Cholangitis Flashcards
What is cholangitis?
-bacterial infection of the biliary tract
What is the cause of cholangitis?
- cholecystitis
- cholelithiasis
- choledocholiathis
- iatrogenic manipulation of the biliary tract like stents and ERCP
What is Charcot’s triad?
- RUQ pain
- jaundice
- fever
What is Reynolds pentad?
- charcots triad plus hypotension and altered mental state
What is the differential diagnosis for RUQ pain?
- gastroeosophageal reflux
- early appendicitis
- acute pancreatitis
- right sided diverticulitis
How do we diagnose cholangitis?
blood test: FBC: leucocytosis, increased CRP, LFT’s raised: increased bilirubin, ALP, AST, ALT
imaging: ERCP, MRCP, CT scan, ultrasound,
What is the treatment for cholangitis?
- 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 - intravenous antibiotics(ceftriaxone and metronidazole) for 7-10 days
- biliary drainage and decompression within 24-48 hours
- ERCP is the treatment of choice
- PTC(Percutaneous transhepatic cholangiography) if ERCP failed
How could we prevent cholangitis?
-cholestectomy
What are the complications of cholangitis?
- septic shock
- death
- electrolyte abnormality(dehydration)
What about cholangitis do you need to mention in exams?
-it is a surgical emergency
How would we do ERCP in these patients?
- Decompress by doing a endoscopic sphincterotomy and stenting
- nasobiliary drain-drain the bile to the nose as an external drain
What is Mirizzi’s syndrome?
-a condition where a gallstone is stuck in hartmann’s pouch that causes compression of the hepatic duct and causes obstructive jaundice
What is the treatment for mirizzi’s syndrome?
- grade 1- laparoscopic cholecystectomy
2. grade 2 to 4-open cholecystectomy and biliary tract exploration
What is the grading system for Mirizzi’s syndrome?
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
What organisms are associated with cholangitis?
- gram negative- e.coli, enterococcus, enterobacter, klebsiella