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Ascending Cholangitis Management Guide

Ascending cholangitis is an inflammation of the bile duct caused by bacterial infection, often due to obstruction from gallstones, strictures, or malignancy. Key clinical features include Charcot’s triad (RUQ pain, fever, jaundice), and management involves resuscitation, antibiotics, and biliary drainage, with ERCP being the preferred method. Investigations include blood tests, imaging techniques like USS and CT, and potential early ERCP for high-risk patients.

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Mackenzie Boudreaux
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73 views1 page

Ascending Cholangitis Management Guide

Ascending cholangitis is an inflammation of the bile duct caused by bacterial infection, often due to obstruction from gallstones, strictures, or malignancy. Key clinical features include Charcot’s triad (RUQ pain, fever, jaundice), and management involves resuscitation, antibiotics, and biliary drainage, with ERCP being the preferred method. Investigations include blood tests, imaging techniques like USS and CT, and potential early ERCP for high-risk patients.

Uploaded by

Mackenzie Boudreaux
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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The ABCs of

Ascending Cholangitis 4. Investigations


UNDERSTANDING THE FACTS BEHIND Blood tests Imaging
FBC - raised WCC USS abdomen
1. Definition
Inflammatory markers - raised CRP Can detect bile duct dilation
Inflammation of the bile duct due to bacterial infection ascending
LFTs - obstructive jaundice pattern and bile duct stone
from the duodenum
Blood cultures CT abdomen w/ contrast
Obstruction of the CBD → biliary → infection
Amylase may be raised If high clinical suspicion but
Causes of obstruction
ERCP USS is -ve
Gallstones (50%)
Can be both diagnostic and therapeutic Good anatomical detail, may
Benign biliary stricture (20%)
Patients with high index of suspicion (full visualise radio-opaque stones
Malignancy (10-20%)
Charcot’s triad, abnormal LFT, history of biliary MRCP
disease, predisposing factors) can be High sensitivity and specificity,
2. Common causative organisms
considered for early ERCP for diagnosis and used when diagnosis unclear
Common causative organisms
therapy despite USS/CT
Escherichia coli (most common)
Klebsiella spp.
Enterobacter spp.
Enterococci
Streptococci

3. Key clinical features


5. Management
Charcot’s triad (Only 50-75% of patients have all three)
Resuscitation including fluids and IV broad spectrum antibiotics (coverage for anaerobes and gram -ve organisms)
RUQ pain
Depending on presence and severity of sepsis and shock, transfer to critical care may be required
Fever
Biliary drainage - timing depending on severity
Jaundice
Mild-moderate, responsive to antibiotics - within 24-48h
Hypotension
Severe, not responsive to antibiotics - urgent drainage within 24h
Altered mental status
ERCP is preferred method
where not possible, percutaneous or surgical drainage
Treatment of predisposing cause
Gallstones
Consider cholecystectomy following resolution
Benign stricture
Stenting or surgical repair
Malignant stenosis
May include medical Mx, stenting, surgery, drain placement etc

CREDITS
Content- James Koay; Design - Chia Yen Lek (SIGMUM 2021/2022)

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