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Cholangitis is inflammation of the bile duct. It is typically the results of a bacterial infection (often secondary to gallstones), but can also occur in other conditions, such as primary sclerosing cholangitis and Caroli’s Syndrome. It may also be present in malignancies of the biliary system.

Acute Ascending Cholangitis

Has a high mortality and morbidity, especially in old people.
Presentation – rigors, fever, abdominal pain, jaundice


It is a medical emergency.
  • IV antibioticsusually cephalosporin- e.g. cefotaxime
  • Urgent biliary drainage – Endoscopically – usually access to the biliary tree is gained by sphincterotomy, and then stones removed with a balloon catheter. Successful in 90% of patients.
  • In severely ill patients, stenting may be used in place of stone removal, to reduce peri-operative risk whilst still providing drainage. Stones will later be removed via ERCP.
  • Surgical drainage carries an extremely high mortality, and is reserved for those with whom endoscopic methods are not effective

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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