Ascending cholangitis
26,247views
00:00 / 00:00
High Yield Notes
13 pages
Flashcards
Ascending cholangitis
of complete
Questions
USMLE® Step 1 style questions USMLE
of complete
| 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?
Memory Anchors and Partner Content
External References
First Aid
2024
2023
2022
2021
Ascending cholangitis p. 404
Transcript
Content Reviewers
Contributors
With ascending cholangitis, “cholang-” refers to the bile ducts and “-itis” refers to inflammation which is usually caused by a bacterial infection.
These bacteria are normally found in the intestines and work their way up the bile ducts from the duodenum of the small intestine, so that’s why it’s known as ascending cholangitis, also sometimes acute cholangitis because it can happen over a relatively short period of time.
Normally bacteria from the gut has a pretty tough time ascending up the bile ducts, and this is because bile flows down from the gallbladder, along with some pancreatic juice from the pancreas, into the duodenum, and this tends to flush out any bacteria trying to sneak their way up.
In ascending cholangitis this flow of bile is often blocked, and one common reason is choledocholithiasis, which refers to gallstones in the common bile duct.
In choledocholithiasis, gallstones form in the gallbladder and occasionally slip out, travel through the cystic bile duct, and then lodge into the common bile duct, obstructing the normal flow of bile.
These gallstones are typically made up of bile components, and risk factors for developing them include things like female sex, obesity, pregnancy, and age, sometimes remembered by the 4 F’s—female, fat, fertile, and forty. Other, less common causes include things that cause stricture, or narrowing of the bile ducts—like a nearby cancerous growth, which can compress the duct as the tumor slowly enlarges, or injury experienced during a laparoscopic procedure.
Once the flow of bile is blocked, bacteria can slowly make their way up the ducts and colonize the biliary system without the risk of being washed away.
Most commonly the bacterial species involved are a mixture of enteric organisms including common ones like E coli, Klebsiella species, and Enterococcus species.
These bacteria can migrate up to the blockage and continue to infect the stagnant bile as well as the surrounding tissue.
Also, since the bile duct is under high pressures from the obstruction, it can cause the spaces between the cells lining the ducts to widen, which allows the bacteria and the bile direct access to the bloodstream.