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  1. Cholangitis Ghadeer Ismail Eideh Supervised by Dr. Aref Rajabi From: step up to medicine
  2. 03 01 02 04 Outlines Introduction Clinical features Diagnosis Treatment
  3. Introduction 01
  4. INTRODUCTION • Infection of biliary tract secondary to obstruction, which leads to biliary stasis and bacterial overgrowth. • Choledocholithiasis accounts for 60% of cases. • Other causes include pancreatic and biliary neoplasm, postoperative strictures, invasive procedures such as ERCP or PTC, and choledochal cysts. • Cholangitis is potentially life threatening and requires emergency treatment.
  5. Clinical features 02
  6. RUQ pain This classic triad is present in only 50% to 70% of cases. Jaundice Charcot triad Fever
  7. Raynolds pentad = Septic shock Altered mental status Charcot traid Reynolds pentad is a highly toxic state that requires emergency treatment. It can be rapidly fatal.
  8. Diagnosis 03
  9. a. This is the definitive test, but it should not be performed during the acute phase of illness. Once cholangitis resolves, proceed with PTC or ERCP to identify the underlying problem and plan treatment. b. Perform PTC when the duct system is dilated (per ultrasound) and ERCP when the duct system is normal. RUQ ultrasound Is the initial study, very accurate in detecting gallstones and biliary tract dilatation, but not very accurate in detecting CBD stones. Laboratory findings Hyperbilirubinemia, leukocytosis, mild elevation in serum transaminases. Cholangiography (PTC or ERCP).
  10. Treatment 04
  11. Treatment 1. IV antibiotics and IV fluids a. Close monitoring of hemodynamics, BP, and urine output is important. b. Most patients respond rapidly. Once the patient has been afebrile for 48 hours, cholangiography (PTC or ERCP) can be performed for evaluation of the underlying condition. 2. Decompress CBD via PTC (catheter drainage); ERCP (sphincterotomy), or laparotomy (T-tube insertion) once the patient is stabilized, or emergently if the condition does not respond to antibiotics.
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  13. Carcinoma of the gallbladder
  14. • Most are adenocarcinomas and typically occur in the elderly. • Associated with gallstones in most cases; other risk factors include cholecystoenteric fistula and porcelain gallbladder (Figure 3-3). Carcinoma of gallbladder
  15. Carcinoma of gallbladder • Clinical features are nonspecific and suggest extrahepatic bile duct obstruction: jaundice, biliary colic, weight loss, anorexia, and RUQ mass. Palpable gallbladder is a sign of advanced disease. • Difficult to remove with surgery: cholecystectomy versus radical cholecystectomy (with wedge resection of liver and lymph node dissection) depending on depth of invasion. • Prognosis is dismal—more than 90% of patients die of advanced disease within 1 year of diagnosis. Disease often goes undetected until it is advanced.
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