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ANKI GI > Cholangitis > Flashcards

Cholangitis Flashcards

1
Q

What is cholangitis?

A

An infection of the biliary tract

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2
Q

What is cholangitis associated with?

A

High morbidity and mortality if left untreated

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3
Q

What is cholangitis caused by?

A

Combination of biliary outflow obstruction and biliary infection

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4
Q

What happens during a biliary outflow obstruction?

A

Stasis of fluid combined with elevated intraluminal pressure allows bacterial colonisation of the biliary tree to become pathological

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5
Q

What kind of conditions can cause cholangitis?

A

Any condition which causes occlusion of the biliary tree has the potential to cause cholangitis

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6
Q

What are the most common causes of cholangitis?

A
  • Gallstones
  • ERCP
  • Cholangiocarcinoma
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7
Q

What are the rarer causes of cholangitis?

A
  • Pancreatitis
  • Primary sclerosing cholangitis
  • Ischaemic cholangiopathy
  • Parasitic infections
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8
Q

What are the most common infective organisms implicated in cholangitis?

A
  • E. Coli
  • Klebsiella
  • Enterococcus
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9
Q

What are the common presenting symptoms of cholangitis?

A
  • RUQ pain
  • Fever
  • Jaundice
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10
Q

What are the other symptoms of cholangitis?

A
  • Pruritis
  • Pale stool
  • Dark urine
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11
Q

What might a patient with cholangitis PMH contain?

A
  • Gallstones
  • Recent biliary tract instrumentation
  • Previous cholangitis
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12
Q

What medications increase the risk of cholangitis?

A
  • OCP

- Fibrates

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13
Q

What might be found on examination with cholangitis?

A
  • Pyrexia
  • Rigors
  • Jaundice
  • RUQ tenderness
  • Confusion
  • Hypotension
  • Tachycardia
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14
Q

What eponymous syndromes are associated with cholangitis?

A
  • Charcots triad

- Reynold’s Pentad

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15
Q

What is Charcots triad?

A
  • Jaundice
  • Fever
  • RUQ pain
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16
Q

What is Reynold’s pentad?

A
  • Jaundice
  • Fever
  • RUQ pain
  • Hypotension
  • Confusion
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17
Q

What is the result of cholangitis not being a complete diagnosis?

A

There is nearly always an underlying cause that should be identified and treated

18
Q

What are the differential diagnoses for cholangitis?

A
  • Biliary colic

- Cholecystitis

19
Q

How can biliary colic be differentiated from cholangitis?

A

Biliary cold won’t have fever, leucocytosis, or jaundice

20
Q

How can cholecystitis be differentiated from cholangitis?

A

Cholecystitis won’t have jaundice

21
Q

What investigations should be done in cholangitis?

A
  • Lab tests

- Imaging

22
Q

What lab tests should be done in cholangitis?

A
  • Routine bloods

- Blood cultures

23
Q

What routine bloods should be done in cholangitis?

A
  • FBC

- LFTs

24
Q

What may be found on FBC in cholangitis?

A

Leucocytosis

25
Q

What may be found on LFTs in cholangitis?

A

Raised ALP plus minus GGT with a raised bilirubin

26
Q

In what % of cases of cholangitis are blood cultures +ve?

A

20%

27
Q

What imaging may be done in cholangitis?

A
  • Ultrasound of biliary tract

- ERCP (gold standard)

28
Q

What may be found on ultrasound of biliary tract in cholecystitis?

A
  • Bile duct dilatation

- Underlying cause, e.g. gallstones

29
Q

How big is the common bile duct usually?

A

Less than 6mm

30
Q

When might the common bile duct be larger?

A
  • Elderly

- Those who have had previous cholecystectomy

31
Q

What can ERCP be used for in cholangitis?

A

Both diagnosis and treatment

32
Q

What may be required before ERCP can be performed?

A

MRCP (to obtain detailed imaging of biliary system prior to scoping_

33
Q

What is involved in the immediate management of cholangitis?

A

If septic;

  • Ensure IV accwess
  • Fluid resus
  • Routine bloods
  • Blood cultures
  • Broad spectrum IV antibiotics
34
Q

What is the definitive management of cholangitis?

A

Endoscopic biliary decompression - removing cause of blocked biliary tree

35
Q

When might endoscopic biliary decompression be done earlier?

A

For those who are deteriorating (compared to those responding well to antibiotic therapy)

36
Q

How is endoscopic biliary decompression performed?

A

ERCP, with or without sphincterotomy and stenting

37
Q

What is the second line investigation for patients who are too sick to tolerate ERCP?

A

Percutaneous transhepatic cholangiography

38
Q

What may be required in the long-term treatment for cholangitis?

A

Cholecystectomy (if gallstones underlying cause)

39
Q

What are the potential complications of ERCP?

A
  • Repeated cholangitis
  • Pancreatitis
  • Bleeding
  • Perforation
40
Q

What is the mortality of cholangitis?

A

5-10%

41
Q

What has been shown to improve patient outcomes in cholangitis?

A

Early ERCP and antibiotic therapy

42
Q

What factors increase the mortality rate of cholangitis?

A
  • Delayed diagnosis
  • Liver failure
  • Cirrhosis
  • CKD
  • Hypertension
  • Female gender
  • > 50 years

ANKI GI (43 decks)

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