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Acute Cholangitis — RACP Adult Medicine MCQ

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ModerateGastroenterology & HepatologyAcute CholangitisRACP Adult Medicine

A 42-year-old woman presents with acute right upper quadrant pain, fever, and jaundice. Her WCC is 18 × 10⁹/L and bilirubin is 95 µmol/L. Ultrasound shows a dilated CBD (12 mm) with a distal stone. What is the most appropriate management?

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Correct answer: B — IV antibiotics and urgent ERCP within 24 hours

Charcot's triad (right upper quadrant pain, fever, jaundice) indicates acute cholangitis. This is a biliary emergency requiring IV antibiotics (eTG recommends ampicillin + gentamicin or piperacillin-tazobactam) and urgent biliary drainage, typically via ERCP with sphincterotomy and stone extraction within 24 hours. Delayed intervention risks sepsis, hepatic abscess, and multiorgan failure. Reynolds' pentad (adding hypotension and confusion) indicates severe cholangitis requiring emergent intervention.

Reference: eTG – 2025 – Antibiotic Guidelines; Tokyo Guidelines – 2018 – Acute Cholangitis