In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss community-acquired biliary sepsis, differentiating between cholecystitis and ascending cholangitis. They explore the symptoms, causes, and diagnostic approaches, including the use of ultrasound, CT scans, and HIDA scans, while also discussing the Tokyo guidelines for diagnosis. The hosts delve into antibiotic treatments, emphasizing the importance of gram-negative coverage and biliary penetration, and caution against relying on vancomycin. They also discuss source control interventions such as ERCP and percutaneous drainage, highlighting the importance of considering ascending cholangitis in septic patients and the need for timely intervention.
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