Ascending_Cholangitis_Flashcards

Question 1

Definition

Answer 1

Ascending cholangitis is a severe, acute infection and inflammation of the biliary tree, often resulting from a blockage that facilitates bacterial ascent from the duodenum.

Question 2

Epidemiology

Answer 2

Impacts both males and females, typically presenting in the 6th decade or later. Higher risk in patients with gallstones, prior biliary surgery, biliary stents, immunosuppression, pancreatitis, or biliary tract tumors.

Question 3

Aetiology

Answer 3

Main causes include biliary calculi (50%), benign biliary strictures (20%), malignancies (10-20%). Infection results from obstruction (e.g., gallstones), leading to bile stasis, bacterial overgrowth, and ascending infection with enteric organisms.

Question 4

Signs and Symptoms

Answer 4

Common presentation includes Charcot’s triad (RUQ pain, fever, jaundice). Severe cases present Reynold’s pentad (hypotension, mental confusion).

Question 5

Key Features Comparison with acute cholecystitis and biliary colic

Answer 5

Feature: Pain Location - RUQ for both Ascending Cholangitis & Cholecystitis; Epigastric/RUQ for Biliary Colic. Fever/Jaundice: Present in Ascending Cholangitis, occasionally in Cholecystitis, absent in Biliary Colic. Murphy’s Sign: Absent in Ascending Cholangitis & Biliary Colic, Present in Cholecystitis.

Question 6

Differential Diagnosis

Answer 6

Includes: Acute hepatitis (jaundice, fever, RUQ pain), Gallstones (RUQ pain, nausea), Pancreatitis (epigastric pain, elevated amylase/lipase), Perforated peptic ulcer (severe pain, peritonitis), Acute appendicitis (lower right pain, fever).

Question 7

Investigations

Answer 7

Bloods: Raised LFTs, WCC, CRP. Imaging: Ultrasound for bile duct dilatation, CT for anatomy/radiopaque stones, MRCP for detailed biliary obstruction causes, ERCP for therapeutic drainage.

Question 8

Management

Answer 8

Includes IV fluids, antibiotics, biliary drainage (via ERCP, PTC, or surgery), and addressing underlying causes (e.g., cholecystectomy for gallstones, malignancy-specific interventions).

Question 9

Summary of ascending cholangitis

Answer 9

Ascending cholangitis is a bacterial infection of the biliary tree characterised by Charcot’s triad: right upper quadrant pain, fever, and jaundice. Reynold’s pentad, which includes hypotension and mental confusion, is observed in severe cases. It is primarily caused by biliary calculi, benign biliary stricture, and malignancy. Most prevalent in patients over 60 or those with a history of gallstones, prior biliary surgery, or a biliary stent, it is diagnosed via a basic blood panel and imaging studies. Management comprises resuscitation, biliary drainage, and addressing the underlying cause.