Overview

• Sex: ♀ = ♂

• Incidence: up to 9% of patients with cholelithiasis [1]

• Peak incidence: 50–60 years

Biliary tract obstruction → bile stasis with increased intraductal pressure → bacterial translocation into the bile ducts → bacterial infection ascends the biliary tract (even into the hepatic ducts)

High intraductal pressure also causes bacterial translocation from bile into the systemic circulation, resulting in bacteremia, which can progress to sepsis, septic shock, and MODS without timely management.

Choledocholithiasis (most common)

• Biliary strictures

  • Congenital

  • Infectious (e.g., HIV)

  • Inflammatory (e.g., primary sclerosing cholangitis, IgG4-related sclerosing cholangitis)

  • Iatrogenic (e.g., ERCP, stent placement)

• Malignant obstruction (e.g., due to cholangiocarcinoma, pancreatic cancer, etc)

• Extrinsic compression (e.g., Mirizzi syndrome)

• Parasitic infection (e.g., liver fluke, hydatid cyst, Ascaris spp.)

• Acute pancreatitis

• Periampullary duodenal diverticulum

• Contamination of bile with intestinal contents

  • Manipulation of the biliary tract (e.g., papillotomy, stent placement, ERCP, liver transplantation)

  • Biliary-enteric fistula

• Charcot cholangitis triad (25–70% of patients present with all three features

• Reynolds pentad

• Features of sepsis, septic shock, and multiorgan dysfunction may be present, depending on the severity of disease at

• Abdominal pain (most commonly RUQ)

• High fever

• Jaundice (least common feature)

Charcot cholangitis triad PLUS hypotension and mental status changes

Reynolds pentad is associated with significant morbidity/mortality.