Wed17November0747PM 9

A 52-year-old man presents with right upper quadrant pain and raised blood sugars. His back ground history includes type 2 diabetes, alcoholic liver disease, smoker.

On examination the patient looks icteric, abdomen is soft but tender in the right upper quadrant, the patient is pyrexial.

Blood results are as follows:

Hb 122 g/L

WCC 25.3 ×109/L

Plts 489 ×109/L

U&E normal

Bilirubin 110 µmol/L

Alk phosphatase 230 IU/L

ALT 900 IU/L

Albumin 33 g/L

Glucose 18 mmol/L

In order to confirm the underlying diagnosis, which of the following would be the most appropriate first line radiological investigation?

(Please select 1 option)

CT KUB

CT abdomen

ERCP

US abdomen Correct

MRI abdomen

Explanation

The triad of fever, jaundice and right upper quadrant pain points to a diagnosis of cholangitis. This is commonly referred to as "Charcot's triad".

Cholangitis is superadded infection in the bile duct, usually due to stones but may be secondary to stricture, tumour, a pre-existing stent or sludge.

Ultrasound can distinguish between cholangitis and cholecystitis which appears differently on ultrasound. Also ultrasound is often more accessible as a first line investigation than a CT.

Gold standard for imaging the biliary tree would be MRCP, however it is more difficult to schedule and would not be considered a first line investigation in most healthcare facilities.

Treatment includes blood cultures to identify the offending organism and aggressive management with antibiotics and fluids. ERCP (which is not a radiological investigation, it is an intervention) may be required to remove the duct obstruction.

Answer Statistics

1

1%

2

19%

3

5%

4

76%

5

1%

Times answered: 305