Gallbladder Disease - Ascending Cholangitis

Question 1

What is acute cholangitis?

Answer 1

A surgical emergency - infection and inflammation in the bile ducts - high mortality due to sepsis and septicaemia.

Question 2

Aetiology of Acute Cholangitis (2).

Answer 2

1. Obstruction in the bile ducts stopping bile flow i.e. gallstones in the common bile duct.
2. Infection introduced during an ERCP procedure.

Question 3

Causative Organisms of Acute Cholangitis (3).

Answer 3

1. E. coli.
2. Klebsiella species.
3. Enterococcus species.

Question 4

Clinical Presentation of Acute Cholangitis (2).

Answer 4

1. Charcot’s Triad : RUQ Pain, Fever, Jaundice (Raised Bilirubin).
2. Reynold’s Pentad : Charcot’s Triad + Hypotension + Confusion.

Question 5

Investigations of Acute Cholangitis.

Answer 5

Least to Most Sensitive :

1. Abdominal US Scan.
2. CT Scan.
3. MRCP.
4. Endoscopic US.

Question 6

Management of Acute Cholangitis.

Answer 6

1. Emergency Admission for Investigations and Management.
2. Acute Management - NBM, IV Fluids, Blood Cultures, IV Antibiotics.
3. ERCP Procedure (after 24-48 hours) to relieve any obstruction.

Question 7

What is PTC?

Answer 7

Percutaneous Transhepatic Cholangiogram - radiologically guided insertion of a drain through the skin and liver into the bile ducts to relieve immediate obstruction and place sent to give longer-lasting relief - if ERCP fails/is not suitable.