OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• ascending cholangitis is a life threatening condition which requires immediate Rx and is suggested by presence of fever, RUQ pain and jaundice (Charcot's triad)
• hepatitis
• cirrhosis
• assessment of hepatic function
• neonatal jaundice

• if pain, fever and jaundice then Mx as per ascending cholangitis until proven otherwise
• if relatively well then
  • nil orally
  • iv fluids
  • FBE, U&E, LFT's, lipase, clotting
  • fluid balance chart
  • Rx coagulopathy with vitamin K
  • analgesia
  • admit under surgical unit
  • DVT prophylaxis

• consider alternative diagnoses
• refer to gastroenterology
• consider CT-IVC, MRCP or EUS but these are generally low yield in this scenario

• ERCP/sphincterotomy +/- cholecystectomy

• CT pancreatic protocol
• tumour markers (CEA, CA19.9)
• refer to upper GIT surgical meeting for discussion
• if suitable for operative Mx, consider pre-op drainage as below
• if not suitable for operative Mx then biliary drainage via either:
  • ERCP + metal stent
  • PTC

• requires further imaging:
  • if bilirubin < 30 then CT-IVC
  • if bilirubin > 30 then MCRP, or if no access to MRI then consider CTAP
  • if cholelithiasis detected Mx as above for cholelithiasis
  • if still no cholelithiasis detected then cholecystectomy may be indicated