Ch. 16 RUQ Pain, Fever, Nausea, Vomiting

Question 1

What are the causes of obstructive jaundice that lead to cholangitis?

Answer 1

• Gallstones
• Bile duct strictures
• Parasites (Ascaris lumbricoides, Clonorchis sinensis)
• Instrumentation of the biliary system (such as during ERCP)
• Indwelling biliary stents

Question 2

What is Reynold’s Pentad? What % of patients with cholangitis have all components?

Answer 2

• RUQ pain
• Fever
• Jaundice
• Hypotension
• AMS

Basically Charcot’s Triad + Septic Shock

It is present in the minority of patients with cholangitis (5%)

Question 3

Mgmt:

What are the most immediate mgmt steps once SIRS is recognized?

Then what’s next?

Answer 3

Aggressive IV fluid resuscitation with NS or LR

Abx, NPO

Once the pt is resuscitated, abx given, and dx established… drain the infected bile (biliary decompression) via ERCP

Once pt’s sepsis has completely resolved, they should undergo lap chole so as to prevent future episodes.

Question 4

A hx of bloody diarrhea in a pt who presents with cholangitis

Answer 4

Suggestive of IBD (most likely UC) with PSC (inflammation and fibrosis of intrahepatic and extrahepatic bile ducts)

ERCP shows “pearls on a string”

Question 5

Answer 5

D. Cholangitis

Charcot’s triad