How is acute cholangitis managed in the emergency department (ED)?

Updated: Dec 29, 2017
  • Author: Timothy M Scott, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Management of acute cholangitis in the emergency department includes the following:

  • After assessment of the ABCs (airway, breathing, circulation), place the patient on a monitor with pulse oximetry, provide oxygen via nasal canula, and obtain an electrocardiogram (ECG). Draw and send laboratory studies (including blood cultures) when the intravenous line is placed.

  • Provide fluid resuscitation with intravenous (IV) crystalloid solution (eg, 0.9% normal saline).

  • Administer parenteral antibiotics empirically after blood cultures are drawn. Do not delay administration of antibiotics if blood cultures cannot be drawn.

  • Correct any electrolyte abnormalities or coagulopathies.

  • For management of patients in septic shock, see Shock, Septic.

  • Standard therapy for cholangitis consists of broad-spectrum antibiotics with close observation to determine the need for emergency decompression of the biliary tree. [17]

  • A nasogastric tube may be helpful for patients who are vomiting.

  • Patients should be nothing by mouth (NPO). Place a Foley catheter in ill patients to monitor urine output.


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