Acute Cholangitis Flashcards
what is the definition of acute cholangitis?
Cholangitis is an infection of the biliary tree that requires prompt diagnosis and treatment.
what is the epidemiology of acute cholangitis?
relatively uncommon, median age 50-60 yrs
what is the aetiology of acute cholangitis?
cholelithiasis leading to choledocholithiasis and biliary obstruction
Iatrogenic biliary duct injury leading to benign strictures
Chronic pancreatitis
what are the risk factors for acute cholangitis?
age >50 years
cholelithiasis
benign stricture
malignant stricture
Post-procedure injury of bile ducts
History of primary sclerosing cholangitis
History of secondary sclerosing cholangitis
what is the pathophysiology of acute cholangitis?
obstruction of the common bile duct leads to bacterial seeding of the biliary tree and bacterial contamination
what are the key presentations of acute cholangitis?
presence of risk factors right upper quadrant (RUQ)/upper abdominal pain RUQ/upper abdominal tenderness Jaundice fever
what are the signs of acute cholangitis?
Presence of risk factors
Jaundice
what are the symptoms of acute cholangitis?
RUQ abdominal pain fever pale stools Pruritus (itching) Uncommon - hypotension, mental status changes
what are the first line and gold standard investigations for acute cholangitis?
FBC serum urea serum creatinine ABG analysis LFTs CRP Serum potassium Serum magnesium Blood cultures Coagulation panel Transabdominal ultrasounds ERCP
what other tests could be performed for acute cholangitis?
abdominal CT scan with intravenous contrast
magnetic resonance cholangiopancreatography (MRCP)
percutaneous trans-hepatic cholangiography (PTC)
endoscopic ultrasonography (EUS)
what are the differential diagnoses for acute cholangitis?
Acute cholecystitis
Peptic ulcer disease
Acute pancreatitis
Hepatic abscess
how is acute cholangitis managed?
intravenous antibiotics and hydration
surgical or non surgical clearing of obstruction
how is acute cholangitis monitored?
Consider subsequent cholecystectomy for patients who had cholangitis with cholelithiasis.
Refer patients with primary sclerosing cholangitis (PSC) to a hepatologist.
Refer patients with HIV to an HIV specialist.
Continue to monitor symptoms and blood tests, including liver function.
what are the complications of acute cholangitis?
Acute pancreatitis, inadequate biliary drainage following intervention, hepatic abscess
what is the prognosis of acute cholangitis?
Once drainage achieved - rapid improvement
For patients with significant underlying medical conditions and those in whom decompression is delayed, prognosis is poorer.
Predictive factors for poor prognosis include hyperbilirubinemia, high fever, leukocytosis, older age, and hypoalbuminemia.
