ASCENDING CHOLANGITIS Flashcards
WHAT IS ASCENDING CHOLANGITIS?
- bacterial infection of biliary tree
- common causative organism is E.coli
WHAT ARE THE CAUSES OF ASCENDING CHOLANGITIS?
Conditions that cause biliary outflow obstruction
1) ERCP
2) Gallstones
caused by a combination of biliary outflow obstruction* and biliary infection.
WHAT ARE THE EXAMINATION FINDINGS OF ASCENDING CHOLANGITIS?
1) Pyrexia
2) Jaundice
3) RUQ tenderness
4) hypotension
5) confusion
WHAT ARE THE CLINICAL FEATURES OF ASCENDING CHOLANGITIS?
1) Charcot’s triad - RUQ abdominal pain, fever, jaundice
2) Reynold’s pentad - RUQ abdominal pain, fever, jaundice and hypotension and confusion
3) Pruritis (bile accumulation)
WHAT IS THE SIGNIFICANCE OF REYNOLD’S PENTAD?
- marker of severe illness
WHAT ARE THE COMPLICATIONS FOR ASCENDING CHOLANGITIS
1) Sepsis
2) Ongoing jaundice and pain post cholecystectomy as stone can migrate to distal end of cystic duct during surgery and enter CBD leading to obstruction.
WHAT IS THE DIFFERENTIAL DIAGNOSIS FOR ASCENGING CHOLANGITIS?
1) biliary colic
2) cholecystitis
3) acute pancreatitis
WHAT ARE THE LAB INVESTIGATIONS FOR ASCENDING CHOLANGITIS?
1) Blood test - FBC (elevated WCC), LFTs (raised ALP +/- GGT, bilirubin), CRP (raised), coagulation profile (prothrombin raised with sepsis
2) Blood culture- sepsis
3) ABG - sepsis
WHAT ARE THE IMAGING INVESTIGATIONS FOR ASCENDING CHOLANGITIS?
1) ERCP - diagnosis and therapeutic
WHAT IS THE IMMEDIATE MANAGEMENT FOR ASCENDING CHOLANGITIS?
1) IV fluid resuscitation
2) IV antibiotics
3) Analgesia
WHAT IS THE DEFINITIVE MANAGEMENT FOR ASCENDING CHOLANGITIS?
1) ERCP - allow observation of pancreatic and bile duct, to relieve obstruction, after 24–48 hours
2) Cholecystectomy- removal of gall bladder(source of gall stones)
WHAT ARE THE COMPLICATIONS OF ASCENDING CHOLANGITIS?
1) Sepsis
2) Ongoing jaundice and pain post-cholecystectomy, occurs when stone migrate to distal end of cystic duct during surgery and enter CBD leading to obstruction perform.
