Acute Cholangitis

Question 1

Another name for acute cholangitis

Answer 1

ascending cholangitis

Question 2

Pathophysiology of acute cholangitis

Answer 2

1. Obstruction of biliary tract (mostly from gallstones)
2. Subsequent bacterial infection (spread up from duodenum, haematogenous from portal vein; E.coli most common)
3. Increased biliary duct pressure -> bacteria and toxins leak into blood stream
4. Systemic inflammatory response (SIRS)

Question 3

Clinical features of acute cholangitis

Answer 3

1. jaundice
2. fever
3. RUQ pain
4. hypotension
5. new confusion
6. tachycardia
7. tachypnoea

Question 4

Charcot’s triad

Answer 4

1. jaundice
2. fever
3. RUQ pain

present in acute cholangitis

Question 5

Reynolds pentad

Answer 5

1. jaundice
2. fever
3. RUQ pain
4. hypotension
5. new confusion

present in acute cholangitis

Question 6

Investigating acute cholangitis

Answer 6

Blood tests:
- raised ALP
- raised GGT

Imaging:
- ultrasound
- CT
- MRCP, ERCP

Question 7

Differentials for acute cholangitis

Answer 7

• bilary colic (RUQ pain)
• acute cholecystitis (RUQ pain, fever)
• acute pancreatitis

Question 8

Management of acute cholangitis

Answer 8

1. fluid resuscitation + sepsis 6
2. analgesia
3. biliary decompression (ERCP, surgery)