Cholangitis Flashcards
What is cholangitis?
Infection of the biliary tract
There is a combination of biliary outflow obstruction and biliary infection.
The stasis of fluid during the obstruction leads to increased intraluminal pressure and allows for bacterial colonisation of the biliary tree
Causes of cholangitis
Anything that occludes the biliary tree
Most common…
Gallstones
ERCP (iatrogenic)
Cholangiocarcinoma
Less common…
Primary sclerosing cholangitis
Ischaemic cholangiopathy
Pancreatitis
Parasitic infections
Most common causative infective organisms in cholangitis
E. Coli
Klebsiella spp.
Enterococcus
Clinical features
RUQ pain
Fever
Jaundice
Pruritus
Pale stools
Dark urine
Usual PMH of cholangitis
Gallstones
Recent ERCP
Previous cholangitis
Oral COCP
Fibrates
Lipid rich diet
Examination findings
Pyrexia
Rigors
Jaundice
RUQ tenderness
Confusion
Hypotension
Tachycardia
Sepsis
Two common eponymous syndromes of cholangitis
Charcot’s triad
Reynold’s Pentad
Explain Charcot’s triad
Jaundice
Fever
RUQ pain
Explain Reynold’s pentad
Jaundice
Fever
RUQ pain
Hypotension
Confusion
Dx
Biliary colic
Cholecystitis
Lab tests
Routine bloods
FBC (leucocytosis)
LFTs (raised ALP +/- GGT and raised bilirubin)
Blood cultures
Imaging
USS of biliary tract
ERCP (Gold standard investigation + therapeutic)
USS findings
Bile duct dilation
Common bile duct is suually less than 6mm in size.
Any diameter bigger suggests dilation.
Should also find a gallstone if that is the cause
ERCP findings
Note that many endoscopists may require MRCP prior to intervention.
General management
Since they might present with sepsis do SEPSIS 6
IV acces with fluid resus
Routine bloods
Blood cultures
Broad spectrum IV antibiotics like co-amoxiclav +/- metronidazole as per local guidelines.
Defintive management
Endoscopic biliary decompression to remove that cause.
ERCP with or without a sphincterotomy and stenting should clear obstruction.
Patients too poor to tolerate ERCP you can do percutaneous transhepatic cholangiograpy.
What long term intervention may be required?
Cholecystectomy if gallstones were the underlying cause
Complications of ERCP
Repeated cholangitis
Pancreatitis
Bleeding
Perforation
Prognosis
Mortality of cholangitis is around 5-10%
Early ERCp and early abx improve outcome.
