Cholangitis Flashcards
What is acute cholangitis?
Infection and inflammation of the biliary tree
What are the causes of cholangitis?
Gallstones in the CBD
Infection introduced during ERCP
Cholangiocarcinoma
Biliary strictures
What organisms most commonly cause acute cholangitis?
E. coli
Klebsiella
Enterococcus
What is charcot’s triad?
RUQ pain
Fever
Jaundice
What are the clinical signs and symptoms of acute cholangitis?
RUQ abdominal pain
Jaundice
Fever
Pruritis
Dark urine and pale stool
Confusion
Hypotension
What is Reynold’s pentad?
Charcot’s triad
+ Confusion and hypotension
What imaging is used in the diagnosis of acute cholangitis?
Abdominal ultrasound scan - first line
CT scan
MRCP - gold standard
Endoscopic ultrasound
What other investigations are useful in the diagnosis of acute cholangitis?
FBC
LFTs - obstructive jaundice
- ALP > ALT
U&Es
CRP
VBG
Blood cultures - before commencing antibiotics
What is the initial management of acute cholangitis?
IV antibiotics - broad spectrum with gram-negative and anaerobic cover
IV fluids
What is the definitive management of acute cholangitis?
ERCP - first line
PTC (percutaneous transhepatic cholangiogram)
What is PTC?
A drain is inserted radiologically through the skin and liver, into the bile ducts - this drain relieves the immediate obstruction
What procedures can be performed during ERCP?
Cholangio-pancreatography - visualising biliary system
Sphincterotomy - makes a cut in the sphincter to dilate it and allow stone removal
Stone removal
Balloon dilatation
Biliary stenting
Biopsy
What is primary sclerosing cholangitis?
An immune mediated chronic liver disease, where the intrahepatic and extrahepatic bile ducts become inflamed, fibrosed and destroyed
What condition is primary sclerosing cholangitis associated with?
Ulcerative colitis
What are the risk factors for primary sclerosing cholangitis?
Male
Aged 30-40
Ulcerative colitis
Family history
What is the presentation of primary sclerosing cholangitis?
RUQ pain
Pruritis
Fatigue
Jaundice
Hepatomegaly
Splenomegaly
What blood tests are used in the diagnosis of primary sclerosing cholangitis?
ALP
Gamma-GT
Bilirubin
ALT/AST
pANCA
ANA
What is the diagnostic investigation of choice for primary sclerosing cholangitis?
MRCP
What is the management of primary sclerosing cholangitis?
Observation and lifestyle optimisation
Cholestyramine - relieves pruritis
Fat soluble vitamin supplementation
Liver transplantation - advanced disease
What are the complications of primary sclerosing cholangitis?
Biliary strictures
Acute bacterial cholangitis
Cholangiocarcinoma
Cirrhosis
Fat soluble vitamin deficiency
Osteoporosis
What is primary biliary cholangitis?
An autoimmune condition characterised by granulomatous destruction of the intrahepatic bile ducts
- This leads to cholestasis and subsequent leakage of bile into the circulation
- The back pressure of bile can lead to liver fibrosis and cirrhosis
What conditions are associated with primary biliary cholangitis?
Sjogren’s syndrome
Raynaud’s syndrome
Autoimmune thyroid disease
Rheumatoid arthritis
Systemic sclerosis
What is the presentation of primary biliary cholangitis?
Fatigue
Pruritis
Abdominal pain
Jaundice
Pale, greasy stools
Dark urine
Xanthoma and xanthelasma
Hepatomegaly
What investigations are used in the diagnosis of primary biliary cholangitis?
ALP, GGT, bilirubin - raised
Coagulation profile
Raised IgM
Antibodies:
- AMA
- ANA
- Smooth muscle antibodies
What is the first line treatment of primary biliary cholangitis?
Ursodeoxycholic acid
Fat soluble vitamin supplementation
Cholestyramine
What is ursodeoxycholic acid?
A bile acid analogue
- Dampens the inflammatory response and improves cholestasis
What are the complications of primary biliary cholangitis?
Malabsorption of fat-soluble vitamins
Hypercholesterolaemia
Liver cirrhosis
Hepatocellular carcinoma
