Acute cholangitis

Question 1

What is acute cholangitis?

Answer 1

infection of biliary tree, commonly caused by obstruction

Question 2

What causes cholangitis?

Answer 2

biliary obstruction
by gallstones, benign/malignant strictures

Question 3

What symptoms of Cholangitis?

Answer 3

(Charcots triad) Fever, jaundice, and RUQ tenderness on examination
Pale stools, upper abdominal pain
pruritus
(severe - hypotension, mental change)

Question 4

What are risk factors for cholangitis?

Answer 4

• age over 50 years
• history of cholelithiasis
• primary or secondary sclerosing cholangitis
• stricture of the biliary tree (benign or malignant)
• post-procedure injury of bile ducts (surgical, endoscopic, or radiological intervention with resulting inadequate biliary drainage).

Question 5

What Ix for cholangitis?

Answer 5

FBC - ↑WBC, less plts
serum urea - ↑
serum creatinine ↑
sepsis - ABG analysis - ↑ lactate, low HCO3
serum LFTs - ↑BR, ↑ALP
^CRP
less serum K
less serum Mg
blood cultures
coagulation panel - ^PR with sepsis
transabdominal ultrasound- BD dilation & stones
endoscopic retrograde cholangiopancreatography (ERCP) - find stones & extract

Question 6

What 1st line Tx is there for acute cholangitis?

Answer 6

• broad spectrum Abx + biliary decompression & drainage (early ERCP w/ sphincterectomy)
• PTC ( Percutaneous trans-hepatic cholangiography)
• Lithotripsy to remove large stones
• analgesic

Question 7

What 2nd line Tx is there for acute cholangitis?

Answer 7

• laparoscopic choledochotomy with T-tube placement or cholecystectomy
• IV Abx
• intensive medical management
• analgesia

Question 8

What Tx is given if cholangitis presents with cholelithiasis?

Answer 8

cholecystectomy

Question 9

What is the prognosis of acute cholangitis like?

Answer 9

after biliary drainage - improvement

decompression delayed - prognosis poorer (^BR, fever, WBC, age, hypoalbuminaemia)

emergent surgery - ^morbidity