eMedicine Specialties > Gastroenterology > Biliary

Cholangitis: Follow-up

Author: Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Coauthor(s): Praveen K Roy, MD,, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute, Albuquerque; Victor Nwakakwa, MD, MRCP (UK), Clinical Instructor, Department of Internal Medicine, Division of Gastroenterology, University of Virginia Health System
Contributor Information and Disclosures

Updated: Nov 16, 2009

Follow-up

Inpatient & Outpatient Medications

Consider maintenance therapy/antibiotics (ie, sulfamethoxazole and trimethoprim [SMZ-TMP] or a fluoroquinolone) for patients with recurrent cholangitis.

Deterrence/Prevention

It has been reported that prophylactic antibiotics do not prevent ERCP-induced cholangitis significantly in unselected patients, and these agents should not be routinely recommended for this reason.5

Complications

  • Pyogenic liver abscess
  • Acute renal failure

Prognosis

The prognosis is usually guarded, although it improves with early antibiotic treatment and appropriate drainage and decompression of biliary tract as needed. Factors reportedly associated with a poor prognosis include old age, female sex, acute renal failure, preexisting cirrhosis, and malignant biliary obstruction.

Miscellaneous

Medicolegal Pitfalls

  • Delay in diagnosis or treatment may result in a higher risk of death.
 


More on Cholangitis

Overview: Cholangitis
Differential Diagnoses & Workup: Cholangitis
Treatment & Medication: Cholangitis
Follow-up: Cholangitis
References
Further Reading

References

  1. Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol. Aug 4 2009;[Medline].

  2. Lee KF, Chong CN, Ng D, et al. Outcome of surgical treatment for recurrent pyogenic cholangitis: a single-centre study. HPB (Oxford). 2009;11(1):75-80. [Medline][Full Text].

  3. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A. Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208. [Medline].

  4. Li FY, Cheng NS, Mao H, Jiang LS, et al. Significance of controlling chronic proliferative cholangitis in the treatment of hepatolithiasis. World J Surg. Jul 30 2009;epub ahead of print. [Medline].

  5. Bai Y, Gao F, Gao J, Zou DW, Li ZS. Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: a meta-analysis. Pancreas. Mar 2009;38(2):126-30. [Medline].

  6. Bilhartz LE, Horton JD. Gallstone disease and its complications. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 6th ed. 1998:948-972.

  7. Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. Sep 2000;14(3):521-46. [Medline].

  8. Kadakia SC. Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis. Med Clin North Am. Sep 1993;77(5):1015-36. [Medline].

  9. Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. Jun 11 1992;326(24):1582-6. [Medline].

  10. Lameris JS, Overhagen HV. Imaging and intervention in patients with acute right upper quadrant disease. In: Bailliere's Clinical Gastroenterology. Vol 9. Harcourt Brace & Co;1995:21-36.

  11. Lee DW, Chung SC. Biliary infection. In: Bailliere's Clinical Gastroenterology. Vol 11. Harcourt Brace & Co;1997:707-724.

  12. Leung JW, Yu AS. Hepatolithiasis and biliary parasites. Bailliere's Clinical Gastroenterology. 1997;11:681-706.

  13. Lillemoe KD. Surgical treatment of biliary tract infections. Am Surg. Feb 2000;66(2):138-44. [Medline].

  14. Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am. Dec 1990;70(6):1297-312. [Medline].

  15. Raraty MG, Finch M, Neoptolemos JP. Acute cholangitis and pancreatitis secondary to common duct stones: management update. World J Surg. Nov 1998;22(11):1155-61. [Medline].

  16. van den Hazel SJ, Speelman P, Tytgat GN, et al. Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clin Infect Dis. Aug 1994;19(2):279-86. [Medline].

Keywords

cholangitis, acute cholangitis, ascending cholangitis, choledocholithiasis, biliary tract obstruction, angiocholitis, cholangeitis, hepatolithiasis, sump syndrome, pyogenic liver abscess, acute renal failure, liver disease, Escherichia coli, E coli, Klebsiella species, Enterococcus species, Bacteroides fragilis, B fragilis

Contributor Information and Disclosures

Author

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Coauthor(s)

Praveen K Roy, MD,, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute, Albuquerque
Praveen K Roy, MD, is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association
Disclosure: Nothing to disclose.

Victor Nwakakwa, MD, MRCP (UK), Clinical Instructor, Department of Internal Medicine, Division of Gastroenterology, University of Virginia Health System
Disclosure: Nothing to disclose.

Medical Editor

Anil Minocha, MD, FACP, FACG, Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center
Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.