CLINICAL PRACTICE GUIDELINES (FULL LIST)

Cholangitis

Cholangitis is a clinical diagnosis classically defined in adults as the Charcot triad of fever, jaundice, and right upper quadrant abdominal pain. Diagnosis in adults has been standardized to also include possible variables such as systemic inflammation and evidence of abnormal bile ducts.(1) This adult definition is ill suited to our pediatric population, particularly those with Biliary Atresia who have undergone Kasai hepatoportoenterostomy. This patient population is particularly at risk for adverse outcomes related to episodes of cholangitis, with repeated episodes of cholangitis and development of bile lakes indications for liver transplantation evaluation. 

CPG team members:

• Ritu Banerjee, peds infectious disease
• Jessica Gillon, pharmacy
• Dan Dulek, peds infectious diseases
• Sarah Kemme, Peds GI
• Saeed Mohammed, Peds GI
• Anita Pai, peds GI

References

1.         Miura F, Okamoto K, Takada T, Strasberg SM, Asbun HJ, Pitt HA, Gomi H, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 2018;25:31-40.

2.  Calinescu, A.M.; Madadi-Sanjani, O.; Mack, C.; Schreiber, R.A.; Superina, R.; Kelly, D.; Petersen, C.; Wildhaber, B.E. Cholangitis Definition and Treatment after Kasai Hepatoportoenterostomy for Biliary Atresia: A Delphi Process and International Expert Panel. J. Clin. Med. 2022, 11, 494. https:// doi.org/10.3390/jcm11030494