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Acute cholangitis — ACEM Fellowship MCQ

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HardGI/Abdominal emergenciesAcute cholangitisACEM Fellowship

A 69-year-old woman presents to a Melbourne ED, triage category 2, with fever, jaundice and right upper quadrant pain. BP 88/54, HR 124, bilirubin 96 micromol/L, ALP 480 U/L and lactate 4.2. Ultrasound shows dilated common bile duct with a distal stone. What is the most appropriate management?

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Correct answer: E — IV antibiotics, resuscitation and urgent biliary drainage

Charcot triad with shock, lactate elevation and obstructed CBD is severe cholangitis requiring antibiotics, resuscitation and drainage.

Reference: eTG biliary sepsis; ACEM gastrointestinal curriculum