Ascending cholangitis PASSMED

Question 1

What is ascending cholangitis?

Answer 1

A bacterial infection (typically E. coli) of the biliary tree.

The most common predisposing factor is gallstones.

Question 2

What is Charcot’s triad?

Answer 2

A clinical presentation of right upper quadrant (RUQ) pain, fever, and jaundice.

Occurs in about 20-50% of patients.

Question 3

What is the most common feature of ascending cholangitis?

Answer 3

Fever, seen in 90% of patients.

Question 4

What percentage of patients experience RUQ pain?

Answer 4

70% of patients.

Question 5

What percentage of patients experience jaundice?

Answer 5

60% of patients.

Question 6

What additional symptoms are common in ascending cholangitis?

Answer 6

Hypotension and confusion.

Question 7

What is Reynolds’ pentad?

Answer 7

Charcot’s triad plus hypotension and confusion.

Question 8

What are other features of ascending cholangitis?

Answer 8

Raised inflammatory markers.

Question 9

What is the first-line investigation for suspected ascending cholangitis?

Answer 9

Ultrasound to look for bile duct dilation and bile duct stones.

Question 10

What is the management for ascending cholangitis?

Answer 10

Intravenous antibiotics and endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction.