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Ascending Cholangitis

Disease Details

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Description: Ascending cholangitis is a bacterial infection of the bile ducts, often caused by obstruction and characterized by fever, jaundice, and abdominal pain.
Type: Ascending cholangitis is not typically associated with a specific type of genetic transmission. It is an infectious disease usually caused by bacterial infection secondary to biliary obstruction.
Signs And Symptoms: A person with cholangitis may complain of abdominal pain (particularly in the right upper quadrant of the abdomen), fever, rigors (uncontrollable shaking) and a feeling of uneasiness (malaise). Some may report jaundice (yellow discoloration of the skin and the whites of the eyes).Physical examination findings typically include jaundice and right upper quadrant tenderness. Charcot's triad is a set of three common findings in cholangitis: abdominal pain, jaundice, and fever. This was assumed in the past to be present in 50–70% of cases, although more recently the frequency has been reported as 15–20%. Reynolds' pentad includes the findings of Charcot's triad with the presence of septic shock and mental confusion. This combination of symptoms indicates worsening of the condition and the development of sepsis, and is seen less commonly still.In the elderly, the presentation may be atypical; they may directly collapse due to sepsis without first showing typical features. Those with an indwelling stent in the bile duct (see below) may not develop jaundice.
Prognosis: Acute cholangitis carries a significant risk of death, the leading cause being irreversible shock with multiple organ failure (a possible complication of severe infections). Improvements in diagnosis and treatment have led to a reduction in mortality: before 1980, the mortality rate was greater than 50%, but after 1980 it was 10–30%. Patients with signs of multiple organ failure are likely to die unless they undergo early biliary drainage and treatment with systemic antibiotics. Other causes of death following severe cholangitis include heart failure and pneumonia.Risk factors indicating an increased risk of death include older age, female gender, a history of liver cirrhosis, biliary narrowing due to cancer, acute kidney injury and the presence of liver abscesses. Complications following severe cholangitis include kidney failure, respiratory failure (inability of the respiratory system to oxygenate blood and/or eliminate carbon dioxide), abnormal heart rhythms, wound infection, pneumonia, gastrointestinal bleeding and myocardial ischemia (lack of blood flow to the heart, leading to heart attacks).
Onset: Ascending cholangitis, also known as acute cholangitis, typically presents with a sudden onset of symptoms. The hallmark features are indicated by Charcot's triad:
1. Fever with chills
2. Right upper quadrant abdominal pain
3. Jaundice

In addition to these, some patients may develop altered mental status and hypotension, which together with Charcot's triad form Reynolds' pentad, indicating severe disease.
Prevalence: The exact prevalence of ascending cholangitis is not well-documented, but it's relatively uncommon. It often occurs as a complication of bile duct obstruction, such as that caused by gallstones, tumors, or strictures.
Epidemiology: In the Western world, about 15% of all people have gallstones in their gallbladder but the majority are unaware of this and have no symptoms. Over ten years, 15–26% will have one or more episodes of biliary colic (abdominal pain due to the passage of gallstones through the bile duct into the digestive tract), and 2–3% will develop complications of obstruction: acute pancreatitis, cholecystitis or acute cholangitis. Prevalence of gallstone disease increases with age and body mass index (a marker of obesity). However, the risk is also increased in those who lose weight rapidly (e.g. after weight loss surgery) due to alterations in the composition of the bile that makes it prone to form stones. Gallstones are slightly more common in women than in men, and pregnancy increases the risk further.
Intractability: Ascending cholangitis is not considered intractable. It is an infection of the bile ducts that can often be effectively treated with a combination of antibiotics and, in some cases, procedures like endoscopic retrograde cholangiopancreatography (ERCP) to relieve bile duct obstruction. Early diagnosis and prompt treatment are crucial to prevent complications such as sepsis.
Disease Severity: For ascending cholangitis, disease severity can vary widely. This condition is a potentially life-threatening infection of the bile ducts. It often causes symptoms such as fever, jaundice, and abdominal pain. If not promptly treated, ascending cholangitis can lead to severe complications, including sepsis and organ failure. Immediate medical attention and intervention, typically involving antibiotics and drainage procedures, are crucial for managing the disease severity.
Healthcare Professionals: Disease Ontology ID - DOID:14270
Pathophysiology: Ascending cholangitis, also known as acute cholangitis, is an infection of the bile ducts.

