Choledocholithiasis & Cholangitis Explained | Biliary Tract Disorders | CanadaQBank
Choledocholithiasis and Cholangitis are two important biliary tract conditions often tested on exams and encountered in clinical practice. But how do you tell them apart, and what are the key steps in management—especially when one becomes a medical emergency?
In this high-yield gastroenterology and hepatobiliary video, we explain the pathophysiology, clinical features, diagnosis, and management of Choledocholithiasis and Cholangitis—perfect for USMLE, MCCQE, PLAB, and NCLEX exam preparation.
What You’ll Learn in This Video:
What is Choledocholithiasis?
Presence of gallstones in the common bile duct (CBD) causing obstruction.
Pathophysiology:
Obstruction → bile stasis → ↑ intraductal pressure → jaundice → possible infection or pancreatitis.
Clinical Features:
Right upper quadrant pain, jaundice, dark urine, pale stool.
Diagnosis:
↑ ALP, ↑ GGT, mild ↑ bilirubin.
Imaging: Ultrasound, MRCP, or ERCP.
Management:
ERCP with stone extraction, followed by cholecystectomy to prevent recurrence.
What is Cholangitis?
Bacterial infection of the biliary tree, typically due to CBD obstruction (most often from stones).
Classic Clinical Triads:
Charcot’s Triad: Fever, jaundice, RUQ pain.
Reynold’s Pentad: + Hypotension + Confusion → indicates sepsis.
Investigations:
↑ WBC, ↑ bilirubin, positive blood cultures, dilated ducts on imaging.
Management:
Medical Emergency!
IV fluids and broad-spectrum antibiotics (e.g., ceftriaxone + metronidazole).
Urgent biliary drainage via ERCP for source control.
High-Yield Pearls:
“Stone in CBD → Choledocholithiasis”
“Infected obstruction → Cholangitis”
Always think ERCP for both diagnosis and therapy.
Charcot’s Triad = Key clue; Reynold’s Pentad = Emergency!
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