Cholangitis physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Cholangitis}} | {{Cholangitis}} | ||
{{CMG}} {{AE}} {{FH}} | {{CMG}}; {{AE}} {{ADS}} {{FH}} | ||
==Overview== | ==Overview== | ||
[[Charcot's triad]], which includes [[abdominal pain]], [[jaundice]], and [[fever]] is a set of three common findings in cholangitis. Reynold's pentad | [[Charcot's triad]], which includes [[abdominal pain]], [[jaundice]], and [[fever]] is a set of three common findings in cholangitis. [[Reynolds' pentad|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. | ||
==Physical Examination== | ==Physical Examination== | ||
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. | [[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 [[Comorbidity|comorbid]] conditions.<ref name="book12">{{Citation | ||
| last1 = Liu | | last1 = Liu | ||
| first1 = Chi-Leung. | | first1 = Chi-Leung. | ||
| Line 17: | Line 17: | ||
| place = Munich, Germany | | place = Munich, Germany | ||
| year = 2001 | | year = 2001 | ||
}}</ref> | }}</ref> | ||
===Signs of acute suppurative cholangitis=== | |||
The prescence of the following [[signs]] help in the diagnosis of acute suppurative cholangitis:<ref name="pmid7025298">{{cite journal |vauthors=Chock E, Wolfe BM, Matolo NM |title=Acute suppurative cholangitis |journal=Surg. Clin. North Am. |volume=61 |issue=4 |pages=885–92 |year=1981 |pmid=7025298 |doi= |url=}}</ref> | |||
* [[Fever]] > 39° C | |||
* Sustained [[hypotension]] | |||
* Mental [[confusion]] | |||
* Steady [[abdominal pain]] | |||
=== Charcot's triad === | |||
The Charcot's triad include the following symptoms:<ref name="pmid28213923">{{cite journal |vauthors=Rumsey S, Winders J, MacCormick AD |title=Diagnostic accuracy of Charcot's triad: a systematic review |journal=ANZ J Surg |volume=87 |issue=4 |pages=232–238 |year=2017 |pmid=28213923 |doi=10.1111/ans.13907 |url=}}</ref><ref name="pmid29089703">{{cite journal |vauthors=Dinc T, Kayilioglu SI, Coskun F |title=Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis |journal=Indian J Surg |volume=79 |issue=5 |pages=427–430 |year=2017 |pmid=29089703 |doi=10.1007/s12262-016-1512-z |url=}}</ref> | |||
* [[Fever]] | |||
* [[Abdominal pain]] | |||
* [[Jaundice]] | |||
=== Reynold's pentad === | |||
* [[Fever]] | |||
* [[Abdominal pain]] | |||
* [[Jaundice]] | |||
* [[Confusion]] | |||
* [[Sepsis]] ([[hypotension]]) | |||
=== Appearance of the patient === | |||
* Patient may appear [[lethargic]] and weak. [[Disorientation]] maybe present if there are signs of [[shock]]. | |||
===Vitals=== | ===Vitals=== | ||
*Fever | *[[Fever]] | ||
*Septic shock | *[[Septic shock]] | ||
*Elderly patients may present with [[hypotension]]<ref name="book312">{{Citation | |||
| last1 = Brunicardi | |||
| first1 = FC | |||
| last2 = Schwartz | |||
| first2 = SI | |||
| lastauthoramp = yes | |||
| title = Schwartz's Principles of Surgery | |||
| publisher = McGraw-Hill Scientific, Technical & Medical | |||
| place = New York, New York | |||
| year = 2005 | |||
}}</ref> | |||
===Skin=== | ===Skin=== | ||
*Jaundice | *[[Jaundice]] | ||
===Abdomen=== | ===Abdomen=== | ||
*Right upper quadrant (RUQ) [[tenderness]] | *[[Right upper quadrant]] ([[RUQ]]) [[tenderness]] | ||
*Abdominal pain | *[[Rebound tenderness]] | ||
*[[Abdominal guarding]] may be present | |||
*[[Abdominal pain]]<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | |||
=== Cardiovascular === | |||
* [[Tachycardia]] | |||
* [[Cardiac arrhythmia|Cardiac arrythmias]] | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
*Mental confusion | *Mental [[confusion]] | ||
*[[Altered mental status]] | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:FinalQCRequired]] | |||
[[Category:Disease]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Surgery]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Farwa Haideri [3]
Overview
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.
Physical Examination
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]
Signs of acute suppurative cholangitis
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
Charcot's triad
The Charcot's triad include the following symptoms:[3][4]
Reynold's pentad
Appearance of the patient
- Patient may appear lethargic and weak. Disorientation maybe present if there are signs of shock.
Vitals
- Fever
- Septic shock
- Elderly patients may present with hypotension[5]
Skin
Abdomen
- Right upper quadrant (RUQ) tenderness
- Rebound tenderness
- Abdominal guarding may be present
- Abdominal pain[6]
Cardiovascular
Neuromuscular
- Mental confusion
- Altered mental status
References
- ↑ Liu, Chi-Leung. & Fan, Sheung-Tat. (2001), Surgical Treatment: Evidence-Based and Problem-Oriented., Munich, Germany: Zuckschwerdt Verlag
- ↑ Chock E, Wolfe BM, Matolo NM (1981). "Acute suppurative cholangitis". Surg. Clin. North Am. 61 (4): 885–92. PMID 7025298.
- ↑ Rumsey S, Winders J, MacCormick AD (2017). "Diagnostic accuracy of Charcot's triad: a systematic review". ANZ J Surg. 87 (4): 232–238. doi:10.1111/ans.13907. PMID 28213923.
- ↑ Dinc T, Kayilioglu SI, Coskun F (2017). "Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis". Indian J Surg. 79 (5): 427–430. doi:10.1007/s12262-016-1512-z. PMID 29089703.
- ↑ Brunicardi, FC & Schwartz, SI (2005), Schwartz's Principles of Surgery, New York, New York: McGraw-Hill Scientific, Technical & Medical
- ↑ Kinney TP (2007). "Management of ascending cholangitis". Gastrointest. Endosc. Clin. N. Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.