Acute Cholangitis/Biliary Sepsis Flashcards
1
Q
ESSENCE
A
Infection and inflammation in the bile ducts
2
Q
AETIOLOGY
Main causes
A
- Obstruction in bile ducts stopping bile flow (eg gallstones)
- Infection introduced during ERCP procedure
3
Q
AETIOLOGY
Most common organisms
A
- E-coli
- Klebsiella species
- Enterococcus species
4
Q
CLINICAL FEATURES
Presentation
A
- Presents with Charcots triad
- Right upper quadrant pain
- Fever
- Jaundice (raised bilirubin)
5
Q
INVESTIGATIONS
First choice
A
- Abdominal US
- ERCP if US shows nothing
- Full bloods
- Blood cultures
- Serum potassium and magnesium - may be decreased
6
Q
Why is this a surgical emergency
A
Quick progression to sepsis and septicaemia
7
Q
MANAGEMENT
General principles
A
- Emergency admission for investigation and management
- Acute management of sepsis and acute abdomen
- Removal of stones by ERCP or PTC
8
Q
A
9
Q
MANAGEMENT
Acute management of sepsis and acute abdomen
A
- Nil by mouth
- IV fluids
- Blood cultures
- IV antibiotics (as per local guidelines)
- Involvement of seniors and potentially HDU or ICU
10
Q
What procedures can be performed during ERCP
A
- Cholangio-pancreatography
- Sphincterotomy
- Stone removal
- Balloon dilation
- Bilary stenting
- Biopsy
11
Q
What is cholangio-pancreatography
A
Retrograde injection of contrast into duct through sphincter of Oddi and x-ray images to visualise bilary system
12
Q
What is sphincterotomy
A
Making cut in sphincter to dilate it and allow stone removal
13
Q
What is balloon dilation
A
Baloon inserted and inflated to treat strictures
14
Q
What is percutaneous transhepatic cholangiogram (PTC)
A
- Radiologically guided insertion of drain through skin and liver into bile duct
- Relieves immediate obstruction
- Stent can be inserted to give longer relief
- Option for patients less suitable for ERCP or where it has failed
15
Q
COMPLICATIONS
A
- Acute pancreatitis
- Hepatic abscess
- Severe sepsis/death
