​Pathology - Choledocholithiasis and Cholangitis

​Pathology - Choledocholithiasis and Cholangitis
Choledocholithiasis is the occurrence of a gallstone in the common bile duct.
Cholangitis is inflammation and bacterial infection in the common bile duct caused by blockage, typically due to gallstones. Tumors might potentially be a cause. strictures or prior placement of biliary stents
Cholangitis Pathology: There are inflammatory alterations in the biliary wall with neutrophils present in the intra-luminal area.
Pathophysiology: Gallstones can go into the bile ducts outside the liver. Obstruction can allow bacteria, typically enteric gram-negative rods, to enter the biliary tree through the sphincter of Oddi, leading to infection and inflammation of the biliary tract.

Clinical Symptoms 
Choledocholithiasis might be asymptomatic or manifest with biliary colic (pain in the right upper quadrant after eating) or jaundice.
Cholangitis manifests with Charcot triad, which includes severe colicky epigastric and right upper quadrant pain, nausea (especially after fatty meals), elevated body temperature, and jaundice. In extreme cases, it can progress to Reynolds pentad, which includes Charcot triad symptoms along with septic shock and altered mental status.

Possible complications are biliary cirrhosis, which can occur due to prolonged common bile duct obstruction, and septic shock, namely from cholangitis.
Laboratory results: High ALP and bilirubin levels, leukocytosis in chol patients. ERCP for stone removal, then cholecystectomy; antibiotics and supportive care for cholangitis.