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Acute cholangitis — SCE Acute Medicine MCQ

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ModerateAcute GI PresentationsAcute cholangitisSCE Acute Medicine

A 72-year-old woman is assessed on the acute medical unit. She has fever, jaundice and right upper quadrant pain. Blood pressure is 90/52 mmHg and bilirubin and alkaline phosphatase are raised. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Give intravenous antibiotics and arrange urgent biliary drainage

Give intravenous antibiotics and arrange urgent biliary drainage is the best answer because Charcot triad with sepsis suggests cholangitis requiring antibiotics and source control by biliary drainage. Give intravenous lorazepam and protect the airway is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Definitive source control is essential when obstruction is present.

Reference: Tokyo Guidelines; NICE CKS gallstones