Acute cholangitis Flashcards
What is cholangitis?
Acute cholangitis (a.k.a. ascending cholangitis) is an infection of the biliary tree caused by a combination of both biliary outflow obstruction and biliary infection.
What is the mortality rate of choloangitis?
It is an uncommon condition (1% of patients with gallstone disease) but is life-threatening with a mortality rate between 17 – 40%
In which region of the abdomen is the gall bladder found?
right hypochondrium
What is the name of the region where the pancreatic duct and common bile duct open into the duodenum?
Ampulla of Vater
What is the name of the sphincter that surrounds the Ampulla of Vater?
Sphincter of Odi
Who is acute cholangitis most common in?
. Cholangitis has an equal sex distribution, and the median age of presentation is 50-60 years old.
What is the biliary tree?
The biliary tree is the system of ducts that transports bile (synthesised by hepatocytes) to the gallbladder for storage and then on to the duodenum.
What is the main function of the gallbladder?
The main function of the gallbladder is to store bile.
What is the anatomy of the biliary tree?
The ducts begin in the liver parenchyma until the right and left hepatic ducts are formed (which drain bile from the left and right lobes of the liver). These two ducts then anastomose to form the common hepatic duct.
The duct which arises from the gallbladder is known as the cystic duct. The cystic duct joins the hepatic duct forming the common bile duct (CBD) which then enters the pancreas.
In the pancreatic head, the common bile duct and the pancreatic duct join to form the ampulla of Vater, which empties into the descending part of the duodenum via the major duodenal papilla (controlled by the sphincter of Oddi, a muscular valve).
Describe how bile duct obstruction fasciliates infection:
when the bile duct becomes obstructed, movement of bile stops, forming biliary sludge which acts as an ideal growth medium for bacteria
The pressure within the biliary system also increases as a result of obstruction increasing the risk of bacterial translocation into the bloodstream resulting in biliary sepsis.
What are the three most common causative organisms of acute cholangitis?
1) Escherichia coli
2) Klebsiella species
3) Enterococcus species
Give the three clinical features of Charcot’s triad:
1) right upper quadrant pain
2) fever
3) jaundice and raised bilirubin
Other than the clinical features named in Charcot’s triad, give 4 other symptoms of acute cholangitis:
1) pruritis
2) pale stools
3) dark urine
4) nausea/ vomiting
What is Reynold’s Pentad?
Charcot’s triad with hypotension, altered mental status (indicating systemic infection)
What is Mirizzi syndrome?
stone in cystic duct causes compression on common bile duct, causing cholangitis