Acute Cholangitis

Question 1

What is acute cholangitis? What is the most common predisposing factor?

Answer 1

bacterial infection of the biliary tree (typically E.coli, 2nd Klebsiella)
Gallstones

Question 2

List 5 causes of acute cholangitis

Answer 2

Cholelithiasis leading to choledocholithiasis + biliary obstruction
Benign strictures (due to surgical injury in cholecystectomy or chronic pancreatitis)
Sclerosing cholangitis (PSC + secondary)
Parasitic infection (Ascaris)
Malignant strictures (e.g. pancreatic, cholangiocarcinoma)

Question 3

What is charcots triad?

Answer 3

Fever with rigors
RUQ Pain
Jaundice

Question 4

What is Reynolds’ Pentad?

Answer 4

Fever
RUQ pain
Jaundice
Confusion
Hypotension

Question 5

Other than Charcot’s triad and Reynolds’ pentad, what 2 S/S may be present in acute cholangitis?

Answer 5

Pruritis
Pale stools

Question 6

List the bloods taken in acute cholangitis

Answer 6

FBC: High WCC
High CRP/ ESR
LFTs: pattern of obstructive jaundice (High BR, ALP + GGT)
U+Es: may be signs of renal dysfunction
Blood cultures: check for sepsis
Amylase: raised if lower part of CBD is involved

Question 7

What first line imaging is performed in suspected acute cholangitis?

Answer 7

Abdominal US: identify stones + dilation of CBD

Question 8

If US negative, what further imaging may be performed in acute cholangitis?

Answer 8

ERCP: diagnostic + therapeutic (GS)
Contrast-enhanced CT/ MRI

Question 9

Describe treatment of acute cholangitis

Answer 9

Resus: if pt in septic shock
BS abx: Piperacillin/ Tazobactam IV (after blood cultures)
Endoscopic biliary drainage to treat underlying obstruction (ERCP) after 24-48h

Question 10

What is the second line biliary decompression approach of acute cholangitis? When is this indicated?

Answer 10

Laparoscopic
If adequate biliary decompression/ drainage not accomplished via non-operative means (ERCP)

Question 11

What is a complication of acute cholangitis?

Answer 11

Acute pancreatitis (also complication of ERCP)