Ascending cholangitis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anila Hussain, MD [2]

Ascending Cholangitis, also known as acute cholangitis is a systemic disease caused by the inflammation and infection of the biliary tree most commonly following an obstruction in the biliary tract. It is characterized by a triad (Charcot’s Triad) of fever, jaundice and right upper quadrant pain. A pentad (also known as Reynold’s pentad) can also be seen in which altered mental status and sepsis are present in addition to usual findings

Patients with ascending cholangitis may have a positive history of:^[1]

• Gallstones
• Common bile duct stones
• Cholecystectomy
• Cholangiogram
• ERCP
• Previous history of cholangitis
• HIV or AIDS – AIDS-related cholangitis is characterized by extrahepatic biliary edema, ulceration, and obstruction

The following symptoms may occur:

• Abdominal pain which is in the right upper quadrant and is intermittent. Pain is sharp, crampy, or dull and may move to the back or below the right shoulder blade.
• Yellowing of the skin (jaundice) – 6- to 70 percent patients
• Fever – seen in 90 percent of patients
• Chills
• Clay-colored stools
• Dark urine
• Nausea and vomiting
• Pruritis
• Fatigue

The clinical triad of ascending cholangitis are pain, jaundice, and fever (Charcot’s triad). In addition, the presence of hypotension and mental confusion (Reynold’s pentad) is suggestive of severe septicemia. The typical clinical picture with a triad is present in only 50 to 70 percent of cases.^[2]

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