Ascending Cholangitis Flashcards
What is another term for ascending cholangitis?
Acute cholangitis
What is ascending cholangitis?
It is defined as a condition in which there is bacterial infection of the biliary tree – caused by a combination of both biliary outflow obstruction and biliary infection
Which bacterial organism is associated with ascending cholangitis?
E.Coli
What are the eight risk factors of ascending cholangitis?
Gallstone Disease
Iatrogenic Biliary Injury
Biliary Strictures
Pancreatic Cancer
Hepatocellular Carcinoma
Cholangiocarcinoma
Primary Sclerosing Cholangitis
Parasitic Infections
What is the most common risk factor of ascending cholangitis?
Gallstone Disease
What two parastitic infections associated with ascending cholangitis?
Roundworm
Liver fluke
What are the nine clinical features of ascending cholangitis?
Fever
Nausea & Vomiting
Right Upper Quadrant Pain
Jaundice
Pruritus
Pale Stools
Dark Urine
Confusion
Hypotension
What is Charcot’s triad?
It is defined as the presentation of fever, right upper quadrant pain and jaundice
What is Reynold’s pentad?
It is defined as the presentation of Charcot’s triad with the additional two clinical features of hypotension and confusion
What are the five investigations used to diagnose ascending cholangitis?
Blood Tests
Arterial Blood Gas (ABG)
Ultrasound Scans
CT Scans
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What are the six blood test results indicative of ascending cholangitis?
Increased WCC Levels
Increased Bilirubin levels
Increased ALP Levels
Increased CRP Levels
Increased Urea Levels
Increased Creatinine Levels
What are the two features of ascending cholangitis on ABG?
Metabolic acidosis
Increased lactate levels
When are ultrasound scans used to diagnose ascending cholangitis?
They are the first line investigation
What are the two features of ascending cholangitis on ultrasound scan?
Dilated Common Bile Duct
Gallstones
When are CT scans, with contrast, used to diagnose ascending cholangitis?
They are the second line investigation used to diagnose ascending cholangitis, recommended when individuals present with negative ultrasound features however there is high clinical suspicion of cholangitis
What is the feature of ascending cholangitis on CT scans with contrast?
Common bile duct dilation
It should be noted that non-calcified gallstones will not be visible
What is the gold standard investigation of ascending cholangitis?
Endoscopic retrograde cholangiopancreatography (ERCP)
What is ERCP?
It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum
In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken
How is ERCP used to diagnose ascending cholangitis?
It is used to confirm diagnosis and determine the underlying pathological cause
What is the pharmacological management option of ascending cholangitis?
IV Antibiotics
Name three IV antibiotics used to manage ascending cholangitis
Piperacillin-tazobactam
Ticarcillin clavulanate
Ampicillin-sulbactam
When is ERCP used to manage ascending cholangitis?
It is the first line management option in all cases of ascending cholangitis, which should be conducted 24-28 hours after diagnosis
How is ERCP used to manage ascending cholangitis?
It involves sphincterotomy of the sphincter of Oddi, to aid bile drainage and passage of gallstones
When is PTC used to manage ascending cholangitis?
It is the second line management option of ascending cholangitis, which should be conducted in cases where individuals are too unwell for ERCP, or it is unsuccessful
What is PTC?
It involves placement of a biliary drain to decompress the biliary tree from above
This is performed by passing a needle though the skin and into the bile ducts
What is the surgical management option of ascending cholangitis?
Laparoscopic Choledochotomy
When is laparoscopic choledochotomy is used to manage ascending cholangitis?
It is the last resort management option of ascending cholangitis
What is laparoscopic choledochotomy?
It involves incision of the common biliary duct and insertion of a drainage tube
What are the three complications of ascending cholangitis?
Acute Pancreatitis
Inadequate Biliary Drainage
Hepatic Abscess Formation
How do we differentiate between ascending cholangitis, acute cholecystitis and biliary colic?
In ascending cholangitis, individuals present with RUQ pain, fever and jaundice - with significant systemic features
In acute cholecystitis, individuals present with RUQ pain and fever - however systemic features are limited
In biliary colic, individuals present with RUQ pain, with absence of systemic features
