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Cholangitis, Emergency Medicine

Robert G. Buckley Reviewed 06/2017
 


Basics

Description

  • Partial or complete obstruction of the common bile duct owing to gallstones, tumor, cyst, or stricture

  • Increased intraluminal pressure in biliary tree

  • Bacterial multiplication results ...

Diagnosis

Signs and Symptoms

History

  • Charcot triad:

    • Classic presentation of fever and chills; right upper quadrant (RUQ) pain and jaundice found in only 50–70%

  • Addition of shock and altered mental status ...

Treatment

Pre-Hospital

Stabilize septic shock. 

Initial Stabilization/Therapy

  • Immediate IV fluid resuscitation for dehydration, hemodynamic compromise, and sepsis

  • 80% respond to IV antibiotics within 1st ...

Follow-Up

Disposition

Admission Criteria

  • All patients with acute cholangitis should be admitted with immediate surgical and gastroenterologic consultation.

  • Admit patients with signs of septic shock to th...

Pearls and Pitfalls

  • Aggressively fluid resuscitate patients.

  • Administer antibiotics.

  • Obtain GI and surgical consultations.

Additional Reading

  • Jackson  PG, Evans  SR. Biliary system. In: Townsend  CM Jr, ed. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: WB Saunders; 2012:1476–1514.

  • Kinney  TP. Management of asc...

Codes

ICD9

576.1 Cholangitis 

ICD10

K83.0 Cholangitis 

SNOMED

  • 82403002 Cholangitis (disorder)

  • 235917005 Sclerosing cholangitis (disorder)

  • 281388009 Human immunodeficiency virus HIV-related sclerosing cholang...

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