# Cholangitis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text CHOLANGITIS 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 Review status: REVIEWED against the source listed above (2026-08) 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 Source StatPearls "Cholangitis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult 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 Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. 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. Caution 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. 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