Ascending cholangitis + Reynold's Pentad
Mnemonic of the week: Reynold’s Pentad
Condition of the week: Ascending cholangitis
Ascending cholangitis is an infection of the biliary tree, typically caused by obstruction and bacterial overgrowth. Here's a comprehensive summary:
Definition
Ascending cholangitis is an acute infection of the extra-hepatic biliary system, often resulting from biliary obstruction.
Pathophysiology
Remember the "3 Bs" of cholangitis pathophysiology:
Blockage: Biliary obstruction
Bacteria: Bacterial overgrowth
Backflow: Increased intraductal pressure leading to cholangiovenous and cholangiolymphatic reflux.
Risk Factors
Memorize "STONE" for key risk factors:
S: Smoking (current smokers)
T: Time (advanced age >70 years)
O: Obstruction (e.g., choledocholithiasis)
N: Narrowing (benign or malignant strictures)
E: Endoscopic procedures (post-ERCP)
Clinical Features
Recall Charcot's triad ("FPJ"):
Fever
Pain (right upper quadrant)
Jaundice
In severe cases, remember Reynolds' pentad by adding "SH" to Charcot's triad:
Shock
Altered mental status (H for "Head")
Investigations
Think "ABCD" for key investigations:
A: Alkaline phosphatase (elevated)
B: Blood cultures
C: C-reactive protein (elevated)
D: Diagnostic imaging (USS, CT, MRCP)
Management
Remember the "3 Ds" of management:
Drainage: Biliary decompression (ERCP, PTC)
Drugs: Antibiotics (targeting common pathogens like E. coli, Klebsiella)
Defuse: Treat underlying cause (e.g., stone removal)
Complications
Think "SEPTIC" for complications:
S: Sepsis
E: Endotoxemia
P: Pancreatitis (acute)
T: Thrombosis (portal vein)
I: Infection spread (hepatic abscess)
C: Circulatory collapse
Prognosis
Mortality rate is approximately 10% even with appropriate treatment. Early recognition and prompt management are crucial for improving outcomes.By using these mnemonics and memory aids, medical students can more easily recall the key aspects of ascending cholangitis, facilitating better understanding and retention of this important condition.
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