• 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
• 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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