Cholangitis

Question 1

What is cholangitis?

Answer 1

obstruction of the CBD w/infection of the common bile duct

Question 1

How does the bile duct get infected in cholangitis?

Answer 1

intestinal bacteria ascends from the duodenum up the biliary tree, resulting in whole biliary tree inflammation

Question 2

What is the prognosis for cholangitis?

Answer 2

This is a medical emergency, without treatment the prognosis is poor

Question 3

What are some common bacteria that result in cholangitis?

Answer 3

E. coli, Klebsiella, Enterococcus

Question 4

What is the pathophys behind cholangitis?

Answer 4

the CBD obstruction results in a closed system where fluid cannot be drained
➔ gives infection/bacteria from the duodenum the opportunity to ascend up the biliary tree

Question 5

What is Charcot’s triad, and what disease is it associated with?

Answer 5

1. intermittent abdo pain
2. fever
3. jaundice

Question 6

What is Reynold’s pentad and what disease is it associated with?

Answer 6

It is charcot’s triad: intermittent abdo pain, fever, jaundice

plus hypotension/shock and altered mental status

Question 7

What does reynold’s pentad mean for the prognosis of cholangitis patients?

Answer 7

it is an indicator for poor prognosis and significant morbidity and mortality

Question 8

What investigations would you order for someone presenting with fever, jaundice, and abdo pain (charcot’s triad)?

Answer 8

1. Abdo u/s
2. bloodwork ➔ CBC, ALT/AST/ALP/GGT, bilirubin, lipase, creatinine, electrolytes
3. if thinking stones, then ERCP which could double as a treatment

** if the pt is clear cholangitis then ERCP would be prioritized as it can be both therpeutic and diagnostic

Question 9

How would you treat cholangitis?

Answer 9

1. emergent ERCP
2. meds: abx and fluids
3. consider cholecystectomy and or a stent to widen the bile ducts so the obstruction doesn’t happen again