Gastro: Ascending Cholangitis: Free MSRA Podcast

 ⚕️ FREE MSRA PODCAST – Ascending Cholangitis🎧 A clear, high-yield breakdown of this acute biliary-tract infection from obstructed ducts – perfect for exam prep and real-life clinicalscenarios. 🧠 Key Learning Points📌 Definition•Acute bacterial infection & inflammation of the common bile duct(s) causedby biliary obstruction that allows gut flora to ascend.📌 Causes & Risk Factors•Gallstones (commonest)•Malignancy – cholangiocarcinoma, pancreatic or ampullary tumours•Benign strictures, primary sclerosing cholangitis•Post-operative or indwelling biliary stent / previous ERCP•Choledochal cyst, AIDS cholangiopathy•Parasitic worms (e.g. liver fluke, roundworm – endemic areas)Mnemonic – STONES Stones TTumour/stricture O Obstruction (cyst,parasite) N ‘No-flow’ afteriNstrumentation (ERCP/stent) E Existingsurgery/scar📌 Pathophysiology•Obstruction → stagnant bile → ↑ intraductal pressure•Enteric Gram-negative/anaerobic bacteria ascend from duodenum•Inflammatory cascade & endotoxaemia → sepsis ± multiorgan failure📌 Symptoms•Charcot’s triad: Fever – RUQ pain – Jaundice(FRJ)•Rigors/chills, nausea ± vomiting•Reynolds’ pentad (severe): FRJ + Hypotension +Altered mental statusMnemonic – FRJ ± Low BP, Confusion📌 Differential Diagnosis•Acute cholecystitis or biliary colic•Acute pancreatitis•Viral / drug-induced hepatitis•Peptic-ulcer perforation, appendicitis, diverticulitis•Pyelonephritis, sepsis of other source📌 Diagnosis•Bloods: ↑ WCC/CRP, cholestatic LFTs(↑ALP, GGT, conjugated bilirubin)•Imaging:–USS first-line (duct dilatation, stones)–MRCP for detailed anatomy–CT if USS inconclusive / suspect tumour–ERCP: diagnostic and therapeutic•Tokyo Guidelines: Charcot’s triad or (≥2 clinical features + raised inflammatorymarkers + imaging evidence) = definite AC.Quick memory tip: “Charcot’s FRJ? ➜ ERCP STAT”.📌 Management•ABCDE & Sepsis 6 – IV fluids, oxygen,lactate, cultures•Broad-spectrum IV antibiotics (cover Gram-ve + anaerobes, e.g.piperacillin-tazobactam ± metronidazole)•Urgent biliary drainage–ERCP within ≤ 24 h if severe (Reynolds /organ dysfunction)–PTBD / EUS-guided or surgery if ERCP unavailable/fails•ICU/HDU for grade III sepsis or shock•Definitive laparoscopic cholecystectomyonce recovered if gallstones were the cause•UK/NICE focus: early senior review, NEWS2 monitoring, timely source control📌 Complications•Septic shock & multiorgan failure•Liver abscess•Acute pancreatitis•Recurrent cholangitis → secondary biliary cirrhosis•Procedure-related: post-ERCP pancreatitis, bleeding, perforation📌 PrognosisMortality< 10 % with prompt antibiotics + drainage; rises steeply with delayedtreatment, advanced age, malignancy or organ failure at presentation. 📎 More MSRA Resources for AscendingCholangitis📝 Revision Notes: https://www.passthemsra.com/topic/ascending-cholangitis-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/ascending-cholangitis-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/ascending-cholangitis-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/ascending-cholangitis-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA#MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards#MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment#MSRAOnlineRevision #MSRARevisionWebsite #AscendingCholangitis