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Ascending cholangitis — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAscending cholangitisRCPSC EM

A 67-year-old man with gallstones presents CTAS 2 with fever, jaundice and right upper quadrant pain. BP is 92/58, HR is 124, bilirubin is 96 µmol/L, ALP is 420 U/L, and ultrasound shows a dilated common bile duct. What is the most appropriate next step?

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Correct answer: E — Give broad-spectrum antibiotics and arrange urgent biliary decompression

Charcot triad with shock physiology and ductal dilation indicates acute ascending cholangitis. Source control by ERCP or drainage and early antibiotics are essential.

Reference: CAEP sepsis guidance; Emergency Care BC sepsis guideline