SAQ 424 – Gastroenterology – ascending cholangitis
Model Answer
Gastroenterology – ascending cholangitis.
a. Diagnosis
- Ascending cholangitis.
b. Investigations
- Upper abdominal ultrasound to assess for stones, mass, or biliary dilatation.
- Blood cultures before antibiotics if this does not delay treatment.
- Liver function tests.
- Lipase.
- EUC/renal function, lactate, glucose, FBC, and coagulation as clinically required.
c. Management priorities
- Fluid resuscitation and sepsis care.
- IV antibiotics appropriate for biliary sepsis and allergy history.
- Analgesia and antiemetics.
- Urgent surgical/gastroenterology review for source control, including ERCP if obstructed.
- Monitor urine output and clinical response.
d. Ongoing orders
- Ceftriaxone 1 g IV twice daily may be acceptable in a non-anaphylactic rash history; use local allergy-appropriate alternatives if needed.
- Metronidazole 500 mg IV/oral three times daily.
- Compound sodium lactate 1 L over 6 hours, then reassess.
- Morphine 2.5-5 mg subcutaneously every 3 hours as required, or alternative opioid titrated to effect.
- Paracetamol and metoclopramide/ondansetron as needed.
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