ACUTE CHOLANGITIS

Question 1

what is acute cholangitis and what can it be caused by

Answer 1

infection of biliary tree caused by choledocholithiasis and benign/ malignant strictures

Question 2

What are the key diagnostic factors ?

Answer 2

CHARCOTS TRIAD-
RUQ pain
fever
jaundice

-RUQ tenderness

Question 3

What are other diagnostic factors

Answer 3

pale stools – due to lack of bile secretion
pruritis
hypotension and confusion and charcots triad =( REYNOLDS PENTAD)

Question 4

What are risk factors ?

Answer 4

over 50 years old
history of cholelithiasis , primary or secondary sclerosing cholangitis , stricture of biliary tree , post procedure injury of bile ducts

Question 5

what is the 1st line of investigation to order

Answer 5

ABDOMINAL ULTRASOUND

Erect CXR- to rule out perforation

FBC, CRP.LFTS

serum urea, creatinine, potassium and magnesium

Question 6

What are more investigations to order

Answer 6

Abdominal CT with contrast if ultrasound is negative

MRCP- if ultrasound and CT negative or difficult to obtain results from

Blood culture and ABG if suspecting sepsis

Question 7

What is the management in order

Answer 7

IV Abx and IV fluids

Draining of biliary tree is most critical step

URGENT ERCP after 24-48h - can be used for diagnosis and biliary stone extraction– perform ASAP in severe cases

Biliary decompression if deteriorating
consider lithotripsy

Question 8

If acute cholangitis is untreated what can this lead to

Answer 8

sepsis with shock
vascular collapse
multiorgan failure

Question 9

What are some complications of ERCP

Answer 9

pancreatitis
infection
aspiration pneumonia

Question 10

What can sphincterotomy cause

Answer 10

duodenal perforation and pneumonia