Cholangitis Flashcards
What is cholangitis?
Inflammation of the biliary tracts
What causes cholangitis?
Biliary outflow obstruction and biliary infection
During obstruction, stasis of fluid combined with elevated intraluminal pressure allows bacterial colonisation of the biliary tree to become pathological.
Describe the biliary tree.
The cystic duct from the gallbladder joins the common hepatic duct from the liver to form the common bile duct.
This is joined by the pancreatic duct to become the hepatopancreatic ampulla of Vater which enters the duodenum
What are common causes of biliary tree occlusion
Gallstones ERCP (iatrogenic) Cholangiocarcinoma Pancreatitis Primary sclerosing cholangitis
What are the most common infective organsisms in cholangitis?
E. coli
Klebsiella
Enterococcus
How does cholangitis present?
RUQ pain Fever Jaundice (>50umol/L bilirubin) This is Charcot's triad \+ hypotension and confusion = Reynold's pentad Itching as a result of bile accumulation
What are Charcot’s triad? Reynold’s pentad?
Charcot’s triad - RUQ pain, fever, jaundice
Reynold’s pentad - RUQ pain, fever, jaundice, hypotension, confusion
What investigations for cholangitis?
Routine bloods - FBC (Low WCC), LFTs (raised ALP±GGT, raised bilirubin (conjugated) due to post-hepatic jaundice)
Blood cultures is suspected
Imaging:
USS of biliary tract - bile duct dilation
Gold standard - ERCP (endoscopic retrograde cholangiopancreatography) - diagnostic and therapeutic
MRCP prior to intervention
What is the immediate management for cholangitis?
May present with sepsis:
IV access, fluid resuscitation, bloods and blood cultures, broad spectrum IV abx
What is definitive management of cholangitis?
Endoscopic biliary decompression, removing cause of the blocked biliary tree
ERCP with or without sphincterotomy (citing of biliary sphincter) and stenting should clear any obstruction.
Percutaneous transhepatic cholagiography is second line
What are complications of ERCP?
Repeated cholangitis
Pancreatitis
Bleeding
Perforation
