Cholangitis history and symptoms: Difference between revisions

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{{Cholangitis}}
==Overview==
==Overview==
The classical clinical manifestation of [[Cholangitis]] is described by [[Charcot's triad]] and includes [[fever]], right upper quadrant pain, and [[jaundice]]. In suppurative cholangitis [[hypotension]], and [[confusion]] can occur. The pentad of presentation is then called as '''[[Reynold's pentad]]'''. Reynold's pentad is associated with significant morbidity, and mortality.
Obtaining a thorough and accurate history is the most important part of making a [[diagnosis]] of cholangitis. A positive history of [[gallstones]] and [[common bile duct]] stones, recent [[cholecystectomy]], [[endoscopic]] manipulation or [[endoscopic retrograde cholangiopancreatography]] (ERCP), [[cholangiogram]] and history of [[HIV]] or [[AIDS]] all point towards a diagnosis of cholangitis in the presence of [[Charcot's triad]]. [[Symptoms]] of cholangitis include [[fever]], [[abdominal pain]], [[nausea and vomiting]], [[Jaundice|jaundice/yellowish discoloration of skin]], [[acholic stools]]/pale stools, [[pruritus]], [[malaise]], and [[confusion]].
 
== History and Symptoms ==
*A positive history of [[gallstones]] and [[common bile duct]] stones, recent [[cholecystectomy]], endoscopic manipulation via [[endoscopic retrograde cholangiopancreatography]] ([[Endoscopic retrograde cholangiopancreatography|ERCP]]), [[cholangiogram]] and history of [[HIV]] or [[AIDS]]
 
*[[Symptoms]] of cholangitis include [[fever]], [[abdominal pain]], [[nausea and vomiting]], [[Jaundice|jaundice/yellowish discoloration of skin]], [[acholic stools]]/pale stools, [[pruritus]], [[malaise]], and [[confusion]].  
===History===
A complete history may help determine the appropriate therapy and [[prognosis]]. A positive history of the following is suggestive of cholangitis in the presence of positive [[Symptoms and Signs|signs and symptoms]]:<ref name="book123">{{Citation
| last1  = Afdhal
| first1 = NH
| last2 = Goldman
| first2 = L
| last3  = Schafer
| first3 = Al
| lastauthoramp = yes
| title    = Goldman's Cecil Medicine
| publisher = Saunders Elsevier
| place    = Philadelphia, PA
| edition = 24
| year    = 2011
}}</ref><ref name="pmid21207254">{{cite journal |vauthors=Mosler P |title=Diagnosis and management of acute cholangitis |journal=Curr Gastroenterol Rep |volume=13 |issue=2 |pages=166–72 |year=2011 |pmid=21207254 |doi=10.1007/s11894-010-0171-7 |url=}}</ref>
*[[Gallstones]] and [[common bile duct]] stones
*Recent [[cholecystectomy]]
*[[Endoscopic]] manipulation of the biliary tree or [[endoscopic retrograde cholangiopancreatography]] ([[Endoscopic retrograde cholangiopancreatography|ERCP]])
**[[Cholangiogram]]
*History of [[HIV]] or [[AIDS]]
**[[AIDS]]-related cholangitis is characterized by extrahepatic biliary [[edema]], [[ulceration]], and obstruction.
 
