Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

Question 24: A 65-Year-Old Male On Plavix Following A Recent Mi And Coronary Stenting Was Seen In The Er With Fever, Pain, Jaundice, And A Wbc Of 18,000. Us Showed A Dilated Bile Duct Of 15 Mm And A Gallbladder Full Of Stones. Mrcp Revealed A 15-Mm Stone In The Distal Cbd. What Would You Do? (continued)

Wei-Chih Liao, MD, PhD

This patient presented with Charcot’s triad (right upper quadrant pain, fever, and jaundice), which is the classic presentation of acute cholangitis. Acute bacterial cholangitis is caused by obstruction of the common bile duct (CBD) and subsequent bacterial infection, and CBD stone is the most common cause.1 For a patient with acute cholangitis, you need to obtain blood culture and start antibiotics as soon as possible. You should also consider giving other supportive measures as needed (eg, oxygen, intravenous fluid, or even inotropic agents if the patient is in profound septic…