Acute Cholangitis

Question 1

Define acute cholangitis

Answer 1

inflammation and infection of the biliary tree (bile ducts) secondary to obstruction

*The term ascending cholangitis refers to the ascension of bacteria from the small intestines to the biliary tree

Question 2

What are the causes/risk factors of acute cholangitis?

Answer 2

• Gallstones being dislodged and trapped in the common bile duct –choledocholithiasis.
• Gallstone risk factors:
- Female
- Fat
- Fertile (Pregnancy)
- Forty
• can occur secondary to CBD obstruction by cancers and via iatrogenic strictures of the CBD
• Gut bacteria like E. Coli, Klebsiella and Enterococcus are the most common causative organisms –they are allowed to ascend the CBD without being ‘flushed away’ due to biliary stasis

Question 3

What are the signs and symptoms of acute cholangitis?

Answer 3

• RUQ pain
• fever
• jaundice
• confusion
• hypotension/shock

Question 4

What investigations are carried out for acute cholangitis?

Answer 4

• FBC - high WCC
• CRP/ESR - high
• Amylase - raised if blockade lower
• LFT - obstructive Jaundice – ALP and GGT increased – alkaline phosphatase and gamma glutamyl transferse
• U&E - kidney dysfunction
• Blood Culture - sepsies

IMAGING
• XR – stones
• MRCP – non calcified stones – magnetic resonance cholangiopancreatography.
• Contrast CT/MRI - cholangitis

Question 5

What is the management for acute cholangitis?

Answer 5

• Resus – if in septic shock
• BS AB – metronidazole (DNA) and cefuroxime or ciproflaxin (B-Lactams)
• Endoscopic biliary drainage.

Question 6

What are the complications of acute cholangitis?

Answer 6

• pyogenic liver abscess
• cholangiolytic abscess (usually small and multiple) in the liver
• longstanding recurrent cholangitis (eg, Asiatic cholangitis)
• acute renal failure