Surgery Definition – What is ascending cholangitis?
Surgery Definition – What is ascending cholangitis?
Ascending cholangitis is a form of severe infection which complicates the distal common bile duct obstruction that spread proximally. The severe infection is caused by gram negative bacilli such as E. coli, Enterobacter, Serratia, Proteus and Klebsiella. Ascending cholangitis is associated with Charcot’s triad which consists of fever with rigors, jaundice and right upper quadrant pain. In severe cases, there will be sepsis and alteration of the central nervous system status which lead to Reynold’s pentad.
The investigation needed in ascending cholangitis may include, full blood count which reveal raise in white blood count, urea and electrolytes for vomiting which result in electrolytes disturbance, liver function test where raise in ALP may occur in biliary tree disease and raise in bilirubin due to obstructive jaundice and blood culture is needed to rule out sepsis. Ultrasound scan is also considered.
The treatment may focus on emergency surgical approach to avoid any endotoxin shock which consists of admission to the ward, nil by mouth, intravenous fluid to correct any electrolytes imbalance, intravenous antibiotic such as gentamicin cefuroxime and metronidazole and opioids. Emergency ERCP is considered with extraction of the stone.
The complication of ascending cholangitis may include endotoxic shock and suppurative cholangitis or pus in the biliary tree. Suppurative cholangitis is an indication for operation where laparotomy with T tube insertion is considered to drain pus which is performed if ERCP and PTC drainage is not working very well.
Ascending cholangitis is a form of severe infection which complicates the distal common bile duct obstruction that spread proximally. The severe infection is caused by gram negative bacilli such as E. coli, Enterobacter, Serratia, Proteus and Klebsiella. Ascending cholangitis is associated with Charcot’s triad which consists of fever with rigors, jaundice and right upper quadrant pain. In severe cases, there will be sepsis and alteration of the central nervous system status which lead to Reynold’s pentad.
The investigation needed in ascending cholangitis may include, full blood count which reveal raise in white blood count, urea and electrolytes for vomiting which result in electrolytes disturbance, liver function test where raise in ALP may occur in biliary tree disease and raise in bilirubin due to obstructive jaundice and blood culture is needed to rule out sepsis. Ultrasound scan is also considered.
The treatment may focus on emergency surgical approach to avoid any endotoxin shock which consists of admission to the ward, nil by mouth, intravenous fluid to correct any electrolytes imbalance, intravenous antibiotic such as gentamicin cefuroxime and metronidazole and opioids. Emergency ERCP is considered with extraction of the stone.
The complication of ascending cholangitis may include endotoxic shock and suppurative cholangitis or pus in the biliary tree. Suppurative cholangitis is an indication for operation where laparotomy with T tube insertion is considered to drain pus which is performed if ERCP and PTC drainage is not working very well.