Acute Cholangitis

Question 1

What is it?

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

Two main causes?

Answer 2

Obstruction in the bile ducts stopping bile flow (i.e. gallstones in the common bile duct)
Infection introduced during an ERCP procedure

The most common organisms are:

Escherichia coli
Klebsiella species
Enterococcus species

Question 3

Charcot’s triad

Answer 3

Acute cholangitis presents with Charcot’s triad:

Right upper quadrant pain
Fever
Jaundice (raised bilirubin)

Question 4

Management?

Answer 4

Patients with suspected acute cholangitis need emergency admission for investigations and management.

Patients need acute management of sepsis and acute abdomen, including:

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