Acute Cholangitis

Question 1

What is acute cholangitis?

Answer 1

Acute inflammation of the bile duct, usually caused by bacterial infection.

Question 2

How does acute cholangitis happen?

Answer 2

Bacteria from the duodenum makes its way up to the bile duct

If there is obstruction to bile flow, the stasis can encourage infection and inflammation

Question 3

How does acute cholangitis present?

Answer 3

CHARCOT’S TRIAD:

• Fever
• RUQ pain
• Jaundice

Other:

• Pruritis
• Acholic stools

Question 4

What are the main complications of acute cholangitis?

Answer 4

Sepsis

Acute pancreatitis

Question 5

What investigations would you do in acute cholangitis?

Answer 5

Bloods - ↑CRP ↑WCC ↓Platelets

U+Es - ↑ urea in severe cases

LFTs – Obstructive +/- hepatitic – obstruction may cause damage to hepatocytes

USS abdo – visualise dilatation of biliary tree

ERCP – visualise +/- remove stones

Question 6

How would you manage acute cholangitis?

Answer 6

MEDICAL EMERGENCY

CONSERVATIVE Tx - IV fluids + ABx, opioid analgesia

Removal of obstruction - ERCP

Question 7

How could an ERCP be therapeutic?

Answer 7

Can remove stone or insert stent to relieve obstruction