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Ascending cholangitis — ABEM Board MCQ

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ModerateGI/Abdominal emergenciesAscending cholangitisABEM Board

A 63-year-old woman arrives with fever, jaundice, and right upper quadrant pain. Triage acuity is ESI 2; BP 88/50 mm Hg, HR 126/min, T 103.4 F. She is confused and has scleral icterus. Labs show leukocytosis and elevated bilirubin. Which of the following is the most appropriate next step in management?

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Correct answer: A — Give broad-spectrum IV antibiotics and arrange urgent biliary decompression

Charcot triad with shock and confusion indicates severe ascending cholangitis requiring antibiotics, resuscitation, and urgent drainage.

Reference: Tokyo Guidelines for acute cholangitis