Cholangitis physical examination

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.

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]

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

The Charcot’s triad include the following symptoms:^[3][4]

• Fever
• Abdominal pain
• Jaundice

• Fever
• Abdominal pain
• Jaundice
• Confusion
• Sepsis (hypotension)

• Patient may appear lethargic and weak. Disorientation maybe present if there are signs of shock.

• Fever
• Septic shock
• Elderly patients may present with hypotension^[5]

• Jaundice

• Right upper quadrant (RUQ) tenderness
• Rebound tenderness
• Abdominal guarding may be present
• Abdominal pain^[6]

• Tachycardia
• Cardiac arrythmias

• Mental confusion
• Altered mental status

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