Cholangitis Flashcards
What is acute cholangitis?
infection and inflammation in the bile ducts.
It is a surgical emergency and has a high mortality due to sepsis and septicaemia.
2 main causes of acute cholangitis
1.Obstruction in the bile ducts stopping bile flow (i.e. gallstones in the common bile duct)
2.Infection introduced during an ERCP procedure
Epidemiology of Acute (ascending) cholangitis
Age >50
M=F
Rare
White, hispanics and Native americans
Aetiology of Acute cholangitis
- Choledocholithiasis, stones in the bile duct, is the most common cause of acute cholangitis.
- Benign stricture: leading to obstruction, may occur in the biliary tree for numerous reasons
- Malignant stricture: e.g. cholangiocarcinoma, pancreatic cancer and gallbladder cancer.
RFs for acute cholangitis
- Gallstones:the most common predisposing factor
- Stricture of the biliary tree:benign or malignant
- Post-procedure injuryof the bile ducts e.g. post-ERCP
Pathophysiology of Acute cholangitis
- Due to bacterial infection secondary to biliary obstruction
- Bilary obstruction due to gallstones in bililary tree
- Obstruction > cholestasis and growth of bacteria - gram negative
Most common organisms that cause acute cholangitis?
Escherichia coli
Klebsiella species
Enterococcus species
What is Charcot’s Triad?
Acute cholangitis presents with Charcot’s triad:
Right upper quadrant pain
Fever
Jaundice (raised bilirubin)
What is the management for acute cholangitis
need emergency admission for investigations and management.
Patients need acute management of sepsis and acute abdomen, including:
Nil by mouth
IV fluids
Blood cultures
IV antibiotics (as per local guidelines)
Involvement of seniors and potentially HDU or ICU
First line investigation for acute cholangitis
- FBC:leukocytosis with neutrophilia
- LFTs:obstructive jaundice with raised ALP > ALT, and bilirubin
- U&Es: pre-renal acute kidney injury in sepsis
- CRP: acute-phase protein and marker of inflammation
- ## VBG: assess for acidosis and lactate if suspecting sepsis
What imaging do we use to diagnose common bile duct (CBD) stones and cholangitis?
Abdominal ultrasound scan
CT scan with IV contrast
Magnetic resonance cholangio-pancreatography (MRCP) - GS
Endoscopic ultrasound
DDs for ascending acute cholangitis
- Acute cholecystitis
- Peptic ulcer disease
- Pancreatitis
- Appendicitis
What procedure is done to remove stones blocking the bile duct?
endoscopic retrograde cholangio-pancreatography (ERCP)
What happens during an ERCP?
involves inserting an endoscope down the oesophagus, past the stomach, to the duodenum and the opening of the common bile duct (the sphincter of Oddi). This gives the operator access to the biliary system.
What is a Percutaneous transhepatic cholangiogram (PTC)?
involves radiologically guided insertion of a drain through the skin and liver, into the bile ducts.