Cholangitis Flashcards

1
Q

What is cholangitis?

A

-bacterial infection of the biliary tract

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2
Q

What is the cause of cholangitis?

A
  • cholecystitis
  • cholelithiasis
  • choledocholiathis
  • iatrogenic manipulation of the biliary tract like stents and ERCP
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3
Q

What is Charcot’s triad?

A
  1. RUQ pain
  2. jaundice
  3. fever
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4
Q

What is Reynolds pentad?

A
  1. charcots triad plus hypotension and altered mental state
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5
Q

What is the differential diagnosis for RUQ pain?

A
  1. gastroeosophageal reflux
  2. early appendicitis
  3. acute pancreatitis
  4. right sided diverticulitis
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6
Q

How do we diagnose cholangitis?

A

blood test: FBC: leucocytosis, increased CRP, LFT’s raised: increased bilirubin, ALP, AST, ALT
imaging: ERCP, MRCP, CT scan, ultrasound,

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7
Q

What is the treatment for cholangitis?

A
  1. Because it is a surgical emergency you need to resuscitate the patient
    - good IV access
    - send bloods for cultures specifically
    - watch urine output by catheterising patient
    - make sure MAP is above 65mmHG
    - do CVP line if patient is unresponsive to fluids
  2. intravenous antibiotics(ceftriaxone and metronidazole) for 7-10 days
  3. biliary drainage and decompression within 24-48 hours
  4. ERCP is the treatment of choice
  5. PTC(Percutaneous transhepatic cholangiography) if ERCP failed
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8
Q

How could we prevent cholangitis?

A

-cholestectomy

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9
Q

What are the complications of cholangitis?

A
  • septic shock
  • death
  • electrolyte abnormality(dehydration)
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10
Q

What about cholangitis do you need to mention in exams?

A

-it is a surgical emergency

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11
Q

How would we do ERCP in these patients?

A
  1. Decompress by doing a endoscopic sphincterotomy and stenting
  2. nasobiliary drain-drain the bile to the nose as an external drain
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12
Q

What is Mirizzi’s syndrome?

A

-a condition where a gallstone is stuck in hartmann’s pouch that causes compression of the hepatic duct and causes obstructive jaundice

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13
Q

What is the treatment for mirizzi’s syndrome?

A
  1. grade 1- laparoscopic cholecystectomy

2. grade 2 to 4-open cholecystectomy and biliary tract exploration

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14
Q

What is the grading system for Mirizzi’s syndrome?

A

grade 1-no fistula formation
grade 1A- presence of the cystic duct
grade 1B-obliteration of the cystic duct
grade 2: less than 33% of the diameter of the common bile duct
grade 3: 33-66% of the common bile duct
grade 4: more than 66% of the common bile duct

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15
Q

What organisms are associated with cholangitis?

A
  1. gram negative- e.coli, enterococcus, enterobacter, klebsiella
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