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Gastrointestinal > Acute Cholangitis > Flashcards

Acute Cholangitis Flashcards

1
Q

Define Acute Cholangitis?

A

Infection of the bile duct

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2
Q

What are some of the causes of Acute Cholangitis?

A

Obstruction of the gallbladder or bile duct due to stones
ERCP
Tumours (e.g. Pancreatic, cholangiocarcinoma)
Bile duct stricture or stenosis
Parasitic Infection (e.g. Ascariasis)

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3
Q

What is 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 are the presenting symptoms of Acute Cholangitis ?

A

Most patients present with Charcot’s Triad of symptoms
This list of symptoms has been extended to include the following two symptoms, following the Reynolds’ Pentad
Patients may also complain of Pruritis

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5
Q

What is Charcot’s Triad?

A

RUQ Pain
Jaundice
Fever with rigors

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6
Q

What is Reynolds’ Pentad?

A

Mental Confusion

Septic Shock

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7
Q

What are the signs of Acute Cholangitis on physical examination?

A 
Fever 
RUQ tenderness 
Mild hepatomegaly
Jaundice 
Mental Status Changes 
Sepsis 
Hypotension
Tachycardia 
Peritonitis (uncommon - check for alternative diagnosis)
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8
Q

What bloods would you do for Acute Cholangitis?

A 
FBC 
CRP/ESR
LFTs
U&Es
Blood Cultures 
Amylase
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9
Q

What would you specifically look for on a FBC for Acute Cholangitis?

A

High WCC

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10
Q

What would you see for CRP/ESR for Acute Cholangitis?

A

Possibly raised

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11
Q

What would you see on LFTs for Acute Cholangitis?

A

Typical pattern of obstructive jaundice (raised ALP + GGT)

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12
Q

What might you see on U&Es for Acute Cholangitis?

A

May be signs of renal dysfunction

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13
Q

Why do we do Blood Cultures for Acute Cholangitis?

A

Check for sepsis

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14
Q

Why do we do Amylase for Acute Cholangitis?

A

May be raised if the lower part of the common bile duct is involved

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15
Q

What imaging do you do for Acute Cholangitis?

A

X-Ray
Abdominal US
Contrast-enhanced CT/MRI
MRCP

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16
Q

Why do we do an X-Ray KUB for Acute Cholangitis?

A

Look for stones

17
Q

Why do we do an Abdominal US for Acute Cholangitis?

A

Look for stones and dilation of the common bile duct

18
Q

Why do we do CT/MRI for Acute Cholangitis?

A

Good for diagnosing cholangitis

19
Q

Why do we do MRCP for Acute Cholangitis?

A

May be necessary to detect non-calcified stones

20
Q

When is management of Acute Cholangitis dependent on?

A

Severity

21
Q

What is Stage 1 of the management plan for Acute Cholangitis (treatment for Mild Acute Cholangitis)?

A

Antimicrobial Therapy

Percutaneous, endoscopic or operative intervention for non-responders (depending on aetiology)

22
Q

What is Stage 2 (for moderate Acute Cholangitis) of the management plan for Acute Cholangitis?

A

Early percutaneous or endoscopic drainage

Endoscopic Biliary Drainage is recommended

23
Q

What is Stage 3 (for Severe Acute Cholangitis) of the management plan for Acute Cholangitis?

A

Treatment of organ failure with ventillary support, vasopressors etc.
Urgent percutaneous or endoscopic drainage
Definitive treatment required once the clinical picture improves

24
Q

What counts as Severe Cholangitis?

A

Including shock, consious disturbance, acute lung injury, AKI, hepatic injury or DIC

25
Q

When do we do Resuscitation for Acute Cholangitis?

A

May be required if the patient is in septic shock

26
Q

When are Broad-spectrum antibiotics given in Acute Cholangitis management?

A

Once blood cultures have been taken

27
Q

How do we select which Broad-Spectrum Antibiotics to choose for Acute Cholangitis?

A

Select drugs that are effective against anaerobes and Gram-negative organisms: e.g. Cerufoxime + metronidazole

28
Q

How do patients with Acute Cholangitis react to Antibiotics?

A

Most patients respond to antibiotics but endoscopic biliary drainage is usually required to treat the underlying obstruction

29
Q

What are the possible complications of Acute Cholangitis?

A 
Liver Abscesses 
Liver Failure 
Bacteraemia 
Gram-negative sepsis
Septic-Shock
AKI
Organ dysfunction
30
Q

What are some of the complications of Percutaneous and Endoscopic drainage?

A

It can lead to:

  • Intra-abdominal or percutaneous bleeding
  • Sepsis
  • Fistulae
  • Bile leakage
31
Q

What is the prognosis for paients with Acute Cholangitis?

A

Moratility between 17-40%

Gastrointestinal (61 decks)

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