Ascending cholangitis: Difference between revisions
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**Compression by malignant disease | **Compression by malignant disease | ||
== | ==Clinical Features== | ||
*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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX RUQ}} | {{DDX RUQ}} | ||
==Diagnosis== | |||
*Labs | |||
**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 | |||
==Management== | ==Management== | ||
*Aggressive volume replacement | |||
*Broad-spectrum parenteral [[abx]] covering [[gram neg]], [[gram pos]], and [[anerobes]] | |||
**[[Piperacillin/tazobactam]] OR [[ampicillin-sulbactam]] OR ([[ceftriaxone]] + [[metronidazole]]) | |||
*Emergent ERCP | |||
== | ==References== | ||
==See Also== | ==See Also== | ||
[[Gallbladder Disease (Main)]] | *[[Gallbladder Disease (Main)]] | ||
[[Category:GI]] | [[Category:GI]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 04:51, 21 May 2015
Background
- Requires the presence of biliary obstruction and infected biliary tract
- Causes:
- Choledocholithiasis
- Biliary tract stricture
- Compression by malignant disease
Clinical Features
- 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
Differential Diagnosis
RUQ Pain
- Gallbladder disease
- Pancreatitis
- Acute hepatitis
- Pancreatitis
- GERD
- Appendicitis (retrocecal)
- Pyogenic liver abscess
- Bowel obstruction
- Cirrhosis
- Budd-Chiari syndrome
- GU
- Other
- Hepatomegaly due to CHF
- Peptic ulcer disease with or without perforation
- Pneumonia
- Herpes zoster
- Myocardial ischemia
- Pulmonary embolism
- Abdominal aortic aneurysm
Diagnosis
- 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
Management
- Aggressive volume replacement
- Broad-spectrum parenteral abx covering gram neg, gram pos, and anerobes
- Emergent ERCP