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ascending cholangitis

spicedmanna

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    My basic understanding of this is that, sometimes with ascending cholangitis, the inflammation can narrow the bile duct (if it's not already obstructed by a stone), resulting in post-hepatic obstruction and the backup of conjugated bilirubin into the blood and urine, which can result in jaundice, dark urine, and pale stools.
     

    Polish Farmer

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      I don't think there is anything intermittent about it. The only people I have seen with cholangitis have been sicker than snot. I had a lady on the floor for four days with fevers, no RUQ pain, slowly dev jaundice. By the time she had abd pain she was septic and died shortly thereafter. A guy I saw in the ED had Tm 100.2, no RUQ pain, and no gross jaundice with a tot bili of 1.5. He said "I feel a little nauseated but overall pretty good," smiling. 4 hours later in the MICU on three pressors, intubated, saw the ERCP with nasty pus and stones getting burned out of his ampulla, he didn't do so hot.

      Fever, RUQ pain, jaundice = death soon, take it seriously!
       
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      SomeDoc

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      1. Attending Physician
        u mean no intermittent jaundice, farmer? why in books it stated that?

        for manna, I'm not asking bout causes of jaundice, but more on INTERMITTENT jaundice. anyway thnx for ur reply

        With primary sclerosing choangitis, an autoimmune phenomenon, there is "intermittent" jaundice which correspond to episodes of autoimmune attacks of the posthepatic (and sometimes intrahepatic) biliary tree, leading to acute obstruction. These attacks are what eventually lead to the "beading" seen on ERCP (endoscopic retrograde cholangiopancreatography). Repeated inflammatory episodes can consequently lead to chronic post or intra-hepatic biliary obstruction as a result of inflammation and fibrosis of the bile duct or biliary tree.
         

        Rendar5

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          With primary sclerosing choangitis, an autoimmune phenomenon, there is "intermittent" jaundice which correspond to episodes of autoimmune attacks of the posthepatic (and sometimes intrahepatic) biliary tree, leading to acute obstruction. These attacks are what eventually lead to the "beading" seen on ERCP (endoscopic retrograde cholangiopancreatography). Repeated inflammatory episodes can consequently lead to chronic post or intra-hepatic biliary obstruction as a result of inflammation and fibrosis of the bile duct or biliary tree.

          thatmakes sense to me. I've never heard of intermittent jaundice as a symptom of ascending colangitis, though. Just the triad of RUQ pain, fever, jaundice. So not good
           
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