Acute Suppurative Cholangitis (2 of 8)

Needle-knife precut sphincterotomy Endoscopic biliary drainage for severe acute cholangitis. The sphincterotomy is iniciates with pre-cut needle emerging abundant purulent secretion (Colangitis) Charcot triad of fever, RUQ pain, and jaundice is found in 50-70% of patients presenting with cholangitis. Fever is present in approximately 90% of cases. Abdominal pain and jaundice is thought to occur in 70% and 60% of patients, respectively. Patients present with altered mental status 10-20% of the time and hypotension approximately 30% of the time. These signs combined with Charcot triad constitute Reynolds pentad. Most patients complain of RUQ pain; however, some patients (ie, elderly persons) are too ill to localize the source of infection. Other symptoms include the following: Jaundice Fever, chills, and rigors Pruritus Acholic or hypocholic stools The patient's past 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. Etiology is uncertain but may be related to cytomegalovirus or cryptosporidium infections. Manage cholangitis as described below, although decompression usually is not necessary.