What are the characteristics of Charcot's Triad (Cholangitis, Jaundice, and Abdominal pain)?

From the Guidelines

Charcot's Triad is characterized by the presence of cholangitis, jaundice, and abdominal pain, which are classic symptoms associated with acute cholangitis, a serious infection of the bile ducts. This triad is an important diagnostic tool for identifying acute cholangitis, and the presence of two out of three symptoms should raise suspicion for cholangitis 1. The characteristics of Charcot's Triad can be broken down into:

• Cholangitis: a frequent biliary infection commonly caused by choledocholithiasis, resulting from a combination of biliary obstruction and bacterial growth in bile 1
• Jaundice: a symptom that occurs due to the obstruction of the bile ducts, leading to the accumulation of bilirubin in the blood 1
• Abdominal pain: typically right upper quadrant pain, which is a common symptom of acute cholangitis 1

When encountering a patient with these symptoms, the following steps should be taken:

1. Conduct a thorough physical examination
2. Order blood tests including liver function tests and blood cultures
3. Perform imaging studies such as ultrasound or CT scan of the abdomen Immediate treatment typically involves:
4. Intravenous antibiotics (e.g., piperacillin-tazobactam 3.375g IV every 6 hours or ceftriaxone 2g IV daily plus metronidazole 500mg IV every 8 hours)
5. Fluid resuscitation
6. Pain management
7. Biliary decompression if necessary (via ERCP or percutaneous transhepatic cholangiography) 1

It's crucial to note that all three symptoms may not always be present simultaneously, and the presence of two out of three symptoms should raise suspicion for cholangitis 1. Understanding this triad is crucial for prompt diagnosis and treatment of acute cholangitis, which can be life-threatening if not addressed quickly. The most recent guidelines recommend source control in emergency general surgery, which includes adequate antimicrobial treatment for 3–5 days and biliary decompression 1.

From the Research

Characteristics of Charcot's Triad

The characteristics of Charcot's Triad, which consists of cholangitis, jaundice, and abdominal pain, are as follows:

• Cholangitis is a life-threatening infection of the biliary tract 2
• Jaundice is a common symptom, seen in 60% of cases 3
• Abdominal pain, specifically right upper quadrant abdominal pain, is seen in 70% of cases 3
• Fever is seen in over 90% of cases 3
• The complete triad of fever and chills, jaundice, and abdominal pain is now seen less frequently, in only 50%-70% of patients 3, 4

Symptoms and Presentation

The symptoms and presentation of Charcot's Triad can vary, with some patients presenting with:

• Mild symptoms to fulminant sepsis 3
• Altered mental status and hypotension, which are associated with severe cases 3
• Reynold's Pentad, which includes fever, right upper quadrant abdominal pain, jaundice, altered mental status, and hypotension 3

Diagnosis and Treatment

Diagnosis of Charcot's Triad is commonly made by the presence of clinical features, laboratory tests, and imaging studies 5

• Treatment modalities include administration of intravenous fluids, antimicrobial therapy, and prompt drainage of the bile duct 5
• Early diagnosis and treatment of acute cholangitis are crucial to prevent unwanted clinical outcomes of the disease 5
• Endoscopic retrograde cholangiopancreatography (ERCP) is a first-line treatment for severe cases 6