Acute cholangitis Flashcards

1
Q

define ascending cholangitis?

A

• infection of the bile duct.

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2
Q

causes of ascending cholangitis?

A

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)

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3
Q

what is the epidemiology of ascending 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
  • Common in caucasians
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4
Q

what are the presenting symptoms of ascending cholangitis?

A

Charcots triad
o RUQ Pain
o Jaundice
o Fever with rigors

Reynolds pentad +
o Mental confusion
o Septic shock

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5
Q

what are the signs of acute cholangitis on physical inspection?

A
  • Fever
  • RUQ tenderness
  • Mild hepatomegaly
  • Jaundice
  • Mental status changes
  • Sepsis
  • Hypotension
  • Tachycardia
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6
Q

how do bloods often present for acute cholangitis?

A

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

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7
Q

what imaging might be undertaken for acute cholangitis?

A

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

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