Cholangitis — ESEGH MCQ

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HardGastroenterologyCholangitisESEGH

A patient with acute cholangitis remains febrile, hypotensive and cholestatic despite antibiotics and adequate IV-fluid resuscitation. Imaging shows an obstructing common-bile-duct stone. What is the next definitive step?

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Correct answer: C — Emergency ERCP for biliary drainage within 24 hours

The best answer is “Emergency ERCP for biliary drainage within 24 hours”. Failure to respond to antibiotics and fluids in obstructive cholangitis is the NICE quality-standard indication for emergency ERCP. “Continue antibiotics alone for 7 days” is less appropriate because persistent obstruction prevents source control “Give high-dose PPI infusion” is less appropriate because acid suppression does not drain an infected biliary system “Arrange elective cholecystectomy before duct drainage” is less appropriate because urgent biliary decompression precedes later definitive gallbladder planning “defer until spontaneous stone passage despite shock” is less appropriate because ongoing organ dysfunction demands source control

Reference: NICE QS104 emergency ERCP: https://www.nice.org.uk/guidance/qs104/chapter/quality-statement-3-emergency-endoscopic-retrograde-cholangiopancreatography-within-24-hours