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Diseases of the Hepatobiliary Tree and Pancreas Associated with Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Clinical manifestations — Cholangitis secondary to common duct stones is typified by Charcot’s triad, namely, biliary colic, jaundice, and fever (with chills). These may be accompanied by hypotension and confusion, making a pentad, which Reynolds and Dargan felt was characteristic of suppurative cholangitis and had a poor prognosis. However, the term has limited value today, as pus may be found in the biliary tree at the time of surgery in patients who do not have a toxic presentation. Vomiting occurs in about half the cases. Charcot’s triad is not universally present. Colicky pain is occasionally absent and the patient may present with prolonged unexplained fever.6,205,206 Another clinical variant is that of fever, chills, and pruritus without jaundice or pain.
Acute Cholangitis
Published in Stephen M. Cohn, Matthew O. Dolich, Kenji Inaba, Acute Care Surgery and Trauma, 2016
Adrian W. Ong, Shannon M. Foster
Recently, comprehensive guidelines establishing diagnostic criteria and a severity classification scheme were developed by expert consensus (“Tokyo Guidelines”). First developed and published in 2007 (“TG07”) [5], the guidelines have recently been revised (“TG13”) [6]. The challenges of establishing objective diagnostic criteria for AC were noted. A set of three standards were proposed (presence of purulent biliary drainage, clinical remission with biliary drainage, and improvement with antimicrobial agents alone when the biliary tree was the only infectious source) and applied to 1432 patients from several centers, to classify patients as those with or without acute cholangitis. Plausible variables were then refined iteratively. The revised TG13 diagnostic criteria (Table 57.1) were found to have a sensitivity of 92% and a specificity of 78% when applied against the aforementioned “gold standards.” Of note, based on the TG13 guidelines, Charcot’s triad had a low sensitivity but high specificity for diagnosis of acute cholangitis [6,7].
General surgery
Published in Janesh K Gupta, Core Clinical Cases in Surgery and Surgical Specialties, 2014
Matthew Clark, Jevan Taylor, Steven Thrush
Abdominal examination may reveal tenderness and even peritonism in the right upper quadrant. Murphy’s sign – the cessation of inspiration as the inflamed gallbladder descends onto the examining fingers in the right upper quadrant – is tested. Charcot’s triad (jaundice, fever with rigors and right upper quadrant pain) indicate ascending cholangitis.
Neuroanniversary 2018
Published in Journal of the History of the Neurosciences, 2018
Jean Martin Charcot (1825–1893) described in his article “Histologie de la sclérose en plaques,” appearing in 1868 in Gazette des Hôpitaux, three characteristic symptoms of multiple sclerosis, also referred to as Charcot’s triad: nystagmus, intention tremor, and telegraphic speech (scanning speech).
The possible association of proton pump inhibitor use with acute cholangitis in patients with choledocholithiasis: a multi-center study
Published in Scandinavian Journal of Gastroenterology, 2023
Wisam Sbeit, Hani Abukaes, Helal Said Ahmad, Moeen Sbeit, Itai Kalisky, Lior Katz, Amir Mari, Tawfik Khoury
We conducted a cross sectional, multicenter retrospective study, using the databases of Galilee Medical Center, EMMS Nazareth Hospital and Hadassah Medical Center. These medical centers cover three districts, two at the north and one in the center of Israel, giving service to almost 1.5 million inhabitants from native Arabs, native Jewish and immigrants (most of them from the former Soviet Union). Therefore, our study population is likely to be representative of the overall country population. All patients who were hospitalized with various clinical presentations due to documented common bile-duct stones including acute cholangitis, biliary pancreatitis, and biliary colic with liver enzyme abnormality during a 10-year period, were considered potentially eligible for enrollment in the study. Patients were excluded if they had suspected or confirmed diagnosis of hepato-biliary and pancreatic malignancies, and if they had suffered a previous episode of acute cholangitis. PPI consumption in all remaining patients was scrutinized, and PPI use of more than four weeks’ duration was considered active use; these patients were included in the study. Patients with clinical manifestation of acute cholangitis, defined by the presence of fever, jaundice, and abdominal pain (Charcot triad), were compared with choledocholithiasis patients who specifically did not have acute cholangitis, in a search for a probable causative effect of PPI consumption on cholangitis and/or its severity. Data extracted from files included demographic variables (age, gender), alcohol use defined by any alcohol drinking, the presence of background diseases, PPI use and presence of gallbladder and gallstones. Moreover, data regarding acute cholangitis severity were extracted and were correlated to PPI use. The data were extracted from the hospital medical documentations and charts and in case of missing data, we accessed the central patient’s registry database to extract all the required information. The data were categorized and coded in an excel database sheet, and statistical analysis by a blinded statistician was performed. Categorial variables were reported as yes or no, and continuous variables were reported as absolute numbers.