American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended intervention if a patient with cholangitis does not show rapid improvement?

1. Admission to intensive care

2. Urgent endoscopic stone removal

3. Surgical consultation

4. Additional imaging studies

The correct answer is: Urgent endoscopic stone removal

In cases of cholangitis, especially when the patient does not show rapid improvement after initial treatment, urgent endoscopic stone removal is often the recommended intervention. Cholangitis, which is characterized by infection and inflammation of the bile duct system often due to obstruction from stones, can lead to severe complications if not addressed promptly. If a patient is experiencing persistent symptoms or does not improve with conservative management such as antibiotics, it suggests that a biliary obstruction may still be present. Endoscopic stone removal, typically performed through endoscopic retrograde cholangiopancreatography (ERCP), allows for direct removal of the obstructing stones and can help alleviate the infection and restore biliary drainage. While other interventions such as admission to intensive care, surgical consultation, and additional imaging studies may play roles in the management of cholangitis, they do not directly address the underlying issue of stone obstruction as effectively as urgent endoscopic intervention. In situations of cholangitis, immediate relief of the obstruction is crucial to prevent further deterioration of the patient’s condition.