70 yo F presents with RUQ pain, fever, and AMS.  What is the diagnosis?

Acute cholangitis is a bacterial infection characterized by fever, jaundice, abdominal pain with or without altered mental status and hypotension resulting from a biliary obstruction.   The majority of the time culture of the obstructive stone reveals the organisms responsible: mixed growth of gram negative and gram positive bacteria.  All patients should have hepatic function panel and blood cultures sent.  Diagnosis can be made on ultrasound followed by ERCP to confirm the diagnosis and provide intervention.   Empiric broad spectrum antibiotics should be started.

June 2022
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