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Z Year3 Conditions > GASTRO (acute cholangitis) > Flashcards

GASTRO (acute cholangitis) Flashcards

1
Q

what is acute cholangitis?

A

infection of biliary tree

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2
Q

what are risk factors for acute cholangitis?

A
  1. Age > 50 years
  2. Cholelithiasis
  3. Benign stricture
  4. Malignant stricture
  5. Post-procedure injury of bile ducts
  6. History of primary sclerosing cholangitis
  7. History of secondary sclerosing cholangitis
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3
Q

what is Charcot’s triad for acute cholangitis?

A
  1. RUQ pain
  2. Jaundice
  3. Fever
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4
Q

what are the symptoms and signs for acute cholangitis?

A
  1. Charcot’s triad
  2. RUQ tenderness
  3. Pale stool
  4. Pruritus
  5. Hypotension
  6. Mental state changes
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5
Q

what are differential diagnosis of acute cholangitis?

A
  1. Acute cholecystitis
  2. Peptic ulcer disease
  3. Acute pancreatitis
  4. Hepatic abscess
  5. Acute pyelonephritis
  6. Acute appendicitis
  7. Right lower lobe pneumonia
  8. HELLP syndrome of pre-eclampsia
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6
Q

what blood tests would you do for acute cholangitis?

A
  1. FBC
  2. Serum urea
  3. Serum creatinine
  4. ABG analysis
  5. Serum LFTs
  6. CRP
  7. Serum potassium
  8. Serum magnesium
  9. Blood cultures
  10. Coagulation panel
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7
Q

what would the fbc show in acute cholangitis?

A
  • high wbc

- plaetlet decrease

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8
Q

what would serum urea and creatinine show is acute cholangitis?

A

raised

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9
Q

what would the ABG analysis in acute cholangitis show?

A
  • raised lactate

- metabolic acidosis

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10
Q

what would serum LFTs be like in acute cholangitis?

A
  1. hyperbilirubinaemia

2. raised serum transaminases 3. raised alkaline phosphatase

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11
Q

what would CRP be like in acute cholangitis?

A

raised

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12
Q

what would serum potassium and magnesium be like in acute cholangitis?

A

decreased

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13
Q

what imaging do you do in acute cholangitis?

A
  1. transabdominal US

2. ERCP

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14
Q

What would the US show is acute cholangitis?

A
  • dilated bile duct

- common bile duct stones

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15
Q

what would the ERCP in acute cholangitis show?

A

bile duct stone or other obstruction

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16
Q

What is the criteria for acute cholangitis?

A

-A: systemic inflammation
-B: cholestasis
-C: Imaging: biliary dilation/aietology on imaging
Severity grade:
I-III

17
Q

What is the first line treatment for acute cholangitis?

A

IV antibiotics + intensive medical management

18
Q

what else is used in treatment of acute cholangitis?

A
  1. biliary decompression + drainage (non surgical – ERCP, PTC)
  2. Consider: opioid analgesia + paracetamol + lithotripsy
19
Q

what antibiotics are used in acute cholangitis?

A

piperacillin/tazobactam: 4.5 g intravenously every 8 hour

20
Q

What is the 2nd line treatment for acute cholangitis?

A
  1. Biliary decompression (surgical)
  2. IV antibiotics + intensive management
    - Consider: opioid analgesia + paracetamol
21
Q

What is the first line treatment for ongoing acute cholangitis with choledocholithiasis, PSC, or HIV cholangiopathy?

A

referral for follow-up medical/surgical care

22
Q

What are complications of acute cholangitis?

A
  • Sepsis with shock
  • Vascular collapse
  • Multi-organ failure
  • Death
  • acute pancreatitis
  • inadequate biliary drainage following performance of endoscopy, radiology, or surgery
  • hepatic abscess
23
Q

What is the prognosis of acute cholangitis?

A

quickly adequately dealt with good prognosis

24
Q

What is Renold’s pentad?

A

Charcot’s triad + shock and altered mental status

25
Q

What is the intial management?

A 
Clear fluids only. 
Analgesics, fluid 
resus, broad IV Abx 
\+
ERCP
26
Q

What is the defintivie management?

A

Elective lap chole

27
Q

What is the patho of cholangitis?

A

Ascending infection of bile ducts by E. Coli in stagnant bile

Z Year3 Conditions (13 decks)

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