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Ascending cholangitis — MCCQE Part 1 MCQ

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HardJaundiceAscending cholangitisMCCQE Part 1

A 76-year-old man presents with fever, confusion and right upper-quadrant pain. He is jaundiced, blood pressure is 92/58 mmHg, bilirubin is 92 µmol/L, alkaline phosphatase is elevated, and ultrasound shows a dilated common bile duct. What is the most appropriate next step in management?

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Correct answer: A — Give intravenous antibiotics, resuscitate, and arrange urgent biliary drainage

Fever, jaundice, pain, hypotension and confusion indicate severe ascending cholangitis, requiring resuscitation, broad-spectrum antibiotics and urgent source control through biliary drainage. Outpatient imaging is unsafe in sepsis with obstruction. Cholecystectomy may follow after stabilisation, but drainage is the urgent intervention.

Reference: Tokyo Guidelines; Canadian Association of General Surgeons resources