Acute Cholangitis

Question 1

What is acute cholangitis?

Answer 1

Infection and inflammation in the bile ducts

Surgical emergency

Question 2

What are the two main causes of acute cholangitis?

Answer 2

Gallstones in the common bile duct

Infection due to ERCP

Question 3

What are the most common causative organisms of acute cholangitis?

Answer 3

Escherichia coli

Klebsiella species

Enterococcus species

Question 4

How does acute cholangitis present?

Answer 4

Charcot’s triad
- RUQ pain
- Fever
- Jaundice

Reynold’s pentad
- Charcot’s triad
- Hypotension
- Confusion

Question 5

How is acute cholangitis managed?

Answer 5

Emergency admission

NbM
IV fluids
Blood cultures
IV antibiotics
ICU

ERCP

Question 6

What imaging can be used to diagnose common bile duct stones and cholangitis?

Answer 6

Endoscopic US
MRCP
CT
Abdominal US

Question 7

What is an ERCP used for?

Answer 7

Remove stones blocking the bile duct

Question 8

What procedures can be performed during an ERCP?

Answer 8

Cholangio-pancreatography
Injection of contrast into duct through sphincter of Oddi

Sphincterotomy
Cut in the sphincter to dilate it and allow stone removal

Stone removal

Balloon dilatation
Inserted and inflated to treat strictures

Biliary stenting
Stent inserted to maintain a patent bile duct

Biopsy

Question 9

What is a percutaneous transhepatic cholangiogram for?

Answer 9

Relieves the immediate obstruction

Option if ERCP is unsuitable

Radiologically guided insertion of drain through liver into bile ducts