Cholangitis and charcot's triad

This is an automatically translated article.

The article is professionally consulted by Master, Doctor Nguyen Ngoc Thang - Gastroenterologist - General Surgery Department - Vinmec Danang International General Hospital. The doctor has 17 years of experience in the field of gastrointestinal and hepatobiliary surgery, and has over 9 years of experience in endoscopic intervention.
Cholangitis is an infection of the bile ducts caused by a blockage of gallstones. Cholangitis, with its typical symptoms ranging from biliary colic to fever and jaundice, is known as Charcot's triad.

1. What is the charcot triad?

Cholangitis is an infection of the bile ducts mainly caused by obstruction of gallstones.
Most cases of cholangitis have 3 typical symptoms: fever, pain and jaundice.
However, cholangitis due to gallstone obstruction will present symptoms in order from pain, to fever, and finally to jaundice. The three symptoms of cholangitis that appear in this sequence are called the charcot triad.

2. Clinical manifestations of the charcot triad

The charcot triad is characterized by the following symptoms:
2.1 Biliary colic Pain appears in the right lower quadrant suddenly, from here, the pain can spread to the right shoulder or to the back. Patients will feel pain, inability to breathe, feeling of pressure, weight, especially in elderly patients, physical decline.
The cause of the pain is a gallstone blocking the bile duct or gallbladder, causing the gallbladder to contract harder and harder to push the bile down.
2.2 Fever Fever is a typical symptom of an infection. In patients with cholangitis, fever is often accompanied by chills and high fever.

2.3 Bile Jaundice Jaundice is an important symptom of biliary tract infection. Jaundice is caused by blocked gallstones in the bile ducts or inflammation of the bile ducts. Depending on the degree of obstruction, the patient will have different degrees of jaundice.

3. Diagnosis of cholangitis

Based on the charcot triad with the above clinical manifestations, it can be concluded that cholangitis is caused by gallstone obstruction. At this time, examination and performing tests will confirm the correct results.
3.1 Hepatomegaly Depending on the degree of gallstone obstruction, the gallbladder and liver size increase differently and cause pain in the right upper quadrant and lower abdomen.
3.2 Blood tests Blood tests show that the leukocytes, erythrocytes, bilirubin, alkaline phosphatase are all increased, liver enzymes are slightly increased. If the patient with pancreatitis may show increased amylase and lipase, if there is sepsis, a blood culture will show the presence of bacteria.
3.3 Ultrasound, computed tomography Both methods allow assessment of inflammation and identification of the cause of cholangitis. However, ultrasound is widely used because of its low cost, high sensitivity, allowing assessment of gallbladder status and degree of biliary dilatation. In complex cases that require a more thorough evaluation of the entire biliary system, magnetic resonance cholangiopancreatography (MRCP) may be indicated.

4. Treatment of cholangitis

If there are symptoms of Charcot's triad, the patient needs to see a doctor to detect, diagnose and promptly treat cholangitis. Depending on the severity of the infection, there will be an appropriate treatment.
4.1 Mild cholangitis Patients receive supportive treatment to relieve symptoms such as pain relief, antibiotics, and at the same time perform blood tests to identify bacteria, prevent the risk of sepsis.
4.2 Severe cholangitis The patient is treated to reduce biliary pressure first by one of the methods such as endoscopic biliary drainage, surgery. A few severe cases or cholangitis causing complications need urgent surgery to remove stones, percutaneous drainage, ....

5. Prevention of cholangitis

Cholangitis is a common disease caused by bacteria originating from worms and causing diseases in the gastrointestinal tract. To prevent disease need:
Wash food before processing. Eat cooked, avoid eating raw food. Drink boiled water. Wash hands thoroughly before and after using the toilet. Take a dewormer periodically. If you have any of the above symptoms, you should immediately seek medical attention for timely examination and treatment. The Charcot triad are three typical symptoms of cholangitis caused by obstructed gallstones, which include biliary colic, fever, and jaundice, respectively. When these symptoms appear, patients should immediately go to specialized medical facilities for timely examination and treatment advice, avoiding long-term dangerous complications.

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