Ascending cholangitis

Diagnosis

1. Charcot's Triad: Fever + jaundice + RUQ pain
   1. Occurs in 50-75%
2. Reynold's Pentad: The triad + AMS + hypotension
   1. Hypotension may be the only presenting sign in elderly pts
3. Labs
   1. Leukocytosis with neutrophil predominance
   2. Elevated alk phos, conj. bilirubin
   3. Blood culture is indicated
4. Imaging
   1. RUQ Ultrasound
      1. Dilatation of CBD ( > 6mm) and presence of choledocholithiasis
      2. May miss small CBD stones and in acute cases CBD may not have had time to dilate
5. ERCP
   1. Should be obtained to confirm the diagnosis and to intervene

Treatment

1. Broad-spectrum parenteral Abx covering gram - and anerobes
   1. CTX + metronidazole OR piperacillin/tazobactam (Zosyn) OR ampicillin-sulbactam (Unasyn)

See Also

Gallbladder Disease (Main)