acute cholangitis

Question 1

what is ascending cholangitis?

Answer 1

acute infection and inflammation of the biliary tree, often resulting from a blockage that facilitates bacterial ascent from the duodenum

Question 2

what features are observed in severe cases?

Answer 2

Reynolds pentad - hypotension + mental confusion

Question 3

what are the characteristic features of ascending cholangitis?

Answer 3

Charcot’s triad: RUQ pain, fever, jaundice

Question 4

aetiology os ascending cholangitis?

Answer 4

Biliary calculi (stones)
Benign biliary stricture
Malignancy - This can originate from the gallbladder, bile duct, ampulla, duodenum, or pancreas

Question 5

what is the pathophysiology of ascending cholangitis?

Answer 5

ascending infection of biliary tree due to obstruction - usually gallstone in common bile duct
leads to bile stasis (causes jaundice), bacterial overgrowth and ascending infection
results in inflammation + oedema leading to fever and RUQ pain

Question 6

features of ascending cholangitis?

Answer 6

RUQ pain, fever, jaundice
hypotension, mental confusion

Question 7

how do you differentiate ascending cholangitis cholecystitis + biliary colic?

Answer 7

Question 8

what bloods do you do for ascending cholangitis??

Answer 8

LFTs (raised)
WCC (elevated)
CRP (elevated)

Question 9

what imaging do you do for ascending cholangitis??

Answer 9

USS abdo - nile duct dilation
CT/MRCP/ERCP
CT - view biliary tree + radiopaque stones
MRCP - detects gallstones + strictures
ERCP - therapeutic

Question 10

management of ascending cholangitis?

Answer 10

IV fluids + abx
biliary drainage via ERCP, surgical, percutaneous
gallstones may necessitate cholecystectomy