Acute cholangitis

Question 1

define ascending cholangitis?

Answer 1

• infection of the bile duct.

Question 2

causes of ascending cholangitis?

Answer 2

o Obstruction of the gallbladder or bile duct due to stones
o ERCP
o Tumours (e.g. pancreatic, cholangiocarcinoma)
o Bile duct stricture or stenosis
o Parasitic infection (e.g. ascariasis)

Question 3

what is the epidemiology of ascending cholangitis?

Answer 3

• 9% of patients admitted to hospital with gallstone disease will have acute cholangitis
• Equal in males and females
• Median age of presentation: 50-60 yrs
• Common in caucasians

Question 4

what are the presenting symptoms of ascending cholangitis?

Answer 4

Charcots triad
o RUQ Pain
o Jaundice
o Fever with rigors

Reynolds pentad +
o Mental confusion
o Septic shock

Question 5

what are the signs of acute cholangitis on physical inspection?

Answer 5

• Fever
• RUQ tenderness
• Mild hepatomegaly
• Jaundice
• Mental status changes
• Sepsis
• Hypotension
• Tachycardia

Question 6

how do bloods often present for acute cholangitis?

Answer 6

o FBC: High WCC
o CRP/ESR: possibly raised
o LFTs: typical pattern of obstructive jaundice (raised ALP + GGT)
o U&Es: may be signs of renal dysfunction
o Blood cultures: check for sepsis
o Amylase: may be raised if the lower part of the common bile duct is involved

Question 7

what imaging might be undertaken for acute cholangitis?

Answer 7

o X-ray (kidneys, ureter, bladder): look for stones
o Abdominal ultrasound: look for stones and dilation of the common bile duct
o Contrast-enhanced CT/MRI: good for diagnosing cholangitis
o MRCP: may be necessary to detectnon-calcifiedstones