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Gallstone pancreatitis with suspected cholangitis — RCPSC EM MCQ

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HardGI/Abdominal emergenciesGallstone pancreatitis with suspected cholangitisRCPSC EM

A patient with gallstones, fever, jaundice and hypotension has a dilated common bile duct and rising lactate. After cultures are drawn, what is the management priority?

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Correct answer: C — Begin IV resuscitation and antibiotics while arranging urgent ERCP drainage

The best answer is “Begin IV resuscitation and antibiotics while arranging urgent ERCP drainage”. This is severe ascending cholangitis with organ dysfunction. Resuscitation and broad IV antibiotics start immediately, while urgent biliary drainage provides essential source control. Repeating imaging, oral outpatient therapy and waiting for pancreatic markers delay treatment of infected obstruction; cholecystectomy does not decompress the common bile duct in this emergency.

Reference: Emergency Care BC: Ascending Cholangitis: https://emergencycarebc.ca/clinical_resource/clinical-summary/ascending-cholangitis/