Ascending cholangitis: Difference between revisions
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#Aggressive volume replacement | #Aggressive volume replacement | ||
#Broad-spectrum parenteral abx covering gram neg, gram pos, and anerobes | #Broad-spectrum parenteral abx covering gram neg, gram pos, and anerobes | ||
##Piperacillin/tazobactam OR ampicillin-sulbactam OR ( | ##Piperacillin/tazobactam OR ampicillin-sulbactam OR ([[ceftriaxone]] + metronidazole) | ||
#Emergent ERCP | #Emergent ERCP | ||
Revision as of 06:12, 27 February 2014
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 (ceftriaxone + metronidazole)
- Emergent ERCP
Source
- UpToDate
- Tintinalli