INFECTIONS OF THE BILIARY TRACT Flashcards
What do we call infections of the biliary tract?
Cholangitis
Under normal circumstances, what prevents infection of the biliary tract?
The sphincter of Oddi, together with HCl of the gastric juices, prevents bacteria ascending the tract.
What are the causes of cholangitis?
Gallstones
Following cholecystectomy
Benign strictures
Post ERCP (especially after insertion of stent)
What are the clinical features of cholangitis?
Jaundice
Fever
Right upper quadrant pain
Septicaemic shock
What investigations should be ordered for someone with suspected cholangitis?
FBC LFTs CRP Blood cultures Ultrasound
What would FBC of someone suffering from cholangitis show?
Neutrophilia
What would the LFTs of someone suffering from cholangitis show?
Raised ALP
Raised bilirubin
Mild increase in ALT and AST
What might ultrasound reveal in someone with cholangitis?
Dilatation of the bile ducts.
How wide should the bile ducts be normally?
Less than 6mm
What is the organism most commonly responsible for cholangitis?
E. coli
What are the complications of cholangitis?
Suppurative cholangitis can be fatal that requires urgent drainage.
How are people with cholangitis treated?
High dose broad spectrum intravenous antibiotics and anaerobic organisms - ceftriaxone and metronidazole.
Removal of cause such as gallstones
