Cholangitis

Question 1

What is cholangitis?

Answer 1

• Infection of biliary tract
• Caused by biliary outflow obstruction and biliary infection
• Stasis of fluid = bacterial colonisation of biliary tree

Question 2

Causes of cholangitis

Answer 2

• Gallstones
• ERCP
• Cholangiocarcinoma
• Rarer - pancreatitis, PSC, ischaemic cholangiopathy, parasitic infection

Question 3

Common organisms involved in cholangitis

Answer 3

• Escherichia coli
• Klebsiella species
• Enterococcus

Question 4

Presentation of cholangitis

Answer 4

Triad:
* RUQ
* Fever
* Jaundice
* May also complain of itching due to bile accumulation, pale stool with dark urine due to obstructive jaundice

Question 5

Eponymous syndromes associated with cholangitis

Answer 5

• Charcots triad - RUQ pain, jaundice, fever
• Reynolds Pentad - jaundice, fever, RUQ pain, hypotension, confusion

Question 6

Lab tests for cholangitis

Answer 6

• Routine bloods - FBC leucocytosis and LFTs - raised ALP +/- GGT
• Blood cultures

Question 7

Imaging for cholangitis

Answer 7

• USS biliary tract –> bile duct dilation
• GOLD STANDARD - ERCP as is diagnostic and therapeutic
• Some may need MRCP before doing ERCP

Endoscopic retrograde cholangiopancreatography

Question 8

Management cholangitis - immediate

Answer 8

• If septic –> SEPSIS 6
• Abx inc co-amoxiclav +/- metronidazole but follow guidelines

Question 9

Definitive management cholangitis

Answer 9

• Endoscopic biliary tree decompression
• ERCP +/- sphincterotomy and stenting
• If too unwell for ERCP - PTC may be done (percutaneous transhepatic cholangiography)
• Long term may need cholecystectomy

Question 10

Complications of ERCP

Answer 10

• Repeated cholangitis
• Pancreatitis
• Bleeding - more common if sphincterotomy
• Perforation