Surg: Ascending Cholangitis: Free MSRA Podcast

🎧 MSRA Podcast: Ascending Cholangitis – The Biliary Emergency You Can’t Miss 🚨🧬Biliary obstruction + infection = a life-threatening emergency. In this high-yield episode, we simplify Ascending (Acute) Cholangitis for the MSRA — from diagnosis to drainage, Charcot’s Triad to Tokyo Guidelines.🧠 What You’ll Learn:✅ Definition:• Bacterial infection of the bile ducts, typically due to obstruction• Common causes: gallstones, strictures, tumours, ERCP complications✅ Pathophysiology:Obstruction → 2. Stasis → 3. Bacterial ascent → 4. Systemic infection✅ Key Mnemonics:• Charcot’s Triad = Fever, Jaundice, RUQ pain (FJR)• Reynolds’ Pentad = FJR + Hypotension + Altered mental state✅ Causes & Risks:• Gallstones = #1 cause• Others: biliary strictures, malignancy, post-ERCP• Risk ↑ with biliary stents, previous episodes, immunosuppression✅ Differentials:• Acute cholecystitis• Pancreatitis• Hepatitis, liver abscess• Pyelonephritis, mesenteric ischaemia, sepsis✅ Clinical Features:• Charcot’s Triad (~30–50%)• Reynolds’ Pentad (~5–7%, indicates severe case)• May also see pale stools, dark urine, pruritus✅ Diagnosis:Need ≥2 of the following:Clinical (fever, jaundice, RUQ pain)Lab (↑ WCC/CRP, deranged LFTs)Imaging (biliary dilation or stones)✅ Imaging:• Ultrasound = first-line• MRCP = non-invasive, detailed• ERCP = gold standard (diagnostic + therapeutic)💉 Management (Emergency!):Stabilise: IV fluids, oxygen, sepsis protocolAntibiotics: Broad-spectrum (e.g. piperacillin–tazobactam)Drainage: • ERCP preferred • Percutaneous if ERCP not feasibleDefinitive treatment: • Cholecystectomy (gallstones) • Surgery (tumour/stricture)🧮 Severity – Tokyo Guidelines:• Grade I (mild): IV abx, outpatient ERCP• Grade II (mod): Early drainage• Grade III (severe): ICU + urgent drainage📉 Complications:• Sepsis, shock, multiorgan failure• Liver abscess, pancreatitis• AKI, DIC, chronic biliary strictures📈 Prognosis:• Good with early treatment• Mortality ↑ with delay or in elderly/immunosuppressed🧠 High-Yield MSRA Recap:• Charcot’s Triad = FJR• Reynolds’ Pentad = FJR + AMS + Hypotension• ERCP = diagnostic + therapeutic• Treat fast with antibiotics + drainage• Always consider malignancy if no stones📚 Free MSRA Revision Resources:• 📘 Notes:https://www.passthemsra.com/topic/ascending-cholangitis-revision-notes/• 🃏 Flashcards:https://www.passthemsra.com/topic/ascending-cholangitis-flashcards/• 📂 Q&A Notes:https://www.passthemsra.com/topic/ascending-cholangitis-accordion-qa-notes/• 🎯 Rapid Quiz:https://www.passthemsra.com/topic/ascending-cholangitis-rapid-quiz/• 🧪 Practice Quiz:https://www.passthemsra.com/quizzes/ascending-cholangitis/🌐 More:https://www.passthemsra.comhttps://www.freemsra.com#MSRA #AscendingCholangitis #CharcotsTriad #ERCP #BiliarySepsis #PassTheMSRA #SurgeryMSRA #FreeMSRA #MedicalPodcast