Cholangitis

Question 1

What is cholangitis?

Answer 1

Infection of the bilary tract -caused by a combination of bilary outflow obstruction and biliary infection.

Question 2

What are the causes of cholangitis?

Answer 2

Any condition that causes occulsion of the biliary tree - gallstones, ERCP(iatrogenic) and cholangiocarcinoma.

Most common oragnsims - E.coli, klebsiella species and Enterococcus

Question 3

What are the clinical feature of cholangitis?

Answer 3

RUQ pain, fever and jaundice. May have itching, pale stool and dark urine.

Examination- pyrexia, rigors, jaundice, RUQ tenderness

Question 4

What are two syndromes associated with cholangitis?

Answer 4

Charcots triad: jaundice, fever and RUQ pain

Reynolds pentad: jaundice, fever and RUQ pain, hypotension and confusion

Question 5

What investigations should be done in cholangitis?

Answer 5

Routine bloods, Blood cultures

Ultrasound of the bilary tract
Gold standard - ERCP which is useful in diagnosis and treatment, but may require MRCP prior to intervention

Question 6

What is the immediate management of cholangitis?

Answer 6

Spesis 6 + ABCDE

Question 7

What is the definitive management of cholangitis?

Answer 7

Endoscopic biliary decompression - ERCP with or without sphincterotomy and stenting

If too sick to tolerate ERCP the second line is percutaneous transhepatic cholangiography (PTC)

Question 8

What are the complications of ERCP?

Answer 8

Repeated cholangitis
Panreatitis
Bleeding
Perforation

Question 9

Which factors increase the mortality in cholangitis?

Answer 9

Liver failure/cirrhosis 
CKD
Hypotension 
Female gender 
>50 yrs