Diagnosis of Cholangitis
This
condition expresses itself in the form of a table that is scalable,
beginning with Charcot's triad that is made of three symptoms: pain,
fever with chills and jaundice moderate. What characterizes them is their association as well as their chronology [18].
Charcot's triad: (~ 70%)
Pain (50-90%)
It precedes a fever a few hours, it reflects the sudden tensioning of the bile duct. It is a little different colic pain, it is lively, situated in the right hypochondrium, with irradiation dorsal and anterior and posterior chest.
Although it is usually epigastric, usually more prolonged and less paroxysmal. Sometimes it is atypical, and may be limited to a simple weight of the right upper quadrant, or even absent.
Acute liver pain must fear the formation of an abscess within the liver.
Fever (90-95%)
It is always present, it means the infection of the bile ducts and discharge bacteremia, why should be performed immediately blood cultures for isolating the causative organism.
It occurs within hours of pain and changes in access pseudo-marsh, made of a succession of major peaks, more or less frequently repeated in the nycthemeron, accompanied by chills, it amounts to a temperature: 40 ° c to 41 ° C, ending with an abrupt defervescence accompanied by sweating between the febrile attacks there remains a sub febrile state.
Jaundice: (60-80%)
It appears from 12 to 48 hours, at most, it is progressive, variable intensity, ranging from a simple sub conjunctival jaundice jaundice mucocutaneous, with coloration of urine and stool discoloration and itching.
In some cases, jaundice may precede fever, which can be an argument for referral to a neoplastic etiology of chronic obstacle or not.
The pentad of REYNOLDS: (5-10%)
It involves, in addition to Charcot's triad, two signs:
- Septic shock.- Mental confusion and / or lethargy.
It is seen especially in the elderly and it is poor prognosis.
General symptoms
It should be understood in fact, that cholangitis is sepsis.The occurrence of cholangitis access leads to greater or lesser impact on the general, it is often noted for signs that may herald the onset of a severe form:
* Alteration facies.
* Acceleration of the pulse.
* Small drop in blood pressure.
* Tachypnea.
* Gastrointestinal disorders: nausea, vomiting.
* Oliguria with dark urine.
The examination
- It searches the notion of a known stone disease, history of jaundice, painful episodes of right flank or febrile episodes.
The physical examination
Clinical examination is generally poor, the palpation of right upper quadrant pain majorises (Murphy's sign), sometimes there is a moderate hepatomegaly. The liver is more or less painful, rarely can feel a big gall tense.
The presence of a defense and a contracture localized or generalized throughout the abdomen, resulting peritoneal involvement.
Charcot's triad: (~ 70%)
Pain (50-90%)
It precedes a fever a few hours, it reflects the sudden tensioning of the bile duct. It is a little different colic pain, it is lively, situated in the right hypochondrium, with irradiation dorsal and anterior and posterior chest.
Although it is usually epigastric, usually more prolonged and less paroxysmal. Sometimes it is atypical, and may be limited to a simple weight of the right upper quadrant, or even absent.
Acute liver pain must fear the formation of an abscess within the liver.
Fever (90-95%)
It is always present, it means the infection of the bile ducts and discharge bacteremia, why should be performed immediately blood cultures for isolating the causative organism.
It occurs within hours of pain and changes in access pseudo-marsh, made of a succession of major peaks, more or less frequently repeated in the nycthemeron, accompanied by chills, it amounts to a temperature: 40 ° c to 41 ° C, ending with an abrupt defervescence accompanied by sweating between the febrile attacks there remains a sub febrile state.
Jaundice: (60-80%)
It appears from 12 to 48 hours, at most, it is progressive, variable intensity, ranging from a simple sub conjunctival jaundice jaundice mucocutaneous, with coloration of urine and stool discoloration and itching.
In some cases, jaundice may precede fever, which can be an argument for referral to a neoplastic etiology of chronic obstacle or not.
The pentad of REYNOLDS: (5-10%)
It involves, in addition to Charcot's triad, two signs:
- Septic shock.- Mental confusion and / or lethargy.
It is seen especially in the elderly and it is poor prognosis.
General symptoms
It should be understood in fact, that cholangitis is sepsis.The occurrence of cholangitis access leads to greater or lesser impact on the general, it is often noted for signs that may herald the onset of a severe form:
* Alteration facies.
* Acceleration of the pulse.
* Small drop in blood pressure.
* Tachypnea.
* Gastrointestinal disorders: nausea, vomiting.
* Oliguria with dark urine.
The examination
- It searches the notion of a known stone disease, history of jaundice, painful episodes of right flank or febrile episodes.
The physical examination
Clinical examination is generally poor, the palpation of right upper quadrant pain majorises (Murphy's sign), sometimes there is a moderate hepatomegaly. The liver is more or less painful, rarely can feel a big gall tense.
The presence of a defense and a contracture localized or generalized throughout the abdomen, resulting peritoneal involvement.
08:47
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