Acute Cholangitis

Question 1

What is it?

Answer 1

Bacterial infection of the biliary tree

Often caused by E.Coli

Question 2

What are the causes?

Answer 2

Gallstones= most common
Strictures
Tumours

Question 3

What are the clinical features?

Answer 3

Charcot Triad
- Fever
- RUQ pain
- jaundice

Reynold’s Pentad
- Charcot PLUS
- hypotension
- altered mental status

Lethargy
Pale stools
Dark urine

Question 4

What investigations are required?

Answer 4

Bloods
-elevated LFTs
- elevated bilirubin
- elevated inflammatory markers

Imaging
1) US- dilated common bile duct
2) Consider CT or MRI if cholangitis not clear

Question 5

What is the management?

Answer 5

Immediate
- IV fluids
- IV abx e.g. ceftriaxone and metronidazole

ERCP or PTC to relieve obstruction
Cholecystectomy can be planned later

Question 6

What are the complications?

Answer 6

Septic shock- high mortality if left untreated
Liver abscess