Acute_Cholangitis_Flashcards 2
What is acute cholangitis?
Acute cholangitis, also known as ascending cholangitis, is an infection of the biliary tree most commonly caused by an obstruction in the bile ducts. This obstruction allows bacterial colonization, which can lead to inflammation, bile duct infection, and, in severe cases, sepsis.
How does acute cholangitis develop pathophysiologically?
Acute cholangitis develops due to obstruction in the bile ducts, typically from gallstones, strictures, or tumors. This obstruction increases intraductal pressure, allowing bacteria from the duodenum to enter the biliary tree. Bacterial proliferation leads to inflammation and infection, and if untreated, bacteria can enter the bloodstream, resulting in bacteremia and sepsis.
What is the epidemiology of acute cholangitis?
Acute cholangitis is relatively uncommon and presents in less than 10% of patients hospitalized for cholelithiasis. It typically affects individuals aged 50-60, with an equal male-to-female ratio. It is more common in Latin American and American Indian populations in the US.
What are common symptoms of acute cholangitis?
Common symptoms include Charcot’s triad—fever, jaundice, and right upper quadrant pain. Patients may also present with nausea, vomiting, pale stools, dark urine, pruritus, and, in severe cases, mental status changes or hypotension (Reynolds’ pentad).
What are typical examination findings in a patient with acute cholangitis?
On examination, findings may include fever, jaundice, right upper quadrant tenderness, tachycardia, and hypotension. Severe cases may show signs of septic shock, including altered mental status, tachypnea, and cold extremities.
What bedside investigations should be performed in suspected acute cholangitis?
Bedside investigations include monitoring vitals (especially fever and hypotension)
What blood tests are recommended for acute cholangitis?
Recommended blood tests include Full blood count (FBC), coagulation profile, C-reactive protein (CRP), liver function tests (LFTs) to assess for cholestasis, renal function tests (urea, creatinine), and blood cultures to identify bacteremia.. Elevated white blood cells and abnormal LFTs (elevated bilirubin, alkaline phosphatase) are common.
What imaging modalities are used in acute cholangitis?
Initial imaging typically includes transabdominal ultrasound to assess bile duct dilation or stones. If ultrasound is inconclusive, CT or MRCP (Magnetic Resonance Cholangiopancreatography) can be performed for further evaluation. ERCP (Endoscopic Retrograde Cholangiopancreatography) may be used for both diagnosis and therapy.
What specialized tests are indicated for acute cholangitis?
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a critical diagnostic and therapeutic test in cholangitis. Percutaneous transhepatic cholangiography (PTC) may be used if ERCP is unavailable or unsuccessful. MRCP and Endoscopic Ultrasound (EUS) are also valuable for non-invasive visualization of the biliary tree.
What conservative measures are involved in managing acute cholangitis?
Conservative management includes fluid resuscitation with IV fluids to maintain hemodynamic stability, correction of electrolyte imbalances, and close monitoring of vital signs and urine output to assess response to initial therapy.
What are the medical management options for acute cholangitis?
Medical management includes broad-spectrum IV antibiotics, with initial choices such as piperacillin-tazobactam or imipenem-cilastatin to cover gram-negative, gram-positive, and anaerobic organisms. Antibiotic choice may be adjusted based on culture results.
What are the surgical treatment options for acute cholangitis?
Surgical management typically involves ERCP with bile duct decompression through sphincterotomy, stone extraction, or stent placement. Percutaneous transhepatic drainage may be used if ERCP is contraindicated. In refractory cases, cholecystectomy or common bile duct exploration may be required.
What are the potential risks associated with treatment for acute cholangitis?
Risks of treatment include antibiotic side effects such as allergic reactions or fluoroquinolone-associated tendonitis and rupture. ERCP may result in pancreatitis, bleeding, perforation, or infection. Surgical risks include bleeding, infection, and bile leak.
What are the benefits of ERCP in the treatment of acute cholangitis?
ERCP is the mainstay of treatment as it effectively relieves biliary obstruction, reduces the risk of recurrent infections, and improves survival. Early ERCP has been shown to reduce hospital stay and mortality in severe cases.
What is the role of laboratory tests in diagnosing acute cholangitis?
Laboratory tests help confirm infection, monitor liver function, assess renal function, and identify the causative bacteria through cultures. Blood tests such as LFTs and FBC are essential in evaluating the severity of the infection.
