Cholangitis

Defined as a triad of fever, jaundice and abdominal pain resulting from stasis and infection in the biliary tract

Rapid surgical/gastroenterology consult for source control (e.g. ERCP, percutanious drainage)

Biliary tract cultures (positive in >90%) to guide therapy

Blood cultures in severely ill and health care associated cholangitis

Procalcitonin (PCT) not usually useful

Empiric Treatment:

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Those who do not meet criteria for severe infection but may have:

  • SIRS (two or more of: Temperature >38°C or <36°C; Heart rate >90/min; Respiratory rate >20/min; White blood cell count >12,000/mm3 or <4,000mm3)

  • Hyperbilirubinemia

  • Hypoalbuminemia

  • Co-morbidities (e.g. diabetes, advanced age)

Requiring ICU admission, or

Sepsis (life-threatening organ dysfunction e.g. hypotension, acute renal failure, caused by dysregulated host response to infection)

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Acquired in the outpatient setting

Acquired more than 48 hours post admission, or

Hospitalization, surgery, regular outpatient visits (e.g. dialysis, chemotherapy) within last 90 days or residing in long term care

Check any, if present: