From the Guidelines
Charcot's triad is a set of three clinical findings that strongly suggests acute cholangitis, consisting of abdominal pain, jaundice, and fever, which requires immediate treatment with intravenous antibiotics and urgent biliary decompression to prevent morbidity and mortality. The triad occurs when a bile duct obstruction, typically from gallstones, allows bacteria to proliferate in the biliary system, leading to a serious bacterial infection of the bile ducts. According to the most recent study 1, acute cholangitis is a frequent biliary infection commonly caused by choledocholithiasis, and source control is based on adequate antimicrobial treatment for 3–5 days and biliary decompression.
The pathophysiology involves increased biliary pressure from obstruction, bacterial colonization, and subsequent systemic inflammatory response. While the classic triad is specific for cholangitis, it's present in only about 50-70% of cases, with some patients presenting with incomplete manifestations. The choice of antibiotic agent should be directed by local practice after taking into consideration the history, severity of liver or renal disease, and bacterial sensitivities, as suggested by 1.
Key points to consider in the management of Charcot's triad include:
- Immediate initiation of antimicrobial therapy to improve survival, as emphasized by 1
- Urgent biliary decompression through endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage, or surgery to prevent septic shock
- Hospitalization to monitor for complications and provide supportive care
- Consideration of the patient's underlying condition, such as primary sclerosing cholangitis (PSC), which may require a multidisciplinary approach, as noted by 1.
Overall, prompt recognition and treatment of Charcot's triad are crucial to preventing morbidity and mortality associated with acute cholangitis.
From the Research
Definition of Charcot's Triad
Charcot's triad is a set of three common symptoms associated with acute cholangitis, which is an infection of the biliary tract. The triad consists of:
- Cholangitis
- Jaundice
- Abdominal pain
Description of Charcot's Triad
According to various studies 2, 3, 4, 5, 6, Charcot's triad is characterized by the presence of fever, jaundice, and abdominal pain, which are the most common symptoms of acute cholangitis. These symptoms occur due to the infection and obstruction of the biliary system, often caused by common bile duct stones.
Clinical Presentation
The clinical presentation of Charcot's triad may vary, but it typically includes:
- Fever
- Jaundice
- Abdominal pain
- Leukocytosis (elevated white blood cell count)
- Elevated alkaline phosphatase and bilirubin levels
Diagnosis and Treatment
Diagnosis of acute cholangitis is often made based on the presence of Charcot's triad, laboratory tests, and imaging studies 3, 4, 5. Treