Ascending cholangitis Flashcards
What is Charcot’s triad?
- Fever
- RUQ pain
- Jaundice
What is Reynold’s pentad?
-Charcot’s triad
-Hypotension
-Altered mental status
Indicates cholangitis + sepsis due to reflux of bacteria from increased intraductal pressure.
What is ascending cholangitis?
Infection of the biliary tree
Aetiology of ascending cholangitis?
- Stasis of biliary tract due to obstruction or stricture (usually previous cholecystectomy)
- Infection originates in duodenum or spreads haematogenously from portal vein
Common bacteria causing ascending cholangitis?
-E. coli
-Klebsiella
-Enterobacter
-Enterococcus
May have coinfection with Bacteroides and Clostridia
Signs/ symptoms in suppurative cholangitis?
Reynold’s pentad
Diagnosis of ascending cholangitis?
- Increased WBC
- Increased ALP and bilirubin
- ALT variably elevated
- Blood culture
- Abdo U/S: CBD dilation, stones
Treatment of ascending cholangitis?
ABx and ICU medical Mx
- Drainage (preferably ERCP)
- ABx (broad spectrum) e.g. piperacillin / tazobactam, metronidazole and ceftriaxone, or carbapenem monotherapy.
- Opioid analgesia
DDx ascending cholangitis?
- Acute cholecystitis (will be Murphy’s +ve)
- PUD (food/antacid improves)
- Acute pancreatitis
Ix in ascending cholangitis?
- FBE
- UEC
- ABGs
- LFTs
- CRP
- Blood cultures
- ERCP
ABG results in severe cholangitis?
Severe cases = low bicarb with raised anion gap metabolic acidosis
What needs to be covered by cholangitis ABx therapy?
- Enterococci
- G-ve bacilli
e. g. ampicillin + gentamicin +/- metronidazole OR tazobactam + piperacillin
