acute cholangitis

Question 1

what is acute cholangitis?

Answer 1

Acute cholangitis is infection and inflammation in the bile ducts.

It is a surgical emergency and has a high mortality due to sepsis and septicaemia.

Question 2

what are the main causes of an acute cholangitis?

Answer 2

1. gallstones obstructing the common bile duct

2. post ERCP procedure

Question 3

what are the most common responsible organisms?

Answer 3

Escherichia coli
Klebsiella species
Enterococcus species

Question 4

what is charcots triad for acute cholangitis?

Answer 4

Right upper quadrant pain
Fever
Jaundice (raised bilirubin)

Question 5

what is the management for acute cholangitis?

Answer 5

Nil by mouth
IV fluids
Blood cultures
IV antibiotics (as per local guidelines)
Involvement of seniors and potentially HDU or ICU

Question 6

what imaging would you do for acute cholangitis?

Answer 6

least to most sensitive are…

Abdominal ultrasound scan
CT scan
Magnetic resonance cholangio-pancreatography (MRCP)
Endoscopic ultrasound

Question 7

what is the treatment for acute cholangitis?

Answer 7

1. ERCP
2. percutaneous transhepatic cholangiogram-> radiologically inserted drain through skin into liver to give relief from obstruction. best for patients less suitable for ERCP or where ERCP has failed