Cholangitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Farwa Haideri [3]
Overview
Charcot's triad, which includes abdominal pain, jaundice, and fever is a set of three common findings in cholangitis. Reynold's pentad adds to this list two other symptoms, septic shock and mental confusion, which are also common markers in a physical examination for cholangitis.
Physical Examination
Charcot's triad is the classical presentation of acute cholangitis. Only 50-70% of patients exhibit all three features. Fever, which is present in over 90% of patients, is most common. Abdominal pain and clinical jaundice occur in about 80% of patients. Obtaining a complete and accurate patient history is the most important aspect of making a diagnosis of cholangitis. It provides insight into causes, precipitating factors, and associated comorbid conditions.[1]
Signs of acute suppurative cholangitis
The prescence of the following signs help in the diagnosis of acute suppurative cholangitis:[2]
- Fever > 39° C
- Sustained hypotension
- Mental confusion
- Steady abdominal pain
Charcot's triad
The Charcot's triad include the following symptoms:[3][4]
Reynold's pentad
Appearance of the patient
- Patient may appear lethargic and weak. Disorientation maybe present if there are signs of shock.
Vitals
- Fever
- Septic shock
- Elderly patients may present with hypotension[5]
Skin
Abdomen
- Right upper quadrant (RUQ) tenderness
- Rebound tenderness
- Abdominal guarding may be present
- Abdominal pain[6]
Cardiovascular
Neuromuscular
- Mental confusion
- Altered mental status
References
- ↑ Liu, Chi-Leung. & Fan, Sheung-Tat. (2001), Surgical Treatment: Evidence-Based and Problem-Oriented., Munich, Germany: Zuckschwerdt Verlag
- ↑ Chock E, Wolfe BM, Matolo NM (1981). "Acute suppurative cholangitis". Surg. Clin. North Am. 61 (4): 885–92. PMID 7025298.
- ↑ Rumsey S, Winders J, MacCormick AD (2017). "Diagnostic accuracy of Charcot's triad: a systematic review". ANZ J Surg. 87 (4): 232–238. doi:10.1111/ans.13907. PMID 28213923.
- ↑ Dinc T, Kayilioglu SI, Coskun F (2017). "Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis". Indian J Surg. 79 (5): 427–430. doi:10.1007/s12262-016-1512-z. PMID 29089703.
- ↑ Brunicardi, FC & Schwartz, SI (2005), Schwartz's Principles of Surgery, New York, New York: McGraw-Hill Scientific, Technical & Medical
- ↑ 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.