Dawaa Reference

chronic

Cholangitis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Cholangitis - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK558946/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD82.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • The illness spans mild disease through fever, chills, feeling unwell, shaking, widespread belly pain, jaundice, itching, and pale stools, up to overwhelming sepsis [abdominal pain · chills · fever · itching · jaundice · malaise · pale stools · sepsis · tremor]
  • Prior gallstones, a recent gallbladder removal or ERCP, past cholangitis, or HIV/AIDS raise the risk of this infection [gallstones]
  • Patients generally look markedly unwell and often present already in severe sepsis or septic shock [sepsis · shock]
  • Roughly 90% of patients run a fever, and 60 to 70% are jaundiced [fever]

Signs — what you find (3)

  • Exam findings can include fever, tenderness in the upper right belly, jaundice, a distended abdomen, confusion, or unstable blood pressure [abdominal distension · confusion · fever · jaundice]
  • The Charcot triad of fever, right-upper-belly pain, and jaundice is very specific (95.9%) but misses most cases (26.4% sensitive) [abdominal pain · fever · jaundice]
  • Adding confusion and sepsis to the classic triad forms the Reynolds pentad [confusion · sepsis]

Tests (10)

  • The 2018 Tokyo criteria catch essentially every case (100% sensitive) and are far more specific (87.4%) than the classic triad
  • Tokyo diagnosis needs two of the three classic findings plus signs of systemic inflammation, abnormal liver tests, and imaging showing duct dilatation with a cause such as stones or strictures
  • A high neutrophil count is typical, while a low white count instead shows up in septic or immunocompromised patients
  • Liver tests show a blocked-flow pattern with raised bilirubin, alkaline phosphatase, and GGT
  • Abdominal ultrasound is the first imaging test ordered and is highly accurate for the gallbladder and duct dilatation
  • A normal ultrasound does not exclude ascending infection of the bile ducts
  • Thickened duct walls, dilated ducts including the common bile duct, gallstones, and pus are the classic ultrasound picture
  • CT scanning is poor at picking up stones lodged in the common bile duct
  • MRCP is the best noninvasive test for finding common bile duct stones
  • ERCP both pinpoints the blockage and treats it, and allows biopsy or culture samples to be taken

If not this — what else fits (2)

  • Other liver and biliary disease to rule out includes acute cholecystitis, hepatitis, cirrhosis, liver failure, or a hepatic abscess
  • Other abdominal and systemic causes to exclude include pancreatitis, a perforated ulcer, appendicitis, diverticulitis, a kidney infection, gut ischemia, or sepsis from elsewhere

SourceStatPearls "Cholangitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

Covers acute ascending (bacterial) cholangitis — fever, jaundice, right upper quadrant pain — a biliary emergency needing same-day hospital admission for IV antibiotics and urgent biliary drainage (ERCP), as well as chronic autoimmune cholangitis (primary biliary cholangitis / primary sclerosing cholangitis) managed long-term with ursodeoxycholic acid under hepatology. GP starts empirical oral antibiotics only as a holding measure before urgent transfer for the acute form. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Covers acute ascending (bacterial) cholangitis — fever, jaundice, right upper quadrant pain — a biliary emergency needing same-day hospital admission for IV antibiotics and urgent biliary drainage (ERCP), as well as chronic autoimmune cholangitis (primary biliary cholangitis / primary sclerosing cholangitis) managed long-term with ursodeoxycholic acid under hepatology. GP starts empirical oral antibiotics only as a holding measure before urgent transfer for the acute form.

Cautions
  • Reynolds' pentad is Charcot's triad plus hypotension and confusion, and is a surgical or GI emergency.
  • No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
  • Charcot's triad is fever, jaundice, and right upper quadrant pain.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.