Ascending cholangitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Ascending cholangitis is a cholangitis caused by bacterial infection. Cholangitis, in turn, is an inflammation of the bile duct.[1]
Historical Perspective
Classification
Pathophysiology
Main factors that are involved in the pathogenesis of ascending cholangitis include obstruction of the biliary tract, increased intraluminal pressure and the infection of bile. Bacterial contamination alone in absence of obstruction does not usually result in cholangitis. However increased pressure within the biliary system (above 20 cmH2O)[2] resulting from obstruction in the bile duct widens spaces between the cells lining the duct, bringing bacterially contaminated bile in contact with the bloodstream while affecting the function of infection prevention macrophages (Kupffer cells) at the same time. In addition, high biliary pressure also spreads the infection into biliary canaliculi, hepatic veins and perihepatic lymph vessels resulting in bacteremia (bacteria in the bloodstream).