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Acute cholangitis — USMLE Step 2 CK MCQ

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HardSurgeryAcute cholangitisUSMLE Step 2 CK

A 74-year-old woman has fever, jaundice, right-upper-quadrant pain, bilirubin 6.2 mg/dL, and a dilated common bile duct containing a stone. After IV fluids and antibiotics, blood pressure normalizes and lactate falls. Which next intervention is most appropriate?

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Correct answer: E — Perform endoscopic biliary drainage within 48 hours during this admission

The best answer is “Perform endoscopic biliary drainage within 48 hours during this admission”. Antibiotics do not provide source control for obstructed infected bile. Once resuscitated, she should undergo prompt ERCP, generally within 48 hours, with drainage and stone management. Endoscopic drainage is preferred when feasible. Clinical improvement does not justify outpatient delay, while open or percutaneous approaches are reserved for selected failures or anatomic constraints.

Reference: ASGE Guideline on Management of Cholangitis: https://www.asge.org/home/resources/publications/guidelines/asge-guideline-on-the-management-of-cholangitis