The classic presentation of acute cholangitis is fever, abdominal pain, and jaundice (Charcot’s triad), although only 50 to 75 percent of patients with acute cholangitis have all three findings. The most common symptoms of acute cholangitis are fever and abdominal pain. Confusion and hypotension can occur in patients with severe cholangitis (Reynolds pentad). Hypotension may be the only presenting symptom in older adults or those on glucocorticoids. Patients with acute cholangitis can also present with complications including hepatic abscess, sepsis, multiple organ system dysfunction, and shock.
●Diagnosis
Acute cholangitis should be suspected in patients with fever, abdominal pain, and jaundice.
A diagnosis of acute cholangitis requires evidence of systemic inflammation with one of the following:
•Fever and/or shaking chills.
•Laboratory evidence of an inflammatory response (abnormal white blood cell count, increased serum C-reactive protein, or other changes suggestive of inflammation).
and both of the following:
•Evidence of cholestasis: Bilirubin ≥2 mg/dL or abnormal liver chemistries (elevated alkaline phosphatase, gamma-glutamyl transpeptidase, alanine aminotransferase, or aspartate aminotransferase, to >1.5 times the upper limit of normal).
•Iaging with biliary dilation or evidence of the underlying etiology (eg, a stricture, stone, or stent).
