We discussed a case about an elderly woman w/ history of cholecystectomy, who presented with acute fevers and RUQ pain, found to have sepsis from E coli bacteremia due to acute cholangitis. A 1.6 x 0.9 cm stone obstructing the distal CBD was visualized on MRCP.

Diagnosis

• Tokyo 2018 guidelines (iPhone, MDCalc) can help with clinical diagnosis and assessing severity of disease

Treatment

• Supportive care (fluids, analgesia)
• Antibiotics: con’t for 4-5 days after source control
• Urgent (w/in 24 hrs) biliary drainage criteria
  • Mild-moderate severity that fails to respond to 24 hrs of initial tx
  • Evidence of severe cholangitis