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Acute cholangitis

  • Inflammation of the bile duct system, typically caused by bacterial infection and often associated with bile duct obstruction.
  • Obstruction: Most commonly due to gallstones. Other causes include strictures, tumours, and parasitic infections.
  • Organisms: E. coli, Klebsiella, Enterococcus, and other enteric bacteria are the predominant pathogens.
Clinical Features (Charcot’s Triad)
  • Fever and chills.
  • Jaundice.
  • Right upper quadrant (RUQ) pain.
  • Reynold’s Pentad (Seen in severe cases): Includes the above three, plus hypotension and altered mental status.
  • Bloods: Raised white cell count (leukocytosis), elevated bilirubin, elevated alkaline phosphatase, and elevated liver transaminases.
  • Imaging: Ultrasound of the abdomen is the first-line imaging test. It assesses for gallstones, dilated bile ducts, and other causes of obstruction.
  • Magnetic resonance cholangiopancreatography (MRCP): Non-invasive imaging technique used to visualise the biliary and pancreatic ducts.
  • Endoscopic retrograde cholangiopancreatography (ERCP): Diagnostic and therapeutic procedure which can also be used to relieve obstruction.
  • Antibiotics: Broad-spectrum initially, tailored to culture results when available.
  • Biliary drainage: Often via ERCP, especially if there’s complete obstruction or patient doesn’t respond to antibiotics alone.
  • Supportive care: Hydration, pain management, etc.
  • Cholecystectomy: Might be needed if gallstones are the primary cause.
  • Septic shock.
  • Multiple organ failure.
  • Abscess formation.
  • Recurrent cholangitis.

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