Acute cholangitis Flashcards

1
Q

define acute cholangitis?

A

infection of the bile duct

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2
Q

outline the aetiology/ risk factors of acute cholangitis?

A

obstruction of gallbladder or bile duct due to stones

ERCP

Tumours ( pancreatic, cholangiocarcinoma)

bile duct structure or stenosis

parasitic infection ( ascariasis)

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3
Q

summarise the epidemiology of acute cholangitis?

A
  • 9% of patients admitted to hospital with gallstone disease will have acute cholangitis
  • Equal in males and females
  • Median age of presentation: 50-60 yrs

Racial distribution follows that of gallstone disease - fair-skinned people

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4
Q

what is charcot’s triad?

A

right upper quadrant pain- may refer to right shoulder

jaundice

fever with rigors

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5
Q

what is reynold’s pentad?

A

mental confusion

septic shock- hypotension

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6
Q

what are the presenting symptoms of acute cholangitis?

A

charcot’s symptoms

  • right upper quadrants- may refer to right shoulder
  • jaundice
  • fever with rigors

Reynolds’ Pentad

  • mental confusion
  • septic shock- hypotension
  • patients may also complain of pruritus
  • stool colour is putty/ clay
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7
Q

what are the signs of acute cholangitis on physical examination?

A

fever

RUQ tenderness

Murphy’s sign positive

Mild hepatomegaly

Jaundice

Mental Status changes

Sepsis

Hypotension

Tachycardia

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8
Q

what are the investigations for acute cholangitis?

A

bloods

ERCP

Abdominal ultrasound- look for stones and dilation of the common bile duct

Contrast- enhanced- good for diagnosing cholangitis but not for detecting gall stones

MRCP- may be necessary to detect non-calcified stones-> when ultrasound

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9
Q

describe blood results for acute cholangitis?

A

○ FBC: High WCC, low plts
○ CRP/ESR: possibly raised
○ LFTs: typical pattern of obstructive jaundice (raised ALP + GGT)
○ U&Es: may be signs of renal dysfunction
○ Blood cultures: check for sepsis
○ Amylase: may be raised if the lower part of the common bile duct is involved
○ In severe cases low bicarbonate and met acidosis
PTT may be raised with sepsis

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10
Q

what are the possible complications of acute cholangitis?

A
  • Liver abscesses
  • Liver failure
  • Bacteraemia
  • Gram-negative sepsis
  • Septic shock
  • AKI
  • Organ dysfunction

• Percutaneous or endoscopic drainage can lead to:
Intra-abdominal or percutaneous bleeding, sepsis, fistulae and bile leakage

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11
Q

summarise the prognosis for patients with acute cholangitis?

A

mortality between 17-40%

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12
Q

Outline a management plan for acute cholangitis?

A

• ABC
• IV antibiotics: given once blood cultures have been taken
○ Piperacillin + tazobactam
OR
○ Imipenem + cilastatin
OR
○ Cefepime + metronidazole
• Resuscitation: may be required if the patient is in septic shock – sepsis 6
• May need opioid analgesics
• Most patients respond to antibiotics but endoscopic biliary drainage is usually required to treat the underlying obstruction
○ ERCP
○ Lithotripsy (US shock waves) if bile duct stones are large or difficult to remove
Last line: choledectomy with T-tube places or cholecystectomy

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