An 82 year old female presents with severe sepsis
- 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)