Ascending cholangitis: Difference between revisions
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===Diagnosis | ==Background== | ||
# Charcot's Triad: Fever + jaundice + RUQ pain | *Requires the presence of biliary obstruction and infected biliary tract | ||
## Occurs in 50 | *Causes: | ||
# Reynold's Pentad: The triad + AMS + hypotension | **Choledocholithiasis | ||
## Hypotension may be the only presenting sign in elderly pts | **Biliary tract stricture | ||
# Labs | **Compression by malignant disease | ||
## Leukocytosis with neutrophil predominance | |||
## Elevated alk phos, conj. bilirubin | ==Diagnosis== | ||
## Blood culture is indicated | #Charcot's Triad: Fever + jaundice + RUQ pain | ||
# Imaging | ##Occurs in ~50% | ||
## [[Ultrasound: Gallbladder|RUQ Ultrasound]] | #Reynold's Pentad: The triad + AMS + hypotension | ||
### Dilatation of CBD ( > 6mm) and presence of choledocholithiasis | ##Occurs in <5% | ||
### May miss small CBD stones and in acute cases CBD may not have had time to dilate | ##Hypotension may be the only presenting sign in elderly pts | ||
# ERCP | #Labs | ||
## Should be obtained to confirm the diagnosis and to intervene | ##Leukocytosis with neutrophil predominance | ||
##Elevated alk phos, conj. bilirubin | |||
##Blood culture is indicated | |||
#Imaging | |||
##[[Ultrasound: Gallbladder|RUQ Ultrasound]] | |||
###Dilatation of CBD ( > 6mm) and presence of choledocholithiasis | |||
###May miss small CBD stones and in acute cases CBD may not have had time to dilate | |||
#ERCP | |||
##Should be obtained to confirm the diagnosis and to intervene | |||
==Treatment== | |||
#Aggressive volume replacement | |||
#Broad-spectrum parenteral Abx covering gram neg, gram pos, and anerobes | |||
##Piperacillin/tazobactam OR ampicillin-sulbactam OR CTX + metronidazole | |||
#Emergent ERCP or surgery | |||
==Source== | |||
*UpToDate | |||
*Tintinalli | |||
==See Also== | ==See Also== | ||
[[Gallbladder Disease (Main)]] | [[Gallbladder Disease (Main)]] | ||
Revision as of 04:29, 1 August 2011
Background
- Requires the presence of biliary obstruction and infected biliary tract
- Causes:
- Choledocholithiasis
- Biliary tract stricture
- Compression by malignant disease
Diagnosis
- Charcot's Triad: Fever + jaundice + RUQ pain
- Occurs in ~50%
- Reynold's Pentad: The triad + AMS + hypotension
- Occurs in <5%
- Hypotension may be the only presenting sign in elderly pts
- Labs
- Leukocytosis with neutrophil predominance
- Elevated alk phos, conj. bilirubin
- Blood culture is indicated
- Imaging
- RUQ Ultrasound
- Dilatation of CBD ( > 6mm) and presence of choledocholithiasis
- May miss small CBD stones and in acute cases CBD may not have had time to dilate
- RUQ Ultrasound
- ERCP
- Should be obtained to confirm the diagnosis and to intervene
Treatment
- Aggressive volume replacement
- Broad-spectrum parenteral Abx covering gram neg, gram pos, and anerobes
- Piperacillin/tazobactam OR ampicillin-sulbactam OR CTX + metronidazole
- Emergent ERCP or surgery
Source
- UpToDate
- Tintinalli