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Ascending cholangitis — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAscending cholangitisRCPSC EM

A 64-year-old woman has fever, jaundice, right upper quadrant pain, confusion, and hypotension. Bilirubin is 86 µmol/L, ALP is elevated, lactate is 4.0 mmol/L, and ultrasound shows a dilated common bile duct with stones. What is the most appropriate initial management?

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Correct answer: B — IV fluids, broad-spectrum antibiotics, and urgent biliary drainage

Charcot triad with shock and confusion indicates severe ascending cholangitis. Initial ED care includes resuscitation and antibiotics, with urgent ERCP or biliary drainage for source control.

Reference: Tokyo Guidelines; Canadian emergency surgery practice