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Acute ascending cholangitis — SCE Acute Medicine MCQ

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ModerateGastroenterology and hepatologyAcute ascending cholangitisSCE Acute Medicine

A 69-year-old woman presents with fever, right upper quadrant pain and jaundice. BP is 86/50 mmHg after fluids, lactate is 4.2 mmol/L and bilirubin is 96 micromol/L. Ultrasound shows a dilated common bile duct with stones. What is the most appropriate next step in management?

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Correct answer: B — Give IV antibiotics and arrange urgent biliary drainage with ERCP

Charcot's triad with shock and ductal stones indicates severe acute cholangitis with sepsis. Management requires resuscitation, IV antibiotics and urgent source control by biliary drainage, usually ERCP. Delaying drainage risks ongoing septic shock despite antibiotics.

Reference: Tokyo Guidelines 2018; NICE NG253