Acute cholangitis Flashcards
define ascending cholangitis?
• infection of the bile duct.
causes of ascending cholangitis?
o Obstruction of the gallbladder or bile duct due to stones
o ERCP
o Tumours (e.g. pancreatic, cholangiocarcinoma)
o Bile duct stricture or stenosis
o Parasitic infection (e.g. ascariasis)
what is the epidemiology of ascending cholangitis?
- 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
- Common in caucasians
what are the presenting symptoms of ascending cholangitis?
Charcots triad
o RUQ Pain
o Jaundice
o Fever with rigors
Reynolds pentad +
o Mental confusion
o Septic shock
what are the signs of acute cholangitis on physical inspection?
- Fever
- RUQ tenderness
- Mild hepatomegaly
- Jaundice
- Mental status changes
- Sepsis
- Hypotension
- Tachycardia
how do bloods often present for acute cholangitis?
o FBC: High WCC
o CRP/ESR: possibly raised
o LFTs: typical pattern of obstructive jaundice (raised ALP + GGT)
o U&Es: may be signs of renal dysfunction
o Blood cultures: check for sepsis
o Amylase: may be raised if the lower part of the common bile duct is involved
what imaging might be undertaken for acute cholangitis?
o X-ray (kidneys, ureter, bladder): look for stones
o Abdominal ultrasound: look for stones and dilation of the common bile duct
o Contrast-enhanced CT/MRI: good for diagnosing cholangitis
o MRCP: may be necessary to detectnon-calcifiedstones