Cholangitis medical therapy: Difference between revisions
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Revision as of 03:23, 22 February 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Cholangitis Microchapters |
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Diagnosis |
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Treatment |
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Cholangitis medical therapy On the Web |
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American Roentgen Ray Society Images of Cholangitis medical therapy |
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Risk calculators and risk factors for Cholangitis medical therapy |
Medical Therapy
- 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.