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cholangitis

Practice targeted AMC-style multiple-choice questions on cholangitis.

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endoscopic retrograde cholangiopancreatography (ERCP)gastroenterologyelderly patientgallstonesabdominal painfevergeriatricsemergency managementjaundicemiddle-aged woman
Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 72-year-old man with a history of cholelithiasis presents with a 2-day history of fever, jaundice, and severe right upper quadrant pain. His vital signs are stable, but laboratory tests show elevated bilirubin and alkaline phosphatase. He is undergoing urgent ERCP for management of suspected choledocholithiasis and cholangitis. Following successful cannulation and injection of contrast, the image is obtained. Considering the findings demonstrated in the image in the context of this patient's presentation, what is the most appropriate immediate next step during this procedure?

A. Placement of a biliary stent
B. Mechanical lithotripsy
C. Balloon dilation of the common bile duct
D. Endoscopic sphincterotomy
E. Attempt stone extraction with a basket
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 70-year-old male with ascending cholangitis undergoes ERCP. The image is obtained. What is the MOST appropriate next step in management?

A. Ursodeoxycholic acid administration
B. Sphincterotomy and stone extraction
C. Observation with serial LFTs
D. Percutaneous transhepatic biliary drainage
E. Cholecystectomy
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 58-year-old woman with cholangitis undergoes ERCP. The image is obtained. What intervention is MOST appropriate at this time?

A. Placement of a biliary stent
B. Observation and repeat ERCP in 24 hours
C. Ursodeoxycholic acid administration
D. Sphincterotomy and stone extraction
E. Cholecystectomy
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 72-year-old male with acute cholangitis is undergoing ERCP for stone extraction. The image is obtained after cannulation. Based on the findings, what is the most appropriate immediate next step in the procedure?

A. Insert nasobiliary drain
B. Terminate procedure and give antibiotics
C. Attempt basket extraction
D. Endoscopic sphincterotomy
E. Perform mechanical lithotripsy
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 72-year-old presents with acute cholangitis (fever, jaundice, RUQ pain). LFTs show obstructive pattern. ERCP is performed for biliary decompression and stone extraction. Following successful cannulation and cholangiography, the image is obtained. Based on the findings demonstrated in the image, what is the most appropriate immediate next step during this procedure?

A. Terminate the procedure and schedule surgery
B. Attempt stone extraction with a balloon catheter
C. Administer intravenous antibiotics and observe
D. Perform a sphincterotomy
E. Insert a biliary stent
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 72-year-old male presents with fever, jaundice, and right upper quadrant pain. Investigations confirm acute cholangitis secondary to choledocholithiasis. He is taken for urgent ERCP. Following successful cannulation of the common bile duct and injection of contrast, the image is captured. Considering the findings visualised in the image, which of the following interventions is the most appropriate immediate next step to enable successful management of the underlying pathology during this procedure?

A. Attempt stone extraction using a balloon catheter
B. Place a temporary biliary stent
C. Perform an endoscopic sphincterotomy
D. Attempt stone extraction using a Dormia basket
E. Abandon the ERCP and proceed to surgical exploration
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 68-year-old woman presented to the emergency department with right upper quadrant abdominal pain, fever, and jaundice. Initial investigations showed a WCC of 14,000, total bilirubin 6.0, ALP 450, ALT 300. She was diagnosed with acute cholangitis and underwent urgent ERCP, during which the image was obtained. Following successful endoscopic stone extraction and significant clinical improvement with normalising inflammatory markers and liver function tests, what is the MOST appropriate next step in the long-term management of this patient's condition?

A. Repeat ERCP with sphincterotomy in three months
B. Commencement of long-term oral antibiotic therapy
C. Referral for urgent liver transplant assessment
D. Elective laparoscopic cholecystectomy
E. Discharge home with outpatient gastroenterology follow-up
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Fluoroscopic image of common bile duct stone seen at the time of ERCP. The stone is impacted in the distal common bile duct.
Image by Samir धर्म at en.wikipedia — CC BY-SA 3.0 · Source

A 68-year-old woman presents to the emergency department with a 2-day history of right upper quadrant abdominal pain, fever, and yellowing of her eyes. Her vital signs are stable, but laboratory investigations reveal elevated inflammatory markers and liver function tests consistent with biliary obstruction and infection. An ERCP is performed, and the image is obtained. Following successful intervention to relieve the obstruction, the patient's symptoms begin to improve. Considering the likely underlying cause of this presentation and the findings during the procedure, what is the MOST appropriate next step in managing this patient's condition?

A. Repeat ERCP in 3 months to check for residual stones.
B. Discharge home with pain relief and follow-up in general practice.
C. Referral for medical dissolution therapy for gallstones.
D. Long-term antibiotic therapy to prevent recurrence.
E. Elective laparoscopic cholecystectomy during the same admission or shortly after discharge.
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