The Internet Book of Critical Care Podcast IBCC Episode 44 - Community Acquired Biliary Sepsis
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Jul 11, 2019 This episode covers the importance of accurate diagnosis and imaging for community-acquired biliary sepsis and cholecystitis, discusses bacterial pathogens and antibiotic coverage, emphasizes the use of Piptaso and de-escalation in treatment, and explores the risks and considerations of performing ERCP for patients with biliary sepsis.
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Different Sepsis Risks Between Gallbladder Disorders
- Cholecystitis is often a contained, abscess-like infection limited to the gallbladder unless it perforates.
- Ascending cholangitis more readily spills bacteria into the bloodstream and causes rapid fulminant sepsis.
Recognize Typical Biliary Presentations
- Expect RUQ pain radiating to the shoulder, nausea, vomiting, anorexia, and fever in biliary infections.
- Look for jaundice and altered mentation particularly with ascending cholangitis.
E. Coli As The Prime Suspect
- Escherichia coli is the dominant pathogen in biliary infections and bacteremia.
- E. coli bacteremia without another source should trigger consideration of ascending cholangitis.