(!) Acute Cholangitis

Question 1

Define Acute Cholangitis

Answer 1

Acute Infection of the billiary tree-needs quick diagnosis and treatment
Most commonly caused by obstruction
More mild is w/o sepsis
Toxic cholangitis or cholangitis with sepsis is very severe

Question 2

Aetiology and risk factors of acute cholangitis

Answer 2

The most common cause is cholelistiasis (GALL STONES) leading to obstruction
Pancreatitis is also a common cause
3rd comon cause is cholangitis sclerosis (24%)
Obstruction leads to bacterial seedling of tree via portal vein. the pressure increase creates a portal for the bacteria to infect the blood

Risk factors
Age 50-60
Gall stones
pancreatitis
cholangitic sclerosis
Procedure injury of bile ducts

Question 3

Epidiemology of Acute Cholangitis

Answer 3

Uncommon (1% of gallstone pt)

between 50 to 60 years old

Question 4

Signs and Sx of acute cholangitis

Answer 4

Mild (not septic) presents often as diffuse RUQ pain AND tenderness
Obstructive jaundice (dark urine and puritus, pale stools
Fever

severe-hypotension, confusion

Question 5

Investigations of Acute cholangitis

Answer 5

FBC-WCC raised, Plt low
LFTs-ALP raised, AST/ALT ok
Billirubin-raised
CRP-raised
Blood cultures-growth (usually gram -ve)
Abdominal USS-dilated bile ducts
ERCP-see obstruction

Sepsis-
Urea, Cr-raised in severe disease
ABG-Metabolic acidosis (low HCO3, BE)

differential -cholescytitis (different as RUQ isn’t diffuse), Pancreatitis, peptic ulcer assess

Question 6

Management for acute cholangitis

Answer 6

IV broad spectrum ABx (e.g.: co-amox)
Billiary decompression-ERCP and placement of stent
If need-surgical decompression

fluids, esp in sepsis

Question 7

Complication of acute cholangitis

Answer 7

Septic shock->death
Acute pancreatitis
Inadequate draining-Sx persist
Rare-hepatic abscesses

Question 8

Prognosis of acute cholangitis

Answer 8

Rapid improvement after drainage and Abx
Need to recognise fast-more delay in drainage worsen prognosis
Worse as older or liver issues
Worse If need surgery