Cholangitis (Acute, PSC, PBC)

Question 1

What is acute cholangitis? Why does it occur?

Answer 1

refers to infection of the biliary tree characteristically resulting in pain, jaundice and fevers.

Acute cholangitis almost always occurs due to bacterial infection secondary to biliary obstruction. The terms acute and ascending cholangitis can be used interchangeably.

Question 2

What are the causes of acute cholangitis?

Answer 2

• Choledocholithiasis, stones in the bile duct, are the most common cause of acute cholangitis.
• Benign strictures leading to obstruction, may occur in the biliary tree for numerous reasons such as chronic pancreatitis, iatrogenic injury (eg. during cholecystectomy), radio/chemo-therapy, idiopathic.
• malignant strictures, including cholangiocarcinoma, pancreatic cancer and gallbladder cancer can cause cholangitis.
• Other causes include- Post-ERCP, blocked biliary stent, extrinsic compression, blood clots, parasites.

Question 3

What is the Charcoat’s triad and the Reynold’s Pentad?

Answer 3

Charcoat’s triad- fever, jaundice, RUQ pain

Reynold’s pentad- fever, jaundice, RUQ pain, confusion, shock

Question 4

What investigations would you do for cholangitis?

Answer 4

• US
• CT abdomen/pelvis
• MRCP
• ERCP
• Urine dip
• pregnancy test
• FBC
• U&Es
• LFTs
• CRP
• Amylase

Question 5

What is the management of cholangitis?

Answer 5

• Patients with an infected, obstructed biliary system require urgent drainage through ERCP or PTC (percutaneous transhepatic cholangiography)
• antibiotics- IV augmentin or tazocin, stat dose of aminoglycoside (gentamicin)
• IV fluids
• Analgesia

Question 6

What is primary biliary cholangitis?

Answer 6

Primary biliary cholangitis (PBC) is an autoimmune liver disorder. It causes autoimmune destruction of the small, intrahepatic bile ducts that leads to poor bile flow (i.e. cholestasis), progressive fibrosis, and eventually cirrhosis.