Ascending cholangitis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Ascending cholangitis}} | {{Ascending cholangitis}} | ||
{{CMG}}; {{AE}} {{AHS}} | |||
== Overview == | == Overview == | ||
Patients with ascending cholangitis usually appear sick and fatigued. Physical examination of patients is usually remarkable for fever, abdominal tenderness and jaundice. Other findings that may be seen include hypotension, tachycardia and altered mental status in patients with septic shock or elderly | Patients with ascending cholangitis usually appear sick and fatigued. Physical examination of patients is usually remarkable for fever, abdominal tenderness and jaundice. Other findings that may be seen include [[hypotension]], [[tachycardia]] and [[altered mental status]] in patients with [[septic shock]] or elderly. | ||
== Physical Examination == | == Physical Examination == | ||
The presence of Fever > 39C, jaundice and right upper quadrant tenderness on physical examination is highly suggestive of acute cholangitis<ref name="pmid175561493">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149 }}</ref> | The presence of [[Fever]] > 39C, [[jaundice]] and [[right upper quadrant tenderness]] on physical examination is highly suggestive of acute cholangitis.<ref name="pmid175561493">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149 }}</ref> | ||
=== Appearance of the Patient === | === Appearance of the Patient === | ||
* Patients with ascending cholangitis usually appear ill and | * Patients with ascending cholangitis usually appear ill and fatigued. | ||
=== Vital Signs === | === Vital Signs === | ||
* High-grade fever | * High-grade fever. | ||
* [[Tachycardia]] with regular pulse may be seen in acute suppurative cholangitis | * [[Tachycardia]] with regular pulse may be seen in acute suppurative cholangitis. | ||
* Low blood pressure - may be seen in acute suppurative cholangitis and in elderly<ref name="pmid17556149">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149 }}</ref> | * Low blood pressure - may be seen in acute suppurative cholangitis and in elderly.<ref name="pmid17556149">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149 }}</ref> | ||
=== Skin === | === Skin === | ||
* Skin examination of patients with ascending can show [[jaundice]]<ref name="pmid175561492">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149 }}</ref> | * Skin examination of patients with ascending can show [[jaundice]].<ref name="pmid175561492">{{cite journal| author=Kinney TP| title=Management of ascending cholangitis. | journal=Gastrointest Endosc Clin N Am | year= 2007 | volume= 17 | issue= 2 | pages= 289-306, vi | pmid=17556149 | doi=10.1016/j.giec.2007.03.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17556149 }}</ref> | ||
* | * | ||
=== HEENT === | === HEENT === | ||
* HEENT examination of patients with acute cholangitis may show yellowness of the eyes | * HEENT examination of patients with acute cholangitis may show yellowness of the eyes. | ||
=== Neck === | === Neck === | ||
* Neck examination of patients with acute cholangitis is usually normal. | * Neck examination of patients with acute cholangitis is usually normal. | ||
=== Lungs === | === Lungs === | ||
* Pulmonary examination of patients with ascending is usually normal. | * Pulmonary examination of patients with ascending is usually normal. | ||
* However abnormalities may be seen in case of complicated suppurrative cholangitis | * However abnormalities may be seen in case of complicated suppurrative cholangitis. | ||
=== Heart === | === Heart === | ||
* Cardiovascular examination of patients with ascending cholangitis is usually normal. | * Cardiovascular examination of patients with ascending cholangitis is usually normal. | ||
* Tachycardia and arrythmias seen in complicated cases | * [[Tachycardia]] and arrythmias seen in complicated cases. | ||
=== Abdomen === | === Abdomen === | ||
* [[Abdominal tenderness]] in the left upper abdominal quadrant | * [[Abdominal tenderness]] in the left upper abdominal quadrant. | ||
* [[Rebound tenderness]] (positive Blumberg sign) | * [[Rebound tenderness]] (positive Blumberg sign). | ||
* Guarding may be present | * Mild [[hepatomegaly]]. | ||
* Guarding may be present. | |||
=== Back === | === Back === | ||
| Line 41: | Line 44: | ||
* Neuromuscular examination of patients with ascending is usually normal. | * Neuromuscular examination of patients with ascending is usually normal. | ||
* Confusion and altered mental status can be seen in elderly or complicated cholangitis with septic shock | * [[Confusion]] and altered mental status can be seen in elderly or complicated cholangitis with septic shock. | ||
=== Extremities === | === Extremities === | ||
| Line 49: | Line 52: | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Needs content]] | [[Category: Needs content]] | ||
Latest revision as of 23:09, 15 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
Patients with ascending cholangitis usually appear sick and fatigued. Physical examination of patients is usually remarkable for fever, abdominal tenderness and jaundice. Other findings that may be seen include hypotension, tachycardia and altered mental status in patients with septic shock or elderly.
Physical Examination
The presence of Fever > 39C, jaundice and right upper quadrant tenderness on physical examination is highly suggestive of acute cholangitis.[1]
Appearance of the Patient
- Patients with ascending cholangitis usually appear ill and fatigued.
Vital Signs
- High-grade fever.
- Tachycardia with regular pulse may be seen in acute suppurative cholangitis.
- Low blood pressure - may be seen in acute suppurative cholangitis and in elderly.[2]
Skin
HEENT
- HEENT examination of patients with acute cholangitis may show yellowness of the eyes.
Neck
- Neck examination of patients with acute cholangitis is usually normal.
Lungs
- Pulmonary examination of patients with ascending is usually normal.
- However abnormalities may be seen in case of complicated suppurrative cholangitis.
Heart
- Cardiovascular examination of patients with ascending cholangitis is usually normal.
- Tachycardia and arrythmias seen in complicated cases.
Abdomen
- Abdominal tenderness in the left upper abdominal quadrant.
- Rebound tenderness (positive Blumberg sign).
- Mild hepatomegaly.
- Guarding may be present.
Back
- Back examination of patients with ascending cholangitis is usually normal.
Genitourinary
- Genitourinary examination of patients with ascending cholangitis is usually normal.
Neuromuscular
- Neuromuscular examination of patients with ascending is usually normal.
- Confusion and altered mental status can be seen in elderly or complicated cholangitis with septic shock.
Extremities
- Extremities examination of patients with ascending cholangitis is usually normal.
References
- ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
- ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
- ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.