When should a patient with cholangitis be referred to secondary care for further management?

Patients with cholangitis should be referred to secondary care urgently for further management if they are systemically unwell with suspected complications of gallstone disease, including cholangitis. This includes those with known gallstones and jaundice or clinical suspicion of biliary obstruction, such as significantly abnormal liver function tests.

Emergency admission should be arranged for these patients to a gastroenterology or surgical service with expertise in biliary diseases.

All other patients diagnosed with symptomatic gallstone disease should be referred to a surgeon for consideration of laparoscopic cholecystectomy, with the urgency of referral based on clinical judgement.

Appropriate pain relief should be offered while awaiting secondary care assessment, and if pain cannot be managed in primary care, emergency hospital referral is indicated.

These recommendations are based on NICE guidelines on gallstone disease and management of complications such as cholangitis.