• Sensibilidad Triada de Charcot 50-70% (26%)

• Charcot’s triad shows very high specificity. The presence of Charcot’s

triad stronglysuggests the presence of acute cholangitis. However,
due to the low sensitivity, it is notapplicable in using as diagnosis
criteria for acute cholangitis.
• Tiene muy alta especificidad, y su presencia sugiere fuertemente una
colangitis aguda, sin embargo debido a su baja sensibilidad, no es
aplicable como un criterio para diagnóstico.
• Criterios de Tokyo tienen una sensibilidad de 90%
• Colestasis es un dato clave en el dx de Colangitis, la ictericia solo se
presenta en 60 a 70% por eso es importnte valorar enzimas hepáticas.
• La ecografía no puede diagnosticar colangitis aguda sino solo un
bloqueo o dilatacion de via biliar ( en realidad tiene baja sensibilidad
para dilatacion de vía biliar y aun menos para calculos biliares). Pero
alta especificidad.
• La procalcitonina puede usarse como marcador de severidad.
• empiric therapy is defined as antimicrobial therapy until the cultures
and susceptibility testing results are available. Once causative
microorganisms and the susceptibilitytesting results are available,
antimicrobial therapy should be adjusted to specific antimicrobial
agentstargeting the organisms. This process is defined as de-
escalation of antimicrobial therapy in the TG 18guidelines
• Prudent antimicrobial usage and early de-escalation or termination of
antimicrobial therapyare now important parts of decision-making.
What is new in TG 18 is that the duration of antimicrobialtherapy for
both acute cholangitis and cholecystitis is systematically reviewed.
• The primary goal of antimicrobial therapy in acute cholangitis and
cholecystitis is to limit boththe systemic septic response and local
inflammation, to prevent surgical site infections in the
superficialwound, fascia, or organ space, and to prevent intrahepatic
abscess formation
• While drainage of the obstructed biliary trees (termed source control)
has been recognized as themainstay of the therapy for patients with
acute cholangitis [9], the roles of antimicrobial therapy for
acutecholangitis is to allow patients to have elective drainage
procedures other than emergency
• There are multiple factors to consider in selecting empiric
antimicrobial agents.. These include targeted organisms,, local
epidemiology and susceptibility data (aantibiogram)),, alignment of in
- vitro activity (oor spectrum)) of the agents with these local data,,
characteristics of the agents such as pharmacokinetics and
pharmacodynamics,, and toxicities,, renal and hepatic function,, and
any history of allergies and other adverse events with antimicrobia
• should be kept in mind that in the treatment of cholangitis,, source
control,, (ii..ee..,, drainage)) is an essential part of management.. The
indications and timing for drainage are provided in the severity and
flowchart of the management sections regarding acute cholangitis
• Historically,, biliary penetration of agents has been considered in the
selection of antimicrobial agents.. However,, there is considerable
laboratory and clinical evidence that as obstruction occurs,, secretion
of antimicrobial agents into bile stops [110 ] . Recent international
guidelines for acute calculous cholecy stitis summarized the bile to
serum concentration ratio and recommend to select agents with good
infected sites penetration [ 5 0 ] . We ll - designed randomized clinical
trials comparing agents with or without good biliary penetration are
needed to determine the clinical relevance and significance of biliary
penetration in treating acute biliary infections..
• The initial management of patients with suspected acute biliary infection starts
with the measurement of vital signs to assess whether or not the situation is
urgent.. If the case is judged to be urgent,, initial medical treatment should be
started immediately including respiratory//ccirculatory management if required,,
without waiting for the definitive diagnosis..
• A detailed examination (cconsultation and physical examination)) is then
performed,, after which blood tests and diagnostic imaging are performed ; on
the basis of the results , a definitive diagnosis is made following the diagnostic
criteria for acute cholangitis and cholecystitis ( clinical practice guidelines ,
CPG))[[44 – 9]]..
• Once the diagnosis has been confirmed,, initial medical treatment should be
started immediately,, the severity should be as sessed according to the severity
grading criteria for acute cholangitis//ccholecystitis,, and the patient’s general
status should be evaluated