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Management Of Ascending Cholangitis BY PROF GOUDA ELLABBAN

Ascending cholangitis

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Management Of Ascending Cholangitis

BYPROF GOUDA ELLABBAN

Investigation(1)

Lab Tests Imaging

1-Blood tests:

neutrophilia

Conjugated Bilirubin

Alkaline phosphatase

Cholestatic picture

2- Lab Studies

1-Blood culture

2-Biliary culture

3-Amylase/Lipase/Calcium

4- Hepatitis profile

Imaging:

Ultrasound:

Endoscopic retrograde Cholengeopancreatography(1):

Endoscopic retrograde Cholengeopancreatography(2)

Q: What is the best way to diagnose cholangitis?

ERCP

Percutaneous transhepatic cholangiogram

Narrowing of Common Bile

Duct

Magnetic resonance cholangiopancreatography :

C.T Scan

Treatment

Immediate Treatment

ABC

IV fluid

Antibiotics

Close observation

NPO

Nasogatric tube

Urine catheter

Surgical Treatment(1):

1-Common Bile Duct stone:1-ERCP/Sphincterectomy

2-Exploration

Surgical Treatment(2):

2-Traumatic

3-Ampullary /duodenal Ca

4-Cholangiocarcinoma

Excision and hepaticojejunestomy

Procedure Names:

1-Roux en Y hepaticojejunostomy

2-Whipples operation

3-Excision and hepaticojejunostomy

Preoperative Preparation:

1- Adequate Hydration

2-Urinary out put

3-Antibiotics

4-Vitamin K

Post Operative Complications:

1-Pancreatitis 2-Perforation3- Hemorrhage/sepsis 4-Biliary peritonitis

Prevention:

1-recognition of cholelithiasis

2-prophylactic Antibiotic before ERCP

Thank You