Cholangitis

Question 1

What is cholangitis

Answer 1

Infection of the biliary tract associated with high mortality and morbidity if left untreated
It’s caused by bile outflow obstruction => stagnant bile => biliary infection

Question 2

What are the causes of Cholangitis

Answer 2

Gall stones 
ERCP
CC
PBC
Pancreatitis

Question 3

What are the most common infective species found in cholangitis

Answer 3

E-Coli
Klebsiella pneumoniae
Enterococcus

Question 4

What are the clinical features of cholangitis

Answer 4

RUQ pain, fever, Jaundice ( charcots triad )

Obstructive jaundice picture - pale stools, dark urine

Question 5

What are the differential diagnosis

Answer 5

Acute cholecystitis
Biliary colic
Pancreatitis

Question 6

How would you investigate cholangitis

Answer 6

Lab tests - FBC, LFT, blood cultures

Imaging - USS ( CBD is usually 6mm ), ERCP ( therapeutic also )

Question 7

What is the immediate management of cholangitis

Answer 7

IV access 
Fluid Resus 
Routine bloods 
Blood cultures 
Broad spec Abx

Question 8

What is the definitive treatment for cholangitis

Answer 8

ERCP+/- sphincterotomy/ stenting

percutaneous transhepatic cholangiography - injection of a dye - 2nd line for those who cannot tolerate the above

Cholecystectomy - if gall stones are the underlying cause

Question 9

What is the prognosis of those with cholangitis

Answer 9

Mortality => 5-10% in those given Abx

This is even higher if people have co-morbidities

Question 10

what is Reynolds Pentad

Answer 10

Jaundice, RUQ, Fever, hypotension and confusion