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Ascending cholangitis — RCPSC EM MCQ

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ModerateGI/Abdominal emergenciesAscending cholangitisRCPSC EM

A 66-year-old man presents with fever, jaundice and confusion. Blood pressure is 86/48 mmHg, bilirubin is 74 µmol/L and alkaline phosphatase is elevated. Ultrasound shows gallstones and a dilated common bile duct. What is the most likely diagnosis?

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Correct answer: C — Acute ascending cholangitis

Fever, jaundice, hypotension and confusion with biliary obstruction indicate severe acute cholangitis. Resuscitation, broad-spectrum antibiotics and urgent biliary drainage are required.

Reference: Tokyo Guidelines; Canadian Association of General Surgeons principles