Charcot’s triad of acute cholangitis

Charcot’s triad of acute cholangitis is the combination of:

  • jaundice
  • fever (usually associated with rigors)
  • right upper quadrant abdominal pain

Not all of the three criteria are always present; fever is seen in 90% of cases.

The spectrum of cholangitis ranges from mild symptoms to fulminant septic shock. When altered mental status and sepsis are added to the three above, we call it the Reynolds pentad.

Frequent causes of cholangitis are common bile duct obstruction (stones, biliopancreatic malignancy) and endoscopic manipulation of biliary tract (ERCP).

Generally, patients with cholangitis are severely ill, sometimes presenting with signs of septic shock, without an apparent source of the infection. Acute cholangitis should be considered in feverish, septic patients, also in jaundiced and elderly with upper abdominal pain.

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