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1. Presents with Charcot's triad - biliary colic, jaundice, fever.

2. Suppurative cholangitis additionally has septic shock and delirium.

3. Common complication of CBD blockage by stone or cancer.

4. Treatment is with parenteral antibiotics, IV hydration, and biliary drainage (ERCP with endoscopic sphincterotomy).

5. If ERCP is unavailable, surgery or percutaneous transhepatic cholangiography with drain placement should be considered.

6. Emphysematous cholecystitis requires emergent laparotomy with cholecystectomy and antibiotics.

7. In both suppurative cholangitis and emphysematous cholecystitis, antibiotic cover should include gram-negative and anaerobic organisms.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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