Ascending cholangitis

Question 1

Bacterial infection is typically ascend from ?

Answer 1

Duodenum

Question 2

What is the most common cause of obstruction

Answer 2

Gallstones

Others : biliary tract manipulation / intervention and stents , strictur

Question 3

What is the clinical features of cholangitis

Answer 3

Charcot triad : Fever , Jaundice , RUQ abdominal pain
Reynold pentad : charcot triad + altered mental status , hypotension (this is d/t septic shock )

The high pressure due to obstruction can cause cholangio-venous reflux –infected bile leaks back into the bloodstream

Question 4

What investigation you want to do and why ? Laboratory ix

Answer 4

Full Blood Count
-to look for leucocytosis

Liver Function Test
-to look for elevation of serum bilirubin ,predominantly conjugated bilirubin

Serum amylase
-TRO gallstone pancreatitis
Inflammatory markers
-C Reactive Protein

Blood Culture
-to look for causative microorganism (E.coli , Klebsiella,Pseudomonas)

Conjugated bilirubin is a marker of cholestasis

Question 5

What investigation you want to do and why ? Imaging Ix

Answer 5

Transabdominal Ultrasound
-to look for the aetiology of obstruction (gallstones)

ERCP
-Diagnostic and therapeutic

CT scan
-to look for the complication

MRCP
-for diagnostic purpose

Question 6

How you want to manage

Answer 6

1)Fluid resuscitation and correction of electrolyte imbalance
2)Broad spectrum antibiotic
3)Biliary drainage (Percutaneous Transhepatic drainage )

Question 7

Complication

Answer 7

1)Septic shock
2)Liver failure
3)Acute renal failure
4)Catheter related : bile leak & bleeding