Pathophysiology

Stones are the most common cause of obstruction, followed by malignancy. The most common bacterial isolates are:

• Klebsiella

• Enterococcus

• Bacteroides

As intrabiliary pressure rises, cholangiovenous reflux occurs at the level of the hepatic sinusoid, allowing bacterial translocation from the bile canaliculus into the vascular system, therefore causing the septic condition associated with cholangitis.

Charcot's triad consists of:

• Right upper quadrant pain

These describe the common clinical findings in cholangitis. Occasionally obtundation and hypotension (Reynold's pentad) indicate acute suppurative cho-langitis.

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