Acute Cholangitis: Incorrect

Acute cholangitis is a bacterial infection of the biliary ducts. This usually occurs secondary to some obstruction of bile flow. This could be a stone in the bile duct, or a tumor compressing the bile duct and limiting flow. The classic triad of symptoms with bacterial cholangitis; biliary colic, jaundice, and chills and fever (Charcot's triad) is only found in about 70% of patients. Laboratory findings include elevated bilirubin, leukocytosis, and elevated alkaline phosphatase levels. Severe cases of cholangitis are called suppurative cholangitis. These patients manifest evidence of sepsis including abdominal pain, fever and chills, jaundice, mental confusion or lethargy, and shock. The diagnosis of acute cholangitis often accompanies choledocholithiasis and may be difficult to differentiate. Patients with acute cholangitis usually respond to I.V. antibiotics rather quickly. Ultrasound may be helpful in diagnosis. ERCP and transhepatic cholangiography is not done during active infection because of the chance of spreading the infection. Most patients respond well to IV antibiotics. About 10% of patients require urgent intervention (eg, endoscopic sphincterotomy, percutaneous transhepatic drainage, or operative decompression).

Mrs. Jones does not meet the criteria for acute cholangitis. She does not appear very ill and has normal LFTs with the exception of a mildly elevated serum bilirubin. Her WBC count is moderately elevated but not as high as would be expected with a bacterial infection (>15-20k). Her temperature is only moderately elevated at 100.5 F.

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