Cholangitis Flashcards
What is ascending cholangitis?
bacterial infection (typically E. Coli) of the biliary tree
What is the bacteria which most commonly causes ascending cholangitis?
E. coli
What is the most common predisposing factor to ascending cholangitis?
gallstones
What is the triad used to remember the cardinal signs of ascending cholangitis?
Chacot’s triad: right upper quadrant (RUQ) pain, fever and jaundice
In what proportion of patients with ascending cholangitis does Charcot’s triad occur?
20-50%
What is the most common clinical feature of ascending cholangitis?
fever (RUQ pain 70%) (jaundice 60%)
What are 2 additional features of ascending cholangitis and what do these form?
- hypotension
- confusion
Reynods’ pentad (with jaundice, fever, right upper quadrant pain)
What are 3 examples of causes of ascending cholangitis?
- Biliary calculi - 50%
- Benign biliary strictures - 20%
- Malignancy - 10-20%
What are 3 causes of benign biliary stricture that can lead to cholangitis?
- Congenital
- Post-infectious
- Inflammatory
What are 5 sources of malignancy which can contribute to he development of ascending cholangitis?
- Gallbladder
- Bile duct
- Ampulla
- Duodenum
- Pancreas
What are 5 investigations to perform in suspected ascending cholangitis?
- Full panel of bloods - LFTs, inflammatory markers
- US abdomen
- CT scan
- MRCP
- ERCP (therapeutic)
What is US abdomen useful for in ascending cholangitis and what are the limitations?
can detect bile duct dilatation but not very good at picking up stones in the mid-distal area of the biliary duct
What are the advantages and limitations of using CT for ascending cholangitis?
good anatomical details of biliary tree and may visualise radiopaque stones, but poor at viewing radiolucent cholesterol stones which are the most common
What is the most accurate imaging modality to determine a diagnosis of ascending cholangitis?
MRCP - can view gallstones, strictures and can view almost all causes of biliary tree blockage
What will MRCP show in ascending cholangitis?
gallstones/strictures, can view almost all causes of biliary tree blockage