Cholangitis medical therapy: Difference between revisions
Created page with "{{CMG}} {{Cholangitis}} ==Overview== 80% of patients with acute cholangitis will respond to conservative therapy and elective drainage. In 15-20%, the cholangitis will progr..." |
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==Overview== | ==Overview== | ||
80% of patients with acute cholangitis will respond to conservative therapy and elective drainage. | *80% of patients with acute cholangitis will respond to conservative therapy and elective drainage. | ||
*In 15-20%, the cholangitis will progress requiring emergent drainage. Markers for these people are persistent abdominal pain, hypotensive, fever >102, and confusion. | |||
Patients should be kept [[Nil per os|NPO]], given [[IVF]], broad spectrum ABX, [[Vitamin K]] and be drained. | Patients should be kept [[Nil per os|NPO]], given [[IVF]], broad spectrum ABX, [[Vitamin K]] and be drained. | ||
Choices for drainage are [[ERCP]] with stone removal and [[sphincterotomy]]/[[stent]] placement, surgically drainage or percutaneous drainage. Intra[[hepatic]] stones cannot be removed via ERCP and should be drained [[percutaneously]]. | |||
[[Clinical trial#Design|Randomized trial]]s comparing ERCP and [[surgery]] showed [[morbidity]] and [[mortality]] benefit for ERCP (4.7-10% versus 10-50%). A nasobiliary catheter can be placed if ERCP is impossible (<5%) either because of [[coagulopathy]] precluding sphincterotomy, too large a stone (>2cm) etc. Next step should be percutaneous drainage as a bridge to elective surgery since emergent surgery has an up to 40% mortality. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:21, 27 July 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
- 80% of patients with acute cholangitis will respond to conservative therapy and elective drainage.
- In 15-20%, the cholangitis will progress requiring emergent drainage. Markers for these people are persistent abdominal pain, hypotensive, fever >102, and confusion.
Patients should be kept NPO, given IVF, broad spectrum ABX, Vitamin K and be drained.
Choices for drainage are ERCP with stone removal and sphincterotomy/stent placement, surgically drainage or percutaneous drainage. Intrahepatic stones cannot be removed via ERCP and should be drained percutaneously.
Randomized trials comparing ERCP and surgery showed morbidity and mortality benefit for ERCP (4.7-10% versus 10-50%). A nasobiliary catheter can be placed if ERCP is impossible (<5%) either because of coagulopathy precluding sphincterotomy, too large a stone (>2cm) etc. Next step should be percutaneous drainage as a bridge to elective surgery since emergent surgery has an up to 40% mortality.