• The triad consists of fever, right upper quadrant (RUQ) pain, and jaundice
• Fever: > 100.4
• Abdominal pain: typically severe
• Jaundice:
• 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  

1. Obstruction of bile flow
1. 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
2. Bacteria enters the biliary tract through the sphincter of Oddi
1. 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  

Editor:

• Anthony J. Busti, MD, PharmD, FNLA, FAHA

Last Reviewed: September 2016

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