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Ascending cholangitis — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAscending cholangitisRCPSC EM

A 71-year-old with gallstones presents with fever, jaundice, and right upper quadrant pain. BP is 88/46 mmHg, lactate is 4.1 mmol/L, bilirubin is 86 micromol/L, and ultrasound shows a dilated common bile duct. What is the most likely diagnosis?

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Correct answer: D — Ascending cholangitis with septic shock

Ascending cholangitis with septic shock is correct: the clues indicate Ascending cholangitis and this option addresses the immediate ED priority. The distractors delay care, target a less likely problem, or are unsafe in this physiology.

Reference: Canadian ED biliary sepsis practice; sepsis principles