- The triad consists of fever, right upper quadrant (RUQ) pain, and jaundice
- Fever: > 100.4
- Abdominal pain: typically severe
- Normal direct bilirubin level: 0.1-0.3 mg/dL (1.71-5.13 mcmol/L)
- Normal indirect bilirubin level: 0.2-0.7 mg/dL (3.42-11.97 mcmol/L)
- Note: the yellow tint of the eyes/skin associated with jaundice is caused by yellow bile pigments accumulating in the blood which are eventually deposited in the skin
- Acute cholangitis (inflammation of the wall of bile ducts; usually caused by bacterial infection of the lumen)
- Bile: an alkaline solution containing bile salts, bile pigments, cholesterol, triglycerides, phospholipids, and electrolytes; produced in the liver and stored in the gallbladder
- Bile canaliculi: tiny canals that bile flows through toward the bile duct branches
- Bile duct: fusion of the cystic duct and the common hepatic duct
- Bilirubin: a yellow-pigmented waste product formed by the breakdown of erythrocytes; found in bile; removed from the body through elimination of feces
- Common hepatic duct: composed of several bile ducts that fuse together; travels downward toward the duodenum
- Cystic duct: drains the gallbladder
- Portal triad: contains a branch of the hepatic artery, a branch of the hepatic portal vein, and a bile duct; located at each of the six corners of the right/left lobule
- Obstruction of bile flow
- Most commonly caused by choledocholithiasis (stones within the biliary tree) but can also be caused by surgery, tumors, indwelling stents/catheters, acute pancreatitis, and benign strictures
- Bacteria enters the biliary tract through the sphincter of Oddi
- Usual pathogens are: E. Coli, Klebsiella, Enterococci, Clostridium, and Bacteroides
- The additional presence of altered mental status and hypotension (known as Reynolds pentad) signifies acute suppurative cholangitis and is an endoscopic emergency
- Bile duct obstruction lasting > 30 days results in liver damage leading to cirrhosis
- Kumar V et al. Robbins Basic Pathology. 9th ed. Philadelphia, PA: Elsevier Saunders. 2013; 642.
- Lexi-Comp, Inc. (Lexi-DrugsTM ). Lexi-Comp, Inc.; 2013; Version 2.3.0
- Marieb EN, Hoehn K. Anatomy & Physiology. 3rd ed. San Francisco, CA: Pearson Benjamin Cummings. 2008; 802-806.
- Papdakis MA et al. Current Medical Diagnosis and Treatment. 53rd ed. McGraw-Hill Education; 2014; 643, 685-687.