Assessment of Ascending cholangitis: Video, Anatomy & Definition | Osmosis

Question

A 55-year-old woman is brought to the emergency department due to progressive upper abdominal pain and fever for the past 2 days. She states she has felt persistently nauseous over this time period and has vomited 5 times. Medical history is noncontributory. Temperature is 38.6°C (101.4°F), pulse is 80/min, and blood pressure is 135/85 mmHg. Examination reveals a patient in acute distress. Physical examination reveals yellow discoloration of the sclera. The abdomen is tender to palpation in the right upper quadrant. There is no rebound tenderness. No hepatomegaly is observed. Laboratory studies show the following:

Laboratory value	Result
Hemoglobin	14 g/dL
Leukocyte count	17,000 mm³
Platelet count	240,000 mm³
Mean corpuscular volume	87 μm³
Serum
Creatinine	0.8 g/dL
BUN	12 mg/dL
Bilirubin
Total	3.8 mg/dL
Direct	2.5 mg/dL
Alanine aminotransferase	190 U/L
Aspartate aminotransferase	210 U/L
Amylase	57 U/L
Lipase	65 U/L
Alkaline phosphatase	412 U/L

Abdominal ultrasound shows dilation of the intra- and extrahepatic ducts. IV fluids and antibiotics are administered. Six hours later, the patient becomes disoriented. Temperature is 38.6°C (101.4°F), pulse is 101/min, and blood pressure is 95/60 mmHg. Which of the following is the most likely cause of this patient’s presentation?

Accepted Answer

Bacteria infiltrating into the biliary system&#160;

Answer

Biliary leak

Answer

Obstruction of the cystic duct

Answer

Gallstone obstructing the pancreatic duct

Answer

Inflammation of the gallbladder without obstruction

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Ascending cholangitis

Pathology

Gastrointestinal system