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Ascending cholangitis — RCPSC EM MCQ

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ModerateGI/Abdominal emergenciesAscending cholangitisRCPSC EM

CTAS 2: A 74-year-old with gallstones has fever, jaundice and right upper-quadrant pain. Vitals are T 39.2°C, BP 92/58, HR 118. Labs show bilirubin 88 µmol/L, ALP 420 U/L and WBC 18. Ultrasound shows a dilated common bile duct. What is the most likely diagnosis?

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Correct answer: D — Ascending cholangitis

Charcot triad plus sepsis and biliary obstruction on ultrasound supports ascending cholangitis. Management is antibiotics, resuscitation and urgent biliary decompression.

Reference: Tokyo Guidelines for cholangitis; Canadian surgical emergency practice