Cholangitis

Question 1

What is acute cholangitis?

Answer 1

Acute cholangitis, also known as ascending cholangitis, is an infection of the biliary tree caused by biliary outflow obstruction and subsequent infection.

Question 2

What are common symptoms of acute cholangitis?

Answer 2

Fever, right upper quadrant (RUQ) pain, jaundice, pruritus, pale stools, dark urine, nausea, and vomiting.

Question 3

What is Charcot’s triad?

Answer 3

The combination of fever, right upper quadrant pain, and jaundice, indicative of acute cholangitis.

Question 4

What is Reynold’s pentad?

Answer 4

Charcot’s triad plus hypotension and confusion, indicating severe acute cholangitis.

Question 5

What are common causes of biliary obstruction leading to cholangitis?

Answer 5

Gallstones, tumours, biliary strictures, sclerosing cholangitis, and parasitic infections.

Question 6

Which bacteria are commonly associated with acute cholangitis?

Answer 6

Escherichia coli, Klebsiella species, and Enterococcus species.

Question 7

What is the initial imaging modality for suspected cholangitis?

Answer 7

Abdominal ultrasound to detect gallstones and bile duct dilation.

Question 8

What blood tests are typically elevated in acute cholangitis?

Answer 8

Raised white cell count (WCC), C-reactive protein (CRP), bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT).

Question 9

What is the gold standard diagnostic and therapeutic procedure for cholangitis?

Answer 9

Endoscopic retrograde cholangiopancreatography (ERCP).

Question 10

What is the first-line treatment for acute cholangitis?

Answer 10

Supportive care with intravenous fluids, broad-spectrum antibiotics, and biliary decompression via ERCP.

Question 11

What are potential complications of untreated acute cholangitis?

Answer 11

Sepsis, hepatic abscess, acute pancreatitis, and multi-organ failure.

Question 12

What is the role of percutaneous transhepatic cholangiography (PTC) in cholangitis?

Answer 12

PTC is an alternative method for biliary drainage if ERCP is unsuccessful or contraindicated.

Question 13

What is the typical age range for the presentation of acute cholangitis?

Answer 13

Median age of presentation is 50-60 years old.

Question 14

What is the mortality rate associated with acute cholangitis?

Answer 14

Mortality rate ranges between 17-40%.

Question 15

What is the significance of a dilated common bile duct (CBD) on imaging?

Answer 15

It suggests biliary obstruction, which may lead to cholangitis.

Question 16

What is the function of the sphincter of Oddi?

Answer 16

It controls the flow of bile and pancreatic juice into the duodenum and prevents reflux of duodenal contents.

Question 17

What is the anatomical location of the gallbladder?

Answer 17

The gallbladder is located in the right hypochondrium beneath the liver.

Question 18

What is the primary function of the gallbladder?

Answer 18

To store and concentrate bile produced by the liver.

Question 19

What is the common bile duct (CBD)?

Answer 19

The duct formed by the union of the common hepatic duct and the cystic duct, which transports bile from the liver and gallbladder to the duodenum.

Question 20

What is the ampulla of Vater?

Answer 20

The dilated junction where the common bile duct and the pancreatic duct meet before emptying into the duodenum.

Question 21

What is the hepatocystic triangle?

Answer 21

An anatomical area bordered by the cystic duct, common hepatic duct, and the inferior edge of the liver, important in surgical procedures like cholecystectomy.

Question 22

What is the role of cholecystokinin in digestion?

Answer 22

It stimulates gallbladder contraction and relaxation of the sphincter of Oddi, facilitating bile release into the duodenum.

Question 23

What is biliary sludge?

Answer 23

A mixture of particulate matter and mucus that forms in bile, often a precursor to gallstones and can contribute to biliary obstruction.

Question 24

What is the significance of a positive Murphy’s sign?

Answer 24

It indicates gallbladder inflammation, commonly seen in acute cholecystitis.

Question 25

What lifestyle modifications can reduce the risk of biliary disease?

Answer 25

Maintaining a healthy weight, adopting a balanced diet low in saturated fats, and regular physical activity.