Ascending cholangitis physical examination: Difference between revisions
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* [[Abdominal tenderness]] in the left upper abdominal quadrant | * [[Abdominal tenderness]] in the left upper abdominal quadrant | ||
* [[Rebound tenderness]] (positive Blumberg sign) | * [[Rebound tenderness]] (positive Blumberg sign) | ||
* Mild hepatomegaly | |||
* Guarding may be present | * Guarding may be present | ||
Revision as of 16:28, 28 September 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
Patients with ascending cholangitis usually appear sick and fatigued. Physical examination of patients is usually remarkable for fever, abdominal tenderness and jaundice. Other findings that may be seen include hypotension, tachycardia and altered mental status in patients with septic shock or elderly
Physical Examination
The presence of Fever > 39C, jaundice and right upper quadrant tenderness on physical examination is highly suggestive of acute cholangitis[1]
Appearance of the Patient
- Patients with ascending cholangitis usually appear ill and fatigued.
Vital Signs
- High-grade fever
- Tachycardia with regular pulse may be seen in acute suppurative cholangitis
- Low blood pressure - may be seen in acute suppurative cholangitis and in elderly[2]
Skin
HEENT
- HEENT examination of patients with acute cholangitis may show yellowness of the eyes
Neck
- Neck examination of patients with acute cholangitis is usually normal.
Lungs
- Pulmonary examination of patients with ascending is usually normal.
- However abnormalities may be seen in case of complicated suppurrative cholangitis
Heart
- Cardiovascular examination of patients with ascending cholangitis is usually normal.
- Tachycardia and arrythmias seen in complicated cases
Abdomen
- Abdominal tenderness in the left upper abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- Mild hepatomegaly
- Guarding may be present
Back
- Back examination of patients with ascending cholangitis is usually normal.
Genitourinary
- Genitourinary examination of patients with ascending cholangitis is usually normal.
Neuromuscular
- Neuromuscular examination of patients with ascending is usually normal.
- Confusion and altered mental status can be seen in elderly or complicated cholangitis with septic shock
Extremities
- Extremities examination of patients with ascending cholangitis is usually normal.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.