- Lipid-rich diet – increased incidence of gallstones
- Any condition causing occlusion of biliary tree.
- Biliary calculi (80%)
- Benign biliary stricture
- Malignancy (cholangiocarcinoma).
- Following biliary procedures e.g. ERCP
- Particularly following post-op stent placement or bile duct injury (iatrogenic).
- Obstruction of the bile duct can also result from external compression e.g. Lemmel syndrome, Mirizzi syndrome or inflammation secondary to acute pancreatitis.
- Intrinsic obstruction can be caused by blood clots or parasites.
- Sclerosing cholangitis (inflammation and scarring of bile ducts causing narrowing).
- Biliary tree obstruction → bile stasis + elevated intraluminal pressure → bacterial colonisation of the duct (most commonly E. coli, Klebsiella or Enterococcus
- Charcot’s triad- Fever, Jaundice and RUQ pain
- Reynold’s pentad – Charcot’s triad + hypotension and mental status changes
- FBC (leucocytosis)
- LFTS (raised ALP +/- GGT and raised bilirubin)
- Blood cultures
- USS of biliary tract → bile duct dilation (>7mm)
- Gold Standard – ERCP (Diagnosis & therapeutic)
- May require MRCP to obtain detailed image prior to intervention
- ?sepsis → IV access → fluid resuscitation, routine bloods and blood cultures, broad spec antibiotics e.g. co-amoxiclav + metronidazole
- Endoscopic biliary decompression (remove cause of obstruction) → via ERCP (+/- spincterotomy/stenting) or percutaneous transhepatic cholangiography if patient too sick
- Long term:
- Cholecystectomy if gallstones were cause, management of other underlying causes
- ERCP complications:
- Repeated cholangitis