Acute Cholangitis Flashcards
what is acute cholangitis
inflammation and infection of the biliary tree due to obstruction of the common bile duct
what is the most common cause of acute cholangitis?
gall stones (cholethiliasis)
what are other causes of acute cholangitis instead of gallstones
malignancy, strictures, ERCP, parasitic infections in Southeast Asia like ascaris or clonorchis
pathogenesis of acute cholangitis
obstruction of the biliary tree causes bile stasis (blockage) and behind that blockage a nidus for infection with bacteria ensures
common bacteria are e.coli, enterococcous, enterobacter, and klebsiella
symptoms of acute cholangitis
RIGORS, N/V
rapid progression to sepsis may present
Charcots triad: fever, jaundice, RUQ pain
Reynolds pentad: hypotension and AMS + charcots
symptoms of sepsis
tachycardia, tachypnea, high fevers
septic shock: hypotension and organ dysfunction
labs in acute cholangitis
HIGH leukocytosis
cholestatic pattern (increased bilirubin, ALP and GGT, lipase and amylase)
increased lipase and amylase in addition to a cholestatic pattern are representative of?
gallstone pancreatitis
labs to monitor a patient with acute cholangitis should also be?
fluid status/electrolytes, PT/INR/PTT, blood cultures
if you suspect acute cholangitis what should you do?
emergency ERCP to decompress the biliary tree
imaging findings in acute cholangitis
obstructed bile ducts
dilation of bile ducts
thickened bile duct wall
options for imaging in acute cholangitis
US, CT, MRCP
immediate management of acute cholangitis should begin with?
IVF +/- vasopressors for resuscitation of sepsis
pain management
IV antibiotics
what IV antibiotics are given if acute cholangitis is suspected?
broad spectrum: ertapenem, piperacillin tazobactam
metronidazole with cephalophorin (ceftriaxone) or quinolone
diagnostic and therapeutic treatment for acute cholangitis
ERCP, with decompression in severe cases
followed by long term management of source of obstruction (cholecystectomy, removal of malignancy)
