Acute cholangitis

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.


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


  • 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

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