Ascending cholangitis

Ascending cholangitis is a bacterial infection (typically E. coli ) of the biliary tree. The most common predisposing factor is gallstones.

Charcot's triad of right upper quadrant (RUQ) pain, fever and jaundice occurs in about 20-50% of patients

• fever is the most common feature, seen in 90% of patients
• RUQ pain 70%
• jaundice 60%
• hypotension and confusion are also common (the additional 2 factors in addition to the 3 above make Reynolds' pentad)

Other features

• raised inflammatory markers

Investigation

• ultrasound is generally used first-line in suspected cases to look for bile duct dilation and bile duct stones

Management

• intravenous antibiotics
• endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction