Lab Case 92 – Interpretation

An 82 year old female presents with severe sepsis

  1. 3 important features of the blood test:

Obstructive liver enzymes

Evidence of infection

Normal Lipase

2. Diagnosis: Ascending Colangitis

Patient has features of Reynold’s pentad – Fever, Jaundice, abdominal pain, hypotension and confusion (Charcot’s triad – fever, abdominal pain and jaundice)

3.   History:

History of gallstones

Recent ERCP

Recent Cholecystectomy

Previous Cholangitis

Immune compromise

4. Causes:

CBD stone

Malignancy – pancreatic, Cholangiocarcinoma, metastatic

Stricture

Post ERCP

other – Ascaris infection, AIDS, sclerosing cholangitis

5. Management:

Resuscitate patient – fluids, inotropes

Antibiotics – broad spectrum ie. Tazocin +/- Meropenem

Analgesia

Urgent gastroenterology referral for ERCP

ICU admission

6. Poor prognostic features:

Female sex

age>50

hypotension/ shock

Fever>38

WCC 17

(other – acute renal failure, low albumin, low platelets, sepsis, comorbidities, malignancy, WCC>12, smoking)

7. Organisms:

E Coli

Klebsiella

Enterococcus (bile culture)

Pseudomonas (blood culture)

 

 

 

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