INFECTIONS OF THE BILIARY TREE

1. Acute cholecystitis (inflammation of the gall bladder)

   1. This is inflammation of the gall bladder. The inflammation occurs as a result of obstruction to bile flow. Once the cystic duct is obstructed, you get infection settling in: E.coli, Klebsiella, B fragilis, enterococci. This causes oedema ≫ blocks off blood supply ≫ tissue necrosis. Finally, the gall bladder may perforate ≫ generalised peritonitis.

   2. Clinical features: RUQ sharp pain (peritoneum involved), +-jaundice, fever, steatorrhoea.

   3. Diagnosis: diagnosis done clinically. Ultrasound is best investigation. Blood culture to pick up organism involved. X ray is only 10% useful as most gall stones are non-radio-opaque.

   4. Treatment: If perforated, perform surgery. If not perforate, you need to settle down the infection before surgery. Give antibiotics ≫ 6 weeks later when patient is stable ≫ perform cholecystectomy. Antibiotics used: aminopenicillins (refer to penicillin summary provided my website), cephalosporins, aminoglycosides, clindamycin.

2. Cholangitis (inflammation of common bile duct)

   1. This is inflammation of the common bile duct. It occurs after blockage of the common bile duct from a gall stone. Infection settles in and the organisms involved are: gram –ve enteric bacilli (i.e.: E. coli, Klebsiella, shigella, salmonella etc). The infection can backtrack to the hepatic structures and cause liver abscesses etc.

   2. Clinical features: cardinal features: jaundice, fever, RUQ pain.

   3. Diagnosis: clinical, ultrasound is best for stones, blood culture to detect organism.

   4. Treatment: Triple therapy: antibiotics, chemotherapy, surgery. Aminopenicillins, Clindamycin, Aminoglycosides.

Category: Pathology Notes