Acute Cholangitis

Question 1

What is acute cholangitis and what are the most common causes?

Answer 1

Infection of the bile ducts

Obstruction of common bile duct by gallstones
Introduction of infection due to ERCP procedure

Question 2

What forms part of Charcot’s triad describing the presentation of acute cholangitis?

Answer 2

RUQ pain
Fever/rigors (involuntary shaking due to bactoraemia)
Jaundice/raised bilirubin

Question 3

Acute cholangitis is a medical emergency. How is it managed?

Answer 3

NBM
IV fluids +O2
Analgesia
Blood cultures
IV antibiotics
ERCP to remove the stones blocking bile duct and place stent if stricture causing obstruction
Percutanous transhepatic cholangiogram (US guided into hepatic duct + guided to drain and fit stent)

I.e. managing sepsis and acute abdomen

Question 4

What are the different imaging techniques which can be used to diagnose CBD stones or cholangitis?

Answer 4

MRCP
CT scan
Abdo USS

Question 5

Apart from gallstones, what are other causes of obstruction?

Answer 5

Strictures= benign or malignant

Biliary stent blockage

Question 6

How can you differentiate between a mild and severe case of cholangitis based on a patients presentation?

Answer 6

Mild= present with confuson 
Severe= present with septic shock

Question 7

What investigations would you do if cholangitis was suspected?

Answer 7

FBC= leukocytosis 
LFT= obstructive picture (due to being caused by obstruction with secondary infection) 
INR= raised due to being associated with element of liver failure 
USS= CBD + intrahepatic duct dilation 
MRCP= detailed biliary anatomy