Cholangitis Flashcards
2 main causes of acute cholangitis?
- Obstruction int he bile ducts stopping bile flow e.g. gallstobes in the common bile duct
- Infection due to ERCP
Most common organisms to cause acute cholangitis?
E.coli
Klebsiella species
Enterococcus species
Charcot’s triad?
Right upper quadrant pain
Fever- most common
Jaundice (raised bilirubin)
Diagnosis- acute cholangitis
What is acute cholangitis?
Infection and inflammation of the bile ducts
ERCP?
Removes stones blocking the bile duct using an endoscope which enters the common bile duct through the sphincter of oddi
PTC?
Involves raiologically guided insertion of a drain through the skin and liver into the bile ducts = relieving the immediate obstruction
Mangement of ascending cholangitis?
IV antibitoics
ERCP after 24-48 hours to relieve any obstruction
What is primary biliary cholangitis and who is it typically seen in?
Chronic liver disorder typically seen in middle aged females
Thought to be autoimmune
Bile ducts become damaged by chronic inflammation= cholestasis
Classical presentation of primary biliary cholangitis?
Itching in middle aged women
Also:
* May be asymptomatic or fatigue
* Raised ALP
* Cholestatic jaundice
* Hyperpigmentation on joints
* Clubbing
May progress to liver failure
Diagnosis of primary biliary cholangitis?
Immunology:
* Anti-mitochondrial antibodies (AMA) M2 subtypes
* Raised serum IgM
* Smooth muscle antiobides in 30 % of patients
Imaging:
* RUQ ultrasound or MRCP
Managment of primary biliary cholangitis?
1st line- ursodeoxycholic acid
Primary sclerosing cholangitis is closely associated with what?
Ulcerative colitis
Features of primary sclerosing cholangitis?
- Cholestasis- jaundice, pruritus
- Raised bilirubin and ALP
- RUQ pain
- Fatigue
Investigations for primary sclerosing cholangitis?
ERCP/MRCP
p-ANCA may be positive
Main risk factor for cholangiocarcinoma?
Primary sclerosing cholangitis
