Ascending (acute) cholangitis

Question 1

What is ascending cholangitis?

Answer 1

Inflammation of the biliary tree

Question 2

What is the most common cuase of ascending cholangitis?

Answer 2

E.coli

Question 3

What is the most common precipitating factor of asending cholangitis?

Answer 3

Gallstones

Question 4

What are the main symptoms of ascending cholangitis?

Answer 4

Charcot’s triad

Question 5

What does charcot’s triad include?

Answer 5

RUQ pain
Fever
Jaundice

Question 6

What other symptoms can occur with acute cholangitis?

Answer 6

Hypotension
Tachycardia
Confusion

If sepsis

Question 7

What would you find in the blood of someone with acute cholangitis?

Answer 7

Raised LFTs
Raised inflammatory markers (WCCs and CRP).

Question 8

What is the first line imaging used for ascending cholangitis?

Answer 8

Ultrasound

Question 9

What is the function of US in someone with ascending cholangitis?

Answer 9

To visulaise bile duct dilation and bile duct stones

Question 10

What is used in the management of ascending cholangitis?

Answer 10

IV antibiotics
Fluid resuscitation (if septic)
ERCP

Question 11

When might you carry out ERCP in someone with acute cholangitis?

Answer 11

24-48 hours after to relieve any obstruction

Question 12

What are the other possible causes of ascending cholangitis?

Answer 12

Benign biliary strictures
Malignancy

Question 13

Which LTF’s will be raised in acute cholangitis?

Answer 13

Raised bilirubin
ALP
Gamma-GT