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Ascending cholangitis — RCPSC EM MCQ

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ModerateGI/Abdominal emergenciesAscending cholangitisRCPSC EM

CTAS 2. A 63-year-old has fever, jaundice, and right upper quadrant pain. BP is 94/58 mmHg, HR 122, bilirubin is 86 µmol/L, and ultrasound shows common bile duct dilatation with gallstones. What is the most appropriate initial management?

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

Charcot triad with sepsis and duct dilatation indicates ascending cholangitis requiring antibiotics, resuscitation, and urgent biliary decompression.

Reference: Tokyo Guidelines for acute cholangitis; Canadian Association of Gastroenterology resources