Ascending Cholangitis

Question 1

What is ascending cholangitis?

Answer 1

Bacterial infection of the biliary tree

Question 2

What is present in 1/3 of patients?

Answer 2

Charcot’s triad:

(1) RUQ pain
(2) Fever
(3) Jaundice

Question 3

Other symptoms (not charcot’s triad)?

Answer 3

If sepsis severe:

• hypotension
• tachycardia
• confusion

Question 4

Causes?

Answer 4

(1) Calculi (50%) - painful
(2) Biliary stricture (20%) - congenital, post-infectious or inflammation (PCB, PSC?)
(3) Malignancy (10-20%) - gallbladder, bile duct, ampulla, pancreas (painful, palpable mass)

Question 5

Investigations?

Answer 5

(1) bloods - raised LFTs (ALP first), raised WCC + CRP
(2) imaging - US abdo, CT abdo
(3) MRCP - most accurate

Question 6

Management?

Answer 6

(1) Resus/ABCDE if sepsis/shock
(2) Drainage - biliary, ERCP, percutanous (PTC), surgical
(3) Manage predisposing factors:
- -> gallstones = cholecystectomy
- -> malignant stricture = further assessment

Question 7

Definitive management of ascending cholangitis?

Answer 7

ERCP