**Pathophysiology:**
1. **Biliary Obstruction:** The fundamental cause is typically a biliary obstruction, often due to gallstones, tumors, or strictures that impede bile flow.
2. **Bacterial Infection:** Stagnant bile becomes infected with bacteria, commonly Escherichia coli, Klebsiella, and Enterococcus, which ascend from the duodenum.
3. **Inflammation and Edema:** The infection causes inflammation and edema of the bile ducts, leading to increased intraluminal pressure.
4. **Systemic Infection:** Bacteria and toxins can enter the bloodstream through damaged bile duct epithelium, potentially leading to sepsis if not promptly treated.

**Nan:** No applicable information.
Carrier Status: Ascending cholangitis does not involve a carrier status. It is an acute bacterial infection of the bile ducts, usually caused by an obstruction such as a gallstone, stricture, or tumor. It is not a condition that one carries asymptomatically or transmits like some genetic or infectious diseases.
Mechanism: Ascending cholangitis, also known as acute cholangitis, is a bacterial infection of the biliary tract.

**Mechanism:**
- **Obstruction:** Typically, the condition arises due to the obstruction of the bile duct, often caused by gallstones, strictures, or tumors.
- **Bacterial Infection:** The obstruction leads to bile stasis, providing a conducive environment for bacterial growth.
- **Bacterial Ascension:** Bacteria usually ascend from the duodenum into the biliary tree. Common causative organisms include Escherichia coli, Klebsiella species, and Enterococcus species.
- **Inflammation and Sepsis:** The infection results in inflammation of the bile ducts (cholangitis) and can rapidly progress to systemic infection and sepsis if not treated.

**Molecular Mechanisms:**
- **Bacterial Toxins:** Pathogenic bacteria produce toxins and enzymes like beta-glucuronidase that contribute to tissue damage.
- **Immune Response:** The host immune response gets activated, involving the release of pro-inflammatory cytokines (e.g., IL-1, IL-6, TNF-alpha). This can lead to systemic inflammatory response syndrome (SIRS).
- **Oxidative Stress:** Infiltration of immune cells, particularly neutrophils, generates reactive oxygen species (ROS), causing further cellular and tissue damage.
- **Biliary Barrier Disruption:** Damage to the biliary epithelium and tight junctions increases permeability, allowing for further bacterial invasion and dissemination of infection.
Treatment: The primary treatment for ascending cholangitis involves antibiotics to address the bacterial infection and biliary decompression to relieve the obstruction. Initial management typically includes broad-spectrum antibiotics that cover gram-negative enteric bacteria and anaerobes. Common antibiotic choices are piperacillin-tazobactam or a combination of a third-generation cephalosporin and metronidazole.

Biliary decompression can be achieved through:

1. **Endoscopic retrograde cholangiopancreatography (ERCP)** - This is the preferred method to remove blockages and insert stents or perform sphincterotomy.
2. **Percutaneous transhepatic cholangiography (PTC)** - An alternative if ERCP is not feasible.
3. **Surgical intervention** - Considered if less invasive measures fail or are not possible.

Supportive care, including fluid resuscitation, pain management, and monitoring for sepsis, is also crucial.
Compassionate Use Treatment: Ascending cholangitis, also known as acute cholangitis, is a serious infection of the bile ducts often caused by bacteria ascending from the digestive tract. It typically necessitates immediate medical treatment, usually involving antibiotics and biliary drainage.

Compassionate use treatments or off-label/experimental treatments for ascending cholangitis include:

1. **Endoscopic Retrograde Cholangiopancreatography (ERCP):** This procedure is commonly used for biliary drainage and is often a primary treatment rather than experimental or off-label. However, in cases where standard ERCP is insufficient or not possible, alternative endoscopic techniques or advanced stents might be used.

2. **Percutaneous Transhepatic Cholangiography (PTC):** When ERCP is not feasible, PTC, another biliary drainage method, may be employed.