===Common symptoms===
{| align="right"
|[[File:Cholangitis Jaundice.jpg|thumb|250px|Sclerotic jaundice in a female patient with ascending cholangitis, Maracay, Venezuela.<ref>By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=10762793</ref>]]
|}
Common [[symptoms]] of cholangitis include: <ref name="book123">{{Citation
| last1  = Afdhal
| first1 = NH
| last2 = Goldman
| first2 = L
| last3  = Schafer
| first3 = Al
| lastauthoramp = yes
| title    = Goldman's Cecil Medicine
| publisher = Saunders Elsevier
| place    = Philadelphia, PA
| edition = 24
| year    = 2011
}}</ref><ref name="pmid21207254" /><ref name="book12">{{Citation
| last1  = Liu
| first1 = Chi-Leung.
| last2  = Fan
| first2 = Sheung-Tat.
| lastauthoramp = yes
| title    = Surgical Treatment: Evidence-Based and Problem-Oriented.
| publisher = Zuckschwerdt Verlag
| place    = Munich, Germany
| year    = 2001
}}</ref><ref name="pmid19652653">{{cite journal |vauthors=Lee JG |title=Diagnosis and management of acute cholangitis |journal=Nat Rev Gastroenterol Hepatol |volume=6 |issue=9 |pages=533–41 |year=2009 |pmid=19652653 |doi=10.1038/nrgastro.2009.126 |url=}}</ref>
*[[Abdominal pain]] in the [[right upper quadrant]]
**May be felt in the back or below the right [[shoulder blade]]
**Episodic
**Sharp, cramp-like, or dull
*[[Fever]], maybe associated with [[Rigors|rigors and chills]]
*[[Jaundice]]/ yellowish discoloration of [[skin]] and [[sclera]]
*[[Nausea and vomiting]]


==History and Symptoms==
===Less common symptoms===
The three classical presentation of Charcot’s triad are present only in 50-60% of the patient population. 95% patients may have fever, 66% [[abdominal pain]], and jaundice is noted in 80% (with a [[bilirubin]] >2.5).  Nonobstructive stones are more likely to present without pain or fever.  Elderly patients may present only with [[hypotension]].
Less common [[symptoms]] of cholangitis include
===Charcot's triad===
*Pale/ [[acholic stools]]
====Abdominal pain====
*[[Malaise]]
* right or middle of the upper abdomen
*[[Confusion]]
* Intermittent
*[[Pruritus]]
* Sharp, crampy, or dull
* Radiation to back or below the right shoulder blade
====Fever====
* With chills and rigor
====Jaundice====
* Clay-colored stools
* Dark urine
* [[Nausea]] and [[vomiting]]
* Yellowing of the skin and sclera
===Reynold's Pentad===


==References==
==References==
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Latest revision as of 20:55, 29 July 2020


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Farwa Haideri [3]

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Overview

Obtaining a thorough and accurate history is the most important part of making a diagnosis of cholangitis. A positive history of gallstones and common bile duct stones, recent cholecystectomy, endoscopic manipulation or endoscopic retrograde cholangiopancreatography (ERCP), cholangiogram and history of HIV or AIDS all point towards a diagnosis of cholangitis in the presence of Charcot's triad. Symptoms of cholangitis include fever, abdominal pain, nausea and vomiting, jaundice/yellowish discoloration of skin, acholic stools/pale stools, pruritus, malaise, and confusion.

History and Symptoms

History

A complete history may help determine the appropriate therapy and prognosis. A positive history of the following is suggestive of cholangitis in the presence of positive signs and symptoms:[1][2]

Common symptoms

Sclerotic jaundice in a female patient with ascending cholangitis, Maracay, Venezuela.[3]

Common symptoms of cholangitis include: [1][2][4][5]

Less common symptoms

Less common symptoms of cholangitis include

References

  1. 1.0 1.1 Afdhal, NH; Goldman, L & Schafer, Al (2011), Goldman's Cecil Medicine (24 ed.), Philadelphia, PA: Saunders Elsevier
  2. 2.0 2.1 Mosler P (2011). "Diagnosis and management of acute cholangitis". Curr Gastroenterol Rep. 13 (2): 166–72. doi:10.1007/s11894-010-0171-7. PMID 21207254.
  3. By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=10762793
  4. Liu, Chi-Leung. & Fan, Sheung-Tat. (2001), Surgical Treatment: Evidence-Based and Problem-Oriented., Munich, Germany: Zuckschwerdt Verlag
  5. Lee JG (2009). "Diagnosis and management of acute cholangitis". Nat Rev Gastroenterol Hepatol. 6 (9): 533–41. doi:10.1038/nrgastro.2009.126. PMID 19652653.


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