• Common bile duct (CBD) obstruction — infection proximal to the obstruction


• Neoplasm (biliary or pancreatic)

• Infiltration with flukes (Qonorchis sinensis, Opistorchis viverrini) Clinical manifestations

• Charcot's triad: RUQ pain, jaundice, fever chills; present in 70% of Pts

• Reynold's pentad: Charcot's triad shock and A MS; present in - 15% of Pts

Diagnostic studies

• Labs: t WBC. bilirubin. A<1.. amylase; • blood cultures

• ERCP or percutaneous transhepatic cholangiogram (if ERCP unsuccessful) Treatment

• Antibiotics (broad spectrum) to cover common bile pathogens (see above)

ampicillin • gentamicin (or levofloxacin) r MNZ (if severe); carbapenems; pip tazo

• 80% Pis respond to conservative mgmt and abx -» biliary drainage on elective basis 20% Pts require urgent biliary decompression via ERCP (papillotomy, stone extraction.

and or stent insertion), percutaneous transhepatic biliary drainage, or surgery

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