QuestionSBA
QuestionChoice
The patient has a complication of gallstone disease, ascending cholangitis. While a cholecystectomy will eventually be required, this will not definitively manage the CURRENT issue. Laparoscopic cholecystectomy is usually preferred over the open approach. The obstructing, infected area needs to be decompressed by ERCP.
10034866
e
Open cholecystectomy
QuestionChoice
This patient has ascending cholangitis and presents with the typical triad of jaundice, fever, and right upper quadrant pain. Antibiotics and fluids will be administered as supportive therapy, but this will not definitively control the source of the infection. An ERCP is required so that the biliary tree can be visualised, and the obstructing stone can be removed, relieving the obstruction and controlling the source of the infection.
10034864
c
Antibiotics and fluids
QuestionChoice
This patient has ascending cholangitis and presents with the typical triad of jaundice (high bilirubin), fever, and right upper quadrant pain. She also has obstructive-pattern liver enzyme derangements. An ERCP is required so that the biliary tree can be visualised, and the obstructing stone can be removed, relieving the obstruction and controlling the source of the infection.
10034862
a
Endoscopic retrograde cholangiopancreatography (ERCP)
QuestionChoice
The patient has a complication of gallstone disease, ascending cholangitis. While a cholecystectomy will eventually be required, this will not definitively manage the CURRENT issue. The obstructing, infected area needs to be decompressed by ERCP.
10034865
d
Laparoscopic cholecystectomy
QuestionChoice
This patient has ascending cholangitis and presents with the typical triad of jaundice (high bilirubin), fever, and right upper quadrant pain. A PTC is a way of assessing the biliary tree, however, an ERCP is less invasive and allows better access for decompression of the infected area and removal of stones.
10034863
b
Percutaneous transhepatic cholangiography (PTC)
QuestionComment
You can have high bili but not have jaundice - is this still cholangitis?!

52502
QuestionComment
think is something of a question error; tend to get jaundice once bilirubin reaches around 50
53455
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DB
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passmed user 1 
QuestionComment
how would i differentiate between this and cholecystitis??

60060
QuestionComment
Raised bilirubin + confusion and hypotension; only in asc cholangitis
60574
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batman
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Fungal Metabolism
Concept
Chapter
2693
6096
Ascending cholangitis
Topic
135
General surgery
19376
Emergency endoscopic retrograde cholangiopancreatography (within 24 hours) is needed for adults with common bile duct stones and acute cholangitis or acute pancreatitis when indicated
A 64-year-old lady is admitted to the hospital with severe abdominal pain and rigors. She is confused and is unable to elaborate on her history. On examination, she is exquisitely tender in the right upper quadrant.


Observations:

 * Heart rate: 112 beats/minute

 * Blood pressure: 102/69 mmHg

 * Respiratory rate: 17 breaths/minute

 * Temperature: 38.7 degrees

 * Oxygen saturations (room air): 98%


Bloods:


||||
|--------------|:-------:|---------------|
|Haemoglobin|121    g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|21x10<sup>9</sup>/L|3.0 - 10.0|
|Mean Cell Volume (MCV)|77.1 fL|80 - 96|
|Creatinine|100 µmol/L|60 - 120|
|Alanine Aminotransferase (ALT)|61 IU/L|10 - 50|
|Aspartate Aminotransferase (AST)|64 IU/L|10 - 40|
|Alkaline Phosphatase (ALP)|428 IU/L|25 - 115|
|Bilirubin|87 µmol/L|< 17|


Which of the following is the definitive management of her acute presentation?
a