- see EMedicine.com for more details
- ascending cholangitis is sepsis of the biliary tree other than just the gallbladder, resulting from obstruction of the CBD, usually by a gallstone in the CBD (choledocholithiasis), or from extension of sepsis from cholecystitis, but may also occur in patients with primary sclerosing cholangitis / primary biliary cirrhosis
- it may occur after ERCP due to introduction of bacteria into the biliary tree which remains at least partially obstructed
- it is a life threatening condition which requires emergent Rx
- the advent of ERCP has reduced mortality from ~100% to 5-10%, although advanced age, co-morbidities, delay in decompression increase mortality to up to 40%
- it is usually differentiated clinically from cholecystitis by presence of either jaundice or imaging evidence of gas in the biliary tree or dilated CBD.
- also suspect cholangitis in older patients presenting with sepsis and mental status changes
- it should not be confused with primary sclerosing cholangitis which is a chronic liver disease that is thought to be due to an autoimmune mechanism.
- nor should it be confused with recurrent pyogenic cholangitis, sometimes referred to as Oriental cholangiohepatitis, which is endemic to Southeast Asia.
ED Mx of suspected ascending cholangitis
- nil orally
- iv access
- bloods for FBE, U&E, LFT's, lipase, clotting, blood culture
- iv fluid Rx as needed
- commence fluid balance chart
- notify gastroenterology team (for early ERCP) or surgical team ASAP
- commence iv antibiotics after ID approval:
- expedite diagnostic imaging if possible (eg. biliary USS) and relief of obstruction via ERCP or PTC
- correct any coagulopathy with vitamin K
- severe cases may warrant IDC
- disposition is usually best to a hospital where there are both ICU and ERCP services available.
- an infective suppurative thrombosis of the portal vein
- usual pathogens Bacteroides fragilis or E. coli
- presents as fever, jaundice, abnormal LFTs in patient with recent abdo sepsis
- CT scan may show:
- gas in the inferior mesenteric vein up to the splenic vein to the portal vein with surrounding fat stranding
- linear gas collections within the liver
cholangitis.txt · Last modified: 2018/12/23 08:58 by 127.0.0.1