3. **Biliary Stenting:** While endoscopic stenting is common, newer types of stents with drug-eluting properties are still considered somewhat experimental in this setting.

4. **Antibiotics:** While antibiotics are the standard treatment, some newer, broad-spectrum, or targeted antibiotics might be used off-label in specific, resistant cases.

5. **Fecal Microbiota Transplantation (FMT):** This is highly experimental and generally used for recurrent Clostridioides difficile infection, but its role in managing certain biliary infections is being investigated.

Such treatments are generally considered only when standard therapies are ineffective or not viable. Any experimental or compassionate use of treatments should be conducted under strict medical supervision and usually within a clinical trial setting or approved compassionate use program.
Lifestyle Recommendations: For ascending cholangitis, lifestyle recommendations are typically supportive and aimed at preventing recurrence and managing overall liver health:

1. **Adequate Hydration:** Ensure you stay well-hydrated to support liver function.
2. **Balanced Diet:** Eat a nutritious diet with plenty of fruits, vegetables, and whole grains. Avoid high-fat foods and limit alcohol intake.
3. **Regular Exercise:** Engage in moderate physical activity to maintain a healthy weight, which can reduce strain on the liver.
4. **Hygiene:** Practice good hygiene, especially handwashing, to lower the risk of infections that could complicate liver disease.
5. **Medication Adherence:** Follow prescribed medications and treatments strictly to manage any underlying conditions like gallstones or infections.

Always consult with a healthcare professional for personalized advice.
Medication: For ascending cholangitis, antibiotics are crucial for treatment. Commonly used antibiotics include a combination of ampicillin, gentamicin, and metronidazole, or piperacillin-tazobactam. In severe cases, carbapenems like meropenem may be used. It's also essential to address any underlying biliary obstruction, often requiring endoscopic or surgical intervention.
Repurposable Drugs: For ascending cholangitis, a bacterial infection of the bile ducts, initial treatment typically involves antibiotics to target the infection and supportive care. While no specific repurposable drugs are universally established, some commonly used antibiotics include:

1. Piperacillin-tazobactam
2. Ceftriaxone combined with metronidazole
3. Ciprofloxacin combined with metronidazole

If you are exploring repurposable drugs specifically, it would be important to consult current medical research or clinical trial data as new potential treatments may emerge.
Metabolites: Ascending cholangitis, also known as acute cholangitis, is a bacterial infection of the biliary tract. Metabolite information specific to ascending cholangitis is not typically highlighted in clinical discussions of the disease. However, key laboratory findings may include:

1. Elevated bilirubin levels (both direct and indirect).
2. Elevated liver enzymes (e.g., alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase).

N-Acetylcysteine (NAC) is sometimes mentioned in the context of liver conditions, but it is not a standard treatment specifically for ascending cholangitis. Treatment usually involves broad-spectrum antibiotics and may require procedures to decompress the biliary system.
Nutraceuticals: There are no specific nutraceuticals known to be effective in treating ascending cholangitis. This condition is a serious bacterial infection of the bile ducts that typically requires prompt medical treatment with antibiotics and often procedures to relieve bile duct obstructions. Nutraceuticals may play a role in general liver health, but they are not a substitute for the medical treatments required for ascending cholangitis. If you suspect you have this condition, immediate medical attention is necessary.
Peptides: Ascending cholangitis, also known as acute cholangitis, is a bacterial infection of the bile ducts. This condition typically results from an obstruction, such as a gallstone, which leads to bile stasis and infection. It is characterized by the Charcot's triad of symptoms: fever, jaundice, and right upper quadrant abdominal pain.

Peptides are short chains of amino acids, and in a clinical context, certain antimicrobial peptides may play a role in the host defense mechanisms against infections, including those associated with ascending cholangitis.

Nan refers to not a number, often indicating missing or undefined numerical data. In the context of ascending cholangitis, if specific peptide data are not available or not applicable, this could be marked as nan.

For diagnosis and treatment, patients often require prompt antibiotic therapy to cover common pathogens (such as E. coli, Klebsiella, and Enterococcus) and may need biliary decompression, potentially through endoscopic retrograde cholangiopancreatography (ERCP).