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acute cholangitis

Friday 10 February 2006

Definition: Inflammation by Neutrophils of Bile Ducts.

The process whereby bile ducts are surrounded and infiltrated by neutrophils is termed acute cholangitis.

The most common cause is biliary tract obstruction with resultant ascending cholangitis.

Characteristically, the ducts are dilated and often show variable and in some instances prominent reduplication.

Associated cholangiolar proliferation is often seen as well, these structures often surrounded by neutrophils.

Repeated bouts of acute cholangitis secondary to biliary tract obstruction seldom lead to duct depletion.

It is important to distinguish “acute cholangitis” from “acute cholangiolitis,” the former representing inflammation of the interlobular bile ducts, the latter representing inflammation of the cholangioles and metaplastic ducts (periportal hepatocytes transformed into duct-like structures that express cytokeratins 7 and 19 characteristic of bile duct epithelium).

Acute cholangiolitis is associated not only with bile duct obstruction but may also be seen in any liver disease related to prominent cholestasis that also involves the periportal zones.

A helpful clue in distinguishing between these duct structures relates to the hepatic microcirculation: the small hepatic artery branches and hepatic arterioles divide to follow a spiral course around the interlobular ducts and hence can be visualized within the portal tracts near the interlobular ducts, while the cholangioles and metaplastic ducts derive their oxygen supply from the peribiliary plexus as it drains into the sinusoids and do not abut against the arterioles, but instead are usually seen at the edges of the portal structures.

Etiology

- immunity / dysimmunity

- viral infections

  • Cytomegalovirus (neonate)

- bacterial infections

  • Salmonellosis
  • Syphilis, secondary
  • Toxic shock syndrome
  • Tuberculosis
  • Pyogenic abscess
  • Reactive changes, bacterial infections
  • Recurrent pyogenic cholangiohepatitis (also large ducts)

- parasitic infections

  • Ascariasis
  • Clonorchiasis (associated bile duct obstruction)
  • Echinococcosis (hydatid cyst) (cyst rupture)
  • Fascioliasis

- malformative biliary obstruction

  • Biliary atresia, extrahepatic (porta hepatitis type 2 ducts)
  • Caroli disease
  • Choledochal cyst (associated bile duct obstruction)

- bile duct obstruction

- Drug-induced
- Hepatic artery thrombosis
- Hyperpyrexia and heat stroke

See also

- cholangitis