Ascending Cholangitis Flashcards
What is cholangitis?
Life-threatening, SECONDARY obstruction and ascending bacterial infection of the biliary tree which can lead to septic shock.
Cholangitis is often associated with complications that can arise from biliary obstruction.
What are the causes of cholangitis?
- Obstruction: Stone, stricture, cancer, stent blockage
- Infection: E.coli (most common)
These causes can lead to the infection and inflammation of the biliary tree.
What are the symptoms of cholangitis?
Charcot’s Triad: Fever, RUQ pain, Jaundice
Reynolds Pentad is an extension of Charcot’s Triad indicating more severe disease.
What is Reynold’s Pentad?
Reynold’s Pentad: Fever, RUQ pain, Jaundice, hypotension, confusion
Septic Shock
What is included in the investigations for cholangitis?
- Exam: +++ Murphy’s sign
- Bloods: High WBC, INR, CPR, Blood cultures
- Obstruction: High conjugated bilirubin, ALP
Murphy’s sign is indicative of gallbladder inflammation - palpate RUQ, get pt. to inhale, + if pain ilicited.
What occurs when liver and gallbladder bile is blocked?
- Increased conjugated bilirubin in blood (Jaundice)
- High ALP - pressure on liver ducts causes ALP enzyme to enter blood
This process results from the obstruction leading to increased pressure in the biliary system.
What imaging techniques are used in cholangitis?
- USS: CBD + intrahepatic dilatation
- MRCP
These imaging techniques help visualize the biliary tree and assess for obstructions.
What is the first step in the treatment of cholangitis?
Manage sepsis: IV fluids, analgesia, antibiotics
Managing sepsis is critical in treating cholangitis to prevent complications.
What procedures are involved in removing obstruction in cholangitis?
- ERCP section
- Shockwave lithotripsy
- Stent to widen ducts
- Stent
These procedures aim to relieve the obstruction in the biliary system.
What is gallstone ileus?
VERY RARE!!! Cholecystoduodenal fistula (fistula between gallbladder and duodenum)
Gallstone ileus occurs when a gallstone passes into the intestinal tract causing obstruction.
What are the symptoms of gallstone ileus?
- Small bowel obstruction symptoms
- Colicky pain, N/V, distention, constipation
Symptoms arise due to obstruction of the small intestine.
What investigations are performed for gallstone ileus?
- ABx - SBO and pneumobilia
- CT - SBO, gallstones, pneumobilia
Pneumobilia indicates the presence of air within the biliary tree, often associated with fistulas.
What is the treatment for gallstone ileus?
- Resuscitation: IV fluids, oxygen
- NG tube
- Surgery (always!)
Surgical intervention is necessary to address the obstruction caused by the gallstone.
