Acute Cholangitis

Question 1

what is acute Cholangitis

Answer 1

acute bacterial infection of biliary tree resulting from a bile duct obstruction

Question 2

what can be the causes of a bile duct obstruction

Answer 2

gallstones, benign or malignant strictures, iatrogenic (ECRP), biliary parasites

Question 3

pathology of acute Cholangitis

Answer 3

the obstruction raises intraluminal pressure in gall bladder. this pressure increase causes translocation of bacteria. bacteria can gain access via lymphatics, blood vessels of portal system.

Question 4

what can the extravasation of bacteria into blood stream lead to

Answer 4

sepsis

Question 5

female to male ratio?

Answer 5

1:1

Question 6

median age of onset

Answer 6

above 50, between 50-60 years

Question 7

risk factors for acute Cholangitis

Answer 7

age above 50, benign or malignant strictures and cholelithiasis

Question 8

what is cholelithiasis

Answer 8

gall stone formation

Question 9

diagnostic factors/ presenting symptoms of Acute Cholangitis

Answer 9

charcots triad, Reynolds pentad, hypotension and tachycardia, pale stools

Question 10

charcots triad

Answer 10

RUQ pain, fever and jaundice

Question 11

Reynolds pentad

Answer 11

Charcots triad PLUS mental confusion and septic shock

Question 12

investigations

Answer 12

bloods and imaging

Question 13

what bloods to order when investigating Acute Cholangitis

Answer 13

FBC (high WCC), CRP/ESR (high), LFT’s (high ALP + GGT), Urea and Electrolytes (renal dysfunction?), blood cultures (check for bacteria), amylase

Question 14

why may amylase be present in someone with acute Cholangitis

Answer 14

lower part of bile duct involved

Question 15

imaging for investigating acute Cholangitis

Answer 15

X-ray KUB, CT/MRI, abdo ultrasound and MRCP

Question 16

why may an MRCP be done

Answer 16

can detect non-calcified stones

Question 17

1st line; acute management of acute Cholangitis

Answer 17

IV antibiotics and intensive medical care. Plus non-operative biliary decompression

Question 18

2nd line; acute management of acute Cholangitis

Answer 18

surgical biliary decompression. Plus IV antibiotics and intensive medical care

Question 19

if chronic presentation, how would you manage?

Answer 19

consider surgery

Question 20

complications of acute Cholangitis

Answer 20

liver abcesses, liver failure, AKI, bacteraemia, septic shock, gram negative sepsis, organ dysfunction. percutaneous or endoscopic drainage can cause internal bleeds/sepsis/shock

Question 21

mortality rate of acute Cholangitis

Answer 21

17 - 40%