Ascending Cholangitis History

Abdominal pain – 70% of patients
• In the right upper side or middle of the upper abdomen
• May come and go
• Pain is sharp, crampy, or dull
• Pain may move to the back or below the right shoulder blade
Fever – 90% of cases
Jaundice – 60% of cases
Rigors(uncontrollable shaking) and a feeling of uneasiness (malaise), pruritis, acholic or hypocholic stools - stools look clay like
Charcot's triad - abdominal pain, jaundice, and fever - 15–20% of cases.
Reynolds' pentad includes the findings of Charcot's triad with hypotension (30% of cases) and mental confusion (10-20% of cases). This combination of symptoms indicates worsening of the condition and the development of septicemia – less common than Charcot’s triad
In the elderly, the presentation may be atypical; they may directly collapse due to septicemia without first showing typical features.
Consider cholangitis in any patient who appears septic, especially in patients who are elderly, jaundiced, or who have abdominal pain.
Most patients complain of RUQ pain; however, some patients (ie, elderly persons) are too ill to localize the source of infection.
• The patient's medical history may be helpful. For example, a history of the following increases the risk of cholangitis:
• Gallstones, CBD stones
• Recent cholecystectomy
• Endoscopic manipulation or ERCP, cholangiogram
• History of cholangitis
• History of HIV or AIDS: AIDS-related cholangitis is characterized by extrahepatic biliary edema, ulceration, and obstruction. The etiology is uncertain, but it may be related to cytomegalovirus or Cryptosporidium infections. The management of this condition is described below, although decompression is usually not necessary.