Overview
Ascending cholangitis, also known as acute cholangitis, is an infection of the biliary tract typically caused by biliary obstruction and bacterial proliferation, often presenting with Charcot's triad (fever, jaundice, and right upper quadrant pain) 1.Diagnosis
Key Diagnostic Criteria: Charcot's triad (fever, jaundice, right upper quadrant pain) 1.
Recommended Tests: Elevated liver enzymes (ALT, AST), bilirubin levels, and positive blood cultures 1.
Grading: Use the Ranson's criteria or the Imrie score to assess severity 1.Management
First-Line Treatment: Intravenous antibiotics targeting biliary pathogens (e.g., piperacillin-tazobactam, ceftriaxone) 1.
Urgent Intervention: Early biliary decompression via endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC) if obstructive jaundice is present 1.
Supportive Care: Fluid resuscitation, pain management, and monitoring for complications such as sepsis 1.Special Populations
Elderly: High-risk patients may benefit from minimally invasive approaches like ERCP under conscious sedation for biliary decompression 1.Key Recommendations
Initiate broad-spectrum intravenous antibiotics promptly in suspected ascending cholangitis (Evidence: Strong 1).
Perform urgent biliary decompression via ERCP or PTC in cases of obstructive jaundice (Evidence: Strong 1).
Consider minimally invasive techniques with conscious sedation for high-risk elderly patients to reduce procedural risks (Evidence: Moderate 1).References
1 Almanfi A, Krajcer Z. Minimally Invasive Endovascular Repair of Ascending Thoracic Aortic Aneurysm with Use of Local Anesthesia and Conscious Sedation. Texas Heart Institute journal 2019. link