Ascending cholangitis Flashcards
What is ascending cholangitis?
An infection and inflammation of the bile ducts. It is a SURGICAL EMERGENCY (high mortality rate due to sepsis and septicaemia)
What are the 2 main causes of ascending cholangitis?
Obstruction in the bile ducts stopping bile flow (i.e. gallstones in the common bile duct)
Infection introduced during an ERCP procedure
What are the 3 most common organisms that cause ascending cholangitis?
Escherichia coli (E.Coli)
Klebsiella species
Enterococcus species
What is the name of the triad of symptoms that patients can present with in ascending cholangitis?
Charcot’s triad
It is comprised of:
-RUQ pain
-Fever
-Jaundice (raised bilirubin)
What are the immediate managements for a patient with ascending cholangitis? What do you need to give them and what tests should be ordered?
Make the patient Nil by mouth
IV fluids
Blood cultures
IV antibiotics (as per local guidelines)
Involvement of seniors and potentially HDU or ICU
What imaging techniques are used to diagnose common bile duct stones and cholangitis? List it from the LEAST to the MOST sensitive imaging.
-Abdominal ultrasound
-CT scan
-MRCP (magnetic resonance cholangio-pancreatography)
-Endoscopic ultrasound
ERCP is required to remove stones blocking the bile duct (if this is the cause).What procedures can be done during ERCP to remove it?
(More info on notion notes for this)
- Cholangio-pancreatography
2.Sphincterotomy
3.Stone removal
4.Ballooon dilatation
5.Biliary stenting
6.Biopsy
What is percutaneous transhepatic cholangiogram?
Percutaneous transhepatic cholangiogram (PTC) involves radiologically guided insertion of a drain through the skin and liver, into the bile ducts. The drain relieves the immediate obstruction. A stent can be inserted to give longer-lasting relief of obstruction. This is an option for patients that are less suitable for ERCP, or where ERCP has failed.
