Acute cholangitis

definition?

a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract

Risk factors

- biliary calculi

- benign biliary stricture (congenital, post-infectious, or inflammatory)

- malignancy (gallbladder, bile duct, ampulla, duodenum, or pancrease)

- ERCP (esp following stent placement, or postoperatively due to bile duct injury or strictured biliary-enteric anastomosis)

- rare: extrinsic sompression of the duct, intrinsic causes (bloodcot, parasite)

อาการ

- fever, adominal pain, jaundice (Charcot's triad)

- + hypotension, mental status changes (Reynolds pentad) = severe (suppurative) cholangitis

 

- CBC

- electrolytes

- PT

- hemoculture

- bile or stent c/s

- imaging

 

Bile c/s when? indication

- acute cholecystitis gr II
- perforation
- emphysematous changes
- necrosis of gallbladder

 

Imagings: when Clinical triad

- + abnormal liver test: ERCP + biliary drainage

- all suspected: transabdominal USG ดู common bile duct dilatation or stones

- CT abdomen

- MRCP

- ERCP

- endoscopic USG ดู evidence of bile duct stones or obstruction

 

CT abdoment when?

- abdominal pain + suspected acute cholangitis + normal abdominal USG

 

MRCP when?

- transabdominal USG and CT abdomen normal

 

ERCP when?

- cannot undergo MRCP + conjugated hyperbilirubinemia

 

Endoscopic USG when?

- liver test normal

- pregnant

- high risk for complications from ERCP

Diagnosis

- suspected: either evidence of cholestasis or imaging

- definitie: all

 

Lab reference

Severity

Severity

Treatment

- supportive treatment

- ATB 4-7 days

- biliary drainage

- surgery

supportive treatment

- IV hydration

- correction of associated electrolyte disorder

- analgesics for pain control

- close monitor for organ dysfunction and septic shock

 

ATB

- low risk community-acquired infection

- High risk community-acquired infection

 

Duration of ATB

 

Biliary drainage

indication?

 

Surgery

indication?