GASTRO (acute cholangitis) Flashcards
what is acute cholangitis?
infection of biliary tree
what are risk factors for acute cholangitis?
- Age > 50 years
- Cholelithiasis
- Benign stricture
- Malignant stricture
- Post-procedure injury of bile ducts
- History of primary sclerosing cholangitis
- History of secondary sclerosing cholangitis
what is Charcot’s triad for acute cholangitis?
- RUQ pain
- Jaundice
- Fever
what are the symptoms and signs for acute cholangitis?
- Charcot’s triad
- RUQ tenderness
- Pale stool
- Pruritus
- Hypotension
- Mental state changes
what are differential diagnosis of acute cholangitis?
- Acute cholecystitis
- Peptic ulcer disease
- Acute pancreatitis
- Hepatic abscess
- Acute pyelonephritis
- Acute appendicitis
- Right lower lobe pneumonia
- HELLP syndrome of pre-eclampsia
what blood tests would you do for acute cholangitis?
- FBC
- Serum urea
- Serum creatinine
- ABG analysis
- Serum LFTs
- CRP
- Serum potassium
- Serum magnesium
- Blood cultures
- Coagulation panel
what would the fbc show in acute cholangitis?
- high wbc
- plaetlet decrease
what would serum urea and creatinine show is acute cholangitis?
raised
what would the ABG analysis in acute cholangitis show?
- raised lactate
- metabolic acidosis
what would serum LFTs be like in acute cholangitis?
- hyperbilirubinaemia
2. raised serum transaminases 3. raised alkaline phosphatase
what would CRP be like in acute cholangitis?
raised
what would serum potassium and magnesium be like in acute cholangitis?
decreased
what imaging do you do in acute cholangitis?
- transabdominal US
2. ERCP
What would the US show is acute cholangitis?
- dilated bile duct
- common bile duct stones
what would the ERCP in acute cholangitis show?
bile duct stone or other obstruction
What is the criteria for acute cholangitis?
-A: systemic inflammation
-B: cholestasis
-C: Imaging: biliary dilation/aietology on imaging
Severity grade:
I-III
What is the first line treatment for acute cholangitis?
IV antibiotics + intensive medical management
what else is used in treatment of acute cholangitis?
- biliary decompression + drainage (non surgical – ERCP, PTC)
- Consider: opioid analgesia + paracetamol + lithotripsy
what antibiotics are used in acute cholangitis?
piperacillin/tazobactam: 4.5 g intravenously every 8 hour
What is the 2nd line treatment for acute cholangitis?
- Biliary decompression (surgical)
- IV antibiotics + intensive management
- Consider: opioid analgesia + paracetamol
What is the first line treatment for ongoing acute cholangitis with choledocholithiasis, PSC, or HIV cholangiopathy?
referral for follow-up medical/surgical care
What are complications of acute cholangitis?
- Sepsis with shock
- Vascular collapse
- Multi-organ failure
- Death
- acute pancreatitis
- inadequate biliary drainage following performance of endoscopy, radiology, or surgery
- hepatic abscess
What is the prognosis of acute cholangitis?
quickly adequately dealt with good prognosis
What is Renold’s pentad?
Charcot’s triad + shock and altered mental status
What is the intial management?
Clear fluids only. Analgesics, fluid resus, broad IV Abx \+ ERCP
What is the defintivie management?
Elective lap chole
What is the patho of cholangitis?
Ascending infection of bile ducts by E. Coli in stagnant bile
