Management Of Ascending Cholangitis
BYPROF GOUDA ELLABBAN
Investigation(1)
Lab Tests Imaging
1-Blood tests:
neutrophilia
Conjugated Bilirubin
Alkaline phosphatase
Cholestatic picture
2- Lab Studies
1-Blood culture
2-Biliary culture
3-Amylase/Lipase/Calcium
4- Hepatitis profile
Imaging:
Ultrasound:
Endoscopic retrograde Cholengeopancreatography(1):
Endoscopic retrograde Cholengeopancreatography(2)
Q: What is the best way to diagnose cholangitis?
ERCP
Percutaneous transhepatic cholangiogram
Narrowing of Common Bile
Duct
Magnetic resonance cholangiopancreatography :
Immediate Treatment
ABC
IV fluid
Antibiotics
Close observation
NPO
Nasogatric tube
Urine catheter
Surgical Treatment(1):
1-Common Bile Duct stone:1-ERCP/Sphincterectomy
2-Exploration
Surgical Treatment(2):
2-Traumatic
3-Ampullary /duodenal Ca
4-Cholangiocarcinoma
Excision and hepaticojejunestomy
Procedure Names:
1-Roux en Y hepaticojejunostomy
2-Whipples operation
3-Excision and hepaticojejunostomy
Preoperative Preparation:
1- Adequate Hydration
2-Urinary out put
3-Antibiotics
4-Vitamin K
Post Operative Complications:
1-Pancreatitis 2-Perforation3- Hemorrhage/sepsis 4-Biliary peritonitis
Prevention:
1-recognition of cholelithiasis
2-prophylactic Antibiotic before ERCP