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Professional term: cholangitis
German: Cholangitis

1 Definition

Cholangitis is defined as the inflammation of the bile tracts.

2 Etiology

The bile tracts get inflamed in cases of obstruction (eg. choledocholithiasis) and bacterial infection. Bacteria can settle in the bile tracts the hematogenic way, or eg. displaced in the course of an ERCP from the intestines.

Special cases are abacterial inflammations subsequent to an autoimmune disease (eg. PBC, PSC).

3 Symptoms

Affected patients have the symptoms of Charcot's triad:

The serum concentration of the direct bilirubin is elevated, lipase and amylase frequently are elevated (more moderately than in pancreatitis).

4 Therapy

Treatment comprises the elimination of obstructions and the administration of an effective antibiotic for combating the bacterial infection.

Stones can also be retrieved by an ERCP under papillotomy. However, you also have to consider cholecystectomy in the course of a cholangitis with cholecystolithiasis and cholecystitis.

You select the antibiotic according to the typical pathogen spectrum (Escherichia coli, enterococci, Klebsiella). Usually, the medium of choice is the third-generation cephalosporin ceftriaxone, since is accumulating in the bile due to its pharmacokinetic characteristics.

Alternatively, you can choose predominantly from ciprofloxacin or piperacillin.

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