Cholangitis

Question 1

What are the 2 main causes of acute cholangitis?

Answer 1

Obstruction in the bile ducts (benign biliary stricture, malignancy, gallstones), stopping bile flow and
infection introduced during an ERCP procedure

Question 2

Why is it a surgical emergency and has a high mortality?

Answer 2

Sepsis and septicaemia

Question 3

Name an organism/species that commonly causes acute cholangitis

Answer 3

• Escherichia coli (commonest)
• Klebsiella species
• Enterococcus species

Question 4

Acute cholangitis presents with Charcot’s triad - what are the 3 components?

Answer 4

• Right upper quadrant pain
• Fever
• Jaundice

Question 5

Name 2 aspects of the acute management of sepsis and acute abdomen caused by cholangitis

Answer 5

• Nil by mouth
• IV fluids
• Blood cultures
• IV antibiotics (as per local guidelines)
• Involvement of seniors and potentially HDU or ICU
• ERCP, percutaneous drainage – PTC (percutaneous transhepatic cholangiography) or surgical drainage