Cholangitis Flashcards
What is acute cholangitis?
Inflammation/Infection of the
bile ducts
What is the name of the cholangitis triad?
Charcot’s triad
Charcot’s Triad
Fever
Jaundice
RUQ pain
Cholangitis Sx
- Charcot’s Triad (Fever, Jaundice, RUQ pain)
- Pale stool
- Dark urine
- Puritis
Most common causative organisms
- E.coli
- Klebsiella
- Enterococcus
Conservative Acute Cholangitis Mx
- IV fluids
- IV Abx
Complications of Acute cholangitis
Sepsis and multi-organ failure
Ix for Acute cholangitis
1st line: Abdo USS (bile duct dilatation)
- Magnetic Resonance Cholangiopancreatography (MRCP)
Acute cholangitis causes
- Biliary calculi (gallstones)
- ERCP procedure causes infection
- Cholangiocarcinoma
what type of hepatic jaundice does cholangitis cause
Post-hepatic jaundice
Cholangitis clinical signs
- Pyrexia
- RUQ tenderness
- Rigors
- Jaundice
- Tachycardia
- Hypotension
how to differentiate cholangitis and cholancystitis
- Absence of jaundice in cholecystitis
- NO CBD dilatation
Blood test findings in cholangitis
- Leucocytosis
- Raised ALP
- Raised bilirubin >50
Gold standard Ix
Endoscopic Retrograde Cholangiopancreatography (ERCP)
Definitive Tx for cholangitis
Endoscopic biliary decompression (ERCP with or without a sphincterotomy and stenting)
ERCP complications
- cholangitis
- pancreatitis
- bleeding (more common when a sphincterotomy is performed) - perforation
what intervention is used for patient too sick for ERCP
2nd line: Percutaneous Transhepatic Cholangiography (PTC)
Increase mortality rate factors
- delayed diagnosis
- liver failure
- liver cirrhosis
- CKD
- hypotension
- female gender
- > 50yrs
CT scans indications in the biliary systems
- Malignancy - pancreatic, cholangiocarcinoma
- Perforation
- Abscesses
