1. Ascending Cholangitis
1.1. Clinical Syndrome
1.1.1. Charcot's Triad
1.1.1.1. Fever
1.1.1.2. RUQ pain
1.1.1.3. Jaundice
1.1.2. Nausea / Vomiting
1.1.3. Frank Sepsis
1.1.3.1. Fever
1.1.3.2. Tachycardia
1.1.3.3. Hypotension
1.1.3.4. Tachpnea
1.1.4. Reynold's Pentad
1.1.4.1. Charcot's Triad + sepsis and AMS
1.2. Pathophysiology
1.2.1. Acute bacterial infection of bile ducts
1.2.1.1. From obstruction of Common Bile Duct
1.2.1.1.1. Causes of Obstruction
1.2.1.2. Bacteria gain access via
1.2.1.2.1. lymphatics
1.2.1.2.2. portal venous blood
1.2.1.2.3. retrograde from duodenum
1.2.1.3. Pathogens
1.2.1.3.1. E. coli
1.2.1.3.2. Klebsiella
1.2.1.3.3. Streptococcus
1.2.1.3.4. Enterobacter
1.2.1.3.5. Pseudomonas
1.2.1.3.6. HIV cholangiopathy
1.2.1.3.7. Parasitic infection
1.3. Diagnosis
1.3.1. Clinical diagnosis
1.3.1.1. Charcot's Triad
1.3.1.2. Reynold's Pentad
1.4. Treatment
1.4.1. Broad Spectrum ABX
1.4.1.1. Piperacillin / Tazobactam
1.4.1.2. Imipenem or Meropenem
1.4.1.3. Ceftriaxone or Cefepime + Metronidazole
1.4.2. Surgery
2. Acute Cholecystitis
2.1. Clinical Syndrome
2.2. Pathophysiology
2.2.1. Obstruction of cystic duct
2.2.1.1. Gallstones
2.2.1.2. Elevated intraluminal pressure of gallbladder
2.2.1.2.1. inflammation
2.2.1.2.2. Translocation of bacteria
2.2.2. Pathogens
2.2.2.1. E. coli
2.2.2.2. Enterococcus
2.2.2.3. Anaerobes
2.3. Diagnosis
2.4. Treatment
2.4.1. Analgesics
2.4.2. Electrolytes
2.4.3. Hydration
2.4.4. ABX
2.4.5. Surgery
2.5. Acute Cholecystitis
3. Liver Abscesses
3.1. Clinical Syndrome
3.1.1. Fever, Chills, night sweats, malaise, nausea, vomiting
3.1.2. RUQ pain
3.2. Pathophysiology
3.2.1. 50% develop from cholangitis
3.2.2. Else
3.2.2.1. bacteremia
3.2.2.1.1. hepatic artery
3.2.2.1.2. Portal vein
3.2.2.2. Diverticulitis
3.2.2.3. Cholecystitis
3.2.2.4. Trauma
3.2.3. Pathogens
3.2.3.1. E. coli
3.2.3.2. Klebsiella
3.2.3.3. Streptococcus
3.2.3.4. Staphylococcus
3.2.3.5. Anaerobes
3.2.3.6. Entamoeba histolytica
3.2.3.6.1. Traveler's disease
3.2.3.6.2. Transmission
3.2.3.6.3. Liver Abscess
3.3. Diagnosis
3.3.1. Ultrasound
3.4. Treatment
3.4.1. Drain abscess
3.4.1.1. culture aspirate
3.4.2. Broad spectrum ABX