Acute cholangitis

Question 1

Define

Answer 1

Ascending cholangitis

• Infection of the biliary tree, most commonly caused by obstruction.
• In its less severe form, there is biliary obstruction with inflammation and bacterial seeding and growth int he biliary tree

Question 2

Aetiology/risk factors

Answer 2

• Most common aetiology is cholelithiasis leading to choledocholithiasis and biliary obstruction.
• Iatrogenic biliary tract injury, most commonly caused via surgical injury cholecystectomy, can lead to benign strictures, which in turn can lead to obstructions
• Acute prancreatitis
• Malignant strictures

Question 3

epidemiology

Answer 3

Relatively uncommon

• Male to female ratio is equal
• Median age of presentation is 50-60

Question 4

symptoms

Answer 4

• Jaundice
• Fever
• Right upper quadrant pain
• Right upper quadrant tenderness

Question 5

signs

Answer 5

Alcoholic stools
- Pruritis

Charcots triad:
> Jaundice
>Fever
> RUQ pain

Renolyd’s Pentad:
> Mental confusion
> Hypotension

Question 6

investigations

Answer 6

• FBC: Raised WBC, decreases platelets
• Serum urea: Raised in severe cases
• Serum creatinine: Raised in severe cases
• ABG: Metabolic acidosis
• LFT: Hyperbilinuraemia
• CRP: Raised
• Serum K & Mg: May be decreased
• Blood cultures: Bacteria usually gram negative, but gram positive bacteria and anaerobes are also implicated in cholangitis

Question 7

management

Answer 7

• IV antibiotics (Piperacillin/Tazobactam
• Biliary decompression
• Opioid analgesics
• Lithotripsy

Question 8

complications

Answer 8

• Acute prancreatitis
• Inadequate biliary drainage following performance of endoscopy, radiology or surgery
• Hepatic abscess

Question 9

prognosis

Answer 9

• If adequate biliary drainage is quickly obtained, most patients experience rapid clinical improvement
• Outcome worse for patient’s with underlying medical conditions