Acute Cholangitis Flashcards
What is acute cholangitis?
It is an infection of the biliary tree, most commonly caused by obstruction. (Also known as ascending cholangitis)
What are the risk factors of acute cholangitis?
Age >50 yrs Cholelithiasis Benign or Malignant Stricture Post procedure injury of bile ducts History of primary or secondary sclerosing cholangitis Also: HIV
How does acute cholangitis progress?
Usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones.
What are the presenting symptoms of acute cholangitis?
Alcoholic stools
Pruritis
Mental status change
What are the signs of acute cholangitis?
RUQ pain and tenderness
Jaundice
Fever
Hypotension
What investigations would you consider for acute cholangitis?
Bloods
ERCP
Transabdominal US
Who gets acute cholangitis?
Relatively Uncommon
Both male and female
Median age is between 50-60
What is Charcot’s triad?
RUQ pain and tenderness
Jaundice
Fever (often with rigors)
What is Reynolds pentad?
Charcot’s triad (right upper quadrant pain, jaundice, and fever)
Shock (low blood pressure, tachycardia)
Altered mental status
What Bloods would you do for acute cholangitis?
FBC (raised WCC, low plts) Cr (raised) LFTs (Raised transaminases, alk phos and BR) CRP (Raised) U&E's (Raised U, decreased K and Mg) Coagulation panel (raised PT) ABG (met. acidosis)
How would you manage acute cholangitis?
IV antibiotics
Biliary decompresssion
Lithotripsy
Opioid analgesics
What are the possible complications of acute cholangitis?
Acute pancreatitis
Inadequate biliary drainage
Hepatic abscess
What is the prognosis/ indicators for acute cholangitis?
Improved drainage helps
Poor prognosis- hyperbilirubinaemia, high fever, leukocytosis, older age, hypoalbuminuria
