Chapter 53: Biliary Tract- Cholangitis

Question 1

What is it?

Answer 1

Bacterial infection of the biliary tract from obstruction (either partial or complete); potentially life-threatening

Question 2

What are the common causes?

Answer 2

1. Choledocholithiasis
2. Stricture (usually postoperative)
3. Neoplasm (usually ampullary carcinoma)
4. Extrinsic compression (pancreatic pseudocyst/pancreatitis)
5. Instrumentation of the bile ducts (e.g., PTC/ERCP)
6. Biliary stent

Question 3

What is the most common cause of cholangitis?

Answer 3

Gallstones in common bile duct (choledocholithiasis)

Question 4

What are the signs and symptoms?

Answer 4

Charcot’s triad:

1. Fever/chills
2. RUQ pain
3. Jaundice

Question 5

What is Reynold’s pentad?

Answer 5

Charcot’s triad PLUS

1. Mental status changes
2. Shock

Question 6

Which organisms are most commonly isolated with cholangitis?

Answer 6

Gram-negative organisms are the most common:

• E. coli
• Klebsiella
• Pseudomonas
• Enterobacter
• Proteus
• Serratia

Question 7

What are the diagnostic tests of choice?

Answer 7

Ultrasound and contrast study (e.g., ERCP or IOC) after patient has “cooled off”with IV antibiotics

Question 8

What is suppurative cholangitis?

Answer 8

Severe infection with sepsis—“pus under pressure”

Question 9

What is the management of cholangitis?

Answer 9

Nonsuppurative:

• IVF and antibiotics
• with definitive treatment later (e.g., lapchole ± ERCP)

Suppurative:

• IVF, antibiotics, and decompression;
  
  • decompression can beo btained by
    
    • ERCP with papillotomy
    • PTC with catheter drainage
    • or laparotomy with T-tube placement