195. Biliary Off Track - An Approach to Cholecystitis and Cholangitis
May 21, 2023
15:30
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Quick takeaways
Charcot's triad for cholangitis includes fever, right upper quadrant pain, and jaundice, which surgeons expanded to include altered mental state and shock forming Reynolds-Pentad.
Diagnosing acute cholecystitis and cholangitis involves considering history, physical exam findings, laboratory, and imaging results for appropriate management interventions.
Deep dives
Evolution of Charcot's Triad to Reynolds-Pentad
Originally described by Dr. Charcot in the 1880s, Charcot's triad for cholangitis consisted of fever, right upper quadrant pain, and jaundice. Surgeons expanded this triad with altered mental state and shock, forming Reynolds-Pentad. Tokyo guidelines now provide diagnostic criteria for gallstone diseases, including acute cholecystitis and cholangitis.
Pathophysiology of Gallstone Diseases
Gallstones in gallbladder or biliary tree cause inflammation in acute cholecystitis and life-threatening cholangitis if a stone obstructs the common bile duct. Infections can lead to bacteremia and septic shock. E. coli, Klebsiella species, and other pathogens are commonly isolated in these conditions.
Assessment and Management of Cholecystitis and Cholangitis
Diagnosing acute cholecystitis and cholangitis involves considering history, physical exam findings, laboratory, and imaging results. Initial management includes stabilizing the patient, fluid resuscitation, antibiotic therapy, and determining the appropriate timing for surgical or endoscopic interventions to relieve obstruction or drain gallbladder contents.
In this episode, we discuss the clinical presentation, severity grading, investigations and management for patients presenting with cholecystitis or cholangitis. Our medicine minute discusses a promising new technique for patients with non-operative cholecystitis.
Podcast written by: Drs. Amine Zoughlami and Ikram Abow-Mohamed (Internal Medicine residents) Reviewed by: Dr. Constantine Soulellis (Gastroenterology) and Dr. Sanabelle Zaabat (Internal Medicine) Sound editing by: Alison lai