Cholangitis

Cholangitis

Systemic infection of acute inflammation & infection of bile ducts resulting from combination of biliary obstruction and bacterial bile growth.

Symptoms:

Charcot’s triad Fever, Abdominal Pain, Jaundice RUQ Abd Pain, pyrexia

((bacteria biliary system to systemic - Reynolds pentad develops))

Reynolds Pentad. Fever, Abdominal pain, Jaundice + Confusion & Hypotension

Signs:

Pyrexia, tachycardia, possibly hypotension, jaundice and mild right upper quadrant tenderness.

Investigations

Blood tests: will show high LFT like obstructive jaundice with leukocytosis

Imaging: Ultrasound abdomen will show dilated extra-hepatic biliary system, possibly will show gallstone and the stone in the common bile duct.

Treatment

1. Admission to the hospital
2. Nothing given by mouth
3. Intravenous fluids infusion
4. Intravenous broad spectrum antibiotics
5. Analgesia
6. Endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction from the bile duct followed by laparoscopic cholecystectomy if the gallbladder containing stones.

Cholangio-venous and cholangio-lymphatic reflux Z

what is most important therapeutic intervention in this case Z Remove stone to alleviate pressure from reflux

Severity assessment of cholangitis according to Tokyo - Guidelines TG13 Y

Comprehensive algorithm for the treatment of cholangitis from the TG13 guidelines for diagnosis and severity grading of acute cholangitis Y

(Table) Which Antibiotics Z

Piperacillin - Tazobactam best for cholangitis Tazocin? - CC

Percutaneous Transhepatic cholangiogram (PTC)

Endoscopic retrograde cholangiopancreatography (ERCP)

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