Cholangitis

Cholangitis

Charcot’s triad- fever, RUQ pain, jaundice

Reynold’s pentad- Charcot’s triad + shock + conscious loss

Diagnosis

A. Systemic inflammationA‐1. Fever and/or shaking chills
A‐2. Laboratory data: evidence of inflammatory response
B. CholestasisB‐1. Jaundice
B‐2. Laboratory data: abnormal liver function tests
C. ImagingC‐1. Biliary dilatation
C‐2. Evidence of the etiology on imaging (stricture, stone, stent etc.)
*Suspected diagnosis: one item in A + one item in either B or C
*Definite diagnosis: one item in A, one item in B and one item in C

Severity

Grade INot fulfilled criteria of grade II and III
Grade II1. Abnormal WBC count (>12,000/mm3, <4,000/mm3)
2. High fever (≥39°C)
3. Age (≥75 years old)
4. Hyperbilirubinemia (total bilirubin ≥5 mg/dl)
5. Hypoalbuminemia (<STDa×0.7)
*Present two of these
Grade III1. Cardiovascular dysfunction: hypotension requiring dopamine ≥5 μg/kgper min, or any dose of norepinephrine
2. Neurological dysfunction: disturbance of consciousness
3. Respiratory dysfunction: PaO2/FiO2 ratio <300
4. Renal dysfunction: oliguria, serum creatinine >2.0 mg/dl
5. Hepatic dysfunction: PT‐INR >1.5
6. Hematological dysfunction: platelet count <100,000/mm3
*Present one of these

Treatment- 

1.Antiobiotic(80%)- Ampicillin + gentamycin/levofloxacin +/- metronidazole

2.MRI/MRCP, endoscopic transpapillary biliary drainage → endoscopic nasobiliary drainage(ENBD), endoscopic biliary stenting(EBS)

3.Coagulopathy- biliary stenting

4.Surgically altered anatomy- Balloon enteroscopy‐assisted ERCP (BE‐ERCP)

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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