Recurrent pyogenic cholangitis

Question 1

What is recurrent pyogenic cholangitis charaterised by?

Answer 1

• recurrent bacterial cholangitis
• intrahepatic pigmen stones
• intrahepatic obstruction

Question 2

What is the pathophysiology of pyogenic cholangitis?

Answer 2

• helminthic infection

- malnutrition

Question 3

What does the history of such a patient look like?

Answer 3

• history of recurrent cholangitis
• 1-2 episodes of fevers, RUQ pain, and jaundice
• history of previous biliary surgery, endoscopic procedures

Question 4

What are the complications of pyogenic cholangitis?

Answer 4

• cholangiocarcinoma

- cirrhosis with portal hypertension

Question 5

What bloods would you need to do for this patient?

Answer 5

-FBC and ALP
-AST AND ALT
-Blood culture
-

Question 6

What imaging do we need to do in these patients?

Answer 6

• Ultrasound
• ERCP or PTC
• CT scan

Question 7

What treatment can we do for these patients?

Answer 7

-biliary drainage
-treat the cause
surgical:
-biliary compression(ERCP)
-Death occurs in 15-20%

Question 8

What is cholangiocarcinoma?

Answer 8

carcinoma of the bile duct

Question 9

Where is the carcinoma usually located?

Answer 9

• intrahepatic(in the hilum)-65%
• distal-25%
• intrahepatic-10%

Question 10

What is the bismuth classification?

Answer 10

-It is the grading for carcinoma of the bile duct
grade 1-below to confluence of the hepatic ducts
grade 2-tumour reaching the confluence
grade 3A/B- tumour involving the common hepatic duct and the right and left hepatic ducts
grade 4:multicentric involving the confluence and both hepatic ducts

Question 11

How does it usually present?

Answer 11

-painless jaundice, pruritis, acholic stools
-if severe:
abdominal pain, weight loss,fatigue, abdominal pain

Question 12

How do we diagnose cholangiocarcinoma?

Answer 12

1. ultrasound which detects biliary distension but not the ducts
2. PTC
3. ERCP

Question 13

How do we treat cholangiocarcinoma?

Answer 13

1. By surgery and liver transplant

. chemo and radiation

Question 14

What are the contra-indications for surgery?

Answer 14

• distant mets
• bilateral or intrahepatic disease
• invasion of portal vein trunk or hepatic artery