Cholangitis Flashcards

1
Q

What is ascending cholangitis?

A

bacterial infection (typically E. Coli) of the biliary tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the bacteria which most commonly causes ascending cholangitis?

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common predisposing factor to ascending cholangitis?

A

gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the triad used to remember the cardinal signs of ascending cholangitis?

A

Chacot’s triad: right upper quadrant (RUQ) pain, fever and jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In what proportion of patients with ascending cholangitis does Charcot’s triad occur?

A

20-50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common clinical feature of ascending cholangitis?

A

fever (RUQ pain 70%) (jaundice 60%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are 2 additional features of ascending cholangitis and what do these form?

A
  1. hypotension
  2. confusion

Reynods’ pentad (with jaundice, fever, right upper quadrant pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 3 examples of causes of ascending cholangitis?

A
  1. Biliary calculi - 50%
  2. Benign biliary strictures - 20%
  3. Malignancy - 10-20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 3 causes of benign biliary stricture that can lead to cholangitis?

A
  1. Congenital
  2. Post-infectious
  3. Inflammatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 5 sources of malignancy which can contribute to he development of ascending cholangitis?

A
  1. Gallbladder
  2. Bile duct
  3. Ampulla
  4. Duodenum
  5. Pancreas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 5 investigations to perform in suspected ascending cholangitis?

A
  1. Full panel of bloods - LFTs, inflammatory markers
  2. US abdomen
  3. CT scan
  4. MRCP
  5. ERCP (therapeutic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is US abdomen useful for in ascending cholangitis and what are the limitations?

A

can detect bile duct dilatation but not very good at picking up stones in the mid-distal area of the biliary duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the advantages and limitations of using CT for ascending cholangitis?

A

good anatomical details of biliary tree and may visualise radiopaque stones, but poor at viewing radiolucent cholesterol stones which are the most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most accurate imaging modality to determine a diagnosis of ascending cholangitis?

A

MRCP - can view gallstones, strictures and can view almost all causes of biliary tree blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What will MRCP show in ascending cholangitis?

A

gallstones/strictures, can view almost all causes of biliary tree blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Within what time frame should ERCP be performed?

A

after 24-48h

17
Q

What are 6 aspects of management of ascending cholangitis?

A
  1. Fluid resuscitation
  2. Broad-spectrum intravenous antibiotics (local guidelines - likely to be AMG abx for abdo infection, amoxicillin, metronidazole, gentamicin)
  3. Endoscopic drainage - early ERCP
  4. Correct any coagulopathy (may have sepsis)
  5. Percutaneous drainage (percutaneous transhepatic cholangiography PTC) or surgical drainage
  6. Consider cholecystectomy if gallstones is cause
18
Q
A