Acute Cholangitis Flashcards

1
Q

What are the causes of cholangitis worldwide?

A

Majority of the world, secondary choledocholithiasis; Southeast Asia, oriental cholangiohepatitis (primary choledocholithiasis)

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2
Q

What mechanisms maintain normal sterility of the biliary tract?

A

a) intact sphincter of Oddi which prevents reflux of duodenal contents b) unimpeded efflux of bile from CBD c)immunoglobulin A in bile c)bacteriostatic properties of bile salts

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3
Q

What are the common bacteria cultured from patients with acute cholangitis and how are these different from those cultured in elderly patients and those who have undergone biliary instrumentation?

A

E. coli, Klebsiella, Enterobacter, Enterococcus (common); elderly-Bacteriodes, Clostridium (in addition to the the above listed)

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4
Q

What is charcot’s triad?

A

fever, jaundice, RUQ abdominal pain

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5
Q

What is Reynold’s pentad?

A

Charcot’s triad + mental status change and hypotension

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6
Q

What are the most common elevated liver function tests in cholangitis?

A

Alk Phos, GGT, and CONJUGATED Bilirubin

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7
Q

What is the best initial test if you are concerned for cholangitis?

A

Ultrasound

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8
Q

In a patient with cholangitis, and ERCP is not available or unsuccessful, what is the next course of action?

A

percutaneous transhepatic cholangiography (PTC) if bile ducts are dilated, then CBD exploration

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9
Q

What should be done during ERCP but prior to injection of contrast in patients with occlusive cholangitis and why?

A

aspiration of bile to decompress CBD; if not done, this can induce bacteremia, sepsis, and rapid decompensation

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10
Q

What procedures can be performed endoscopically for patients who have contradindication to sphincterotomy but also have cholangitis?

A

Nasobiliary drain or Internal Biliary stent without sphincterotomy

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11
Q

What are the indications for percutaneous transhepatic drainage?

A

Patients who fail ERCP, pts with difficult to access biliary tree (e.g. hepaticojejunostomy), proximal biliary obstruction (e.g. hilar cholangiocarcinoma), large periampullary duodenal diverticula, intrahepatic biliary obstruction from hepatolithiasis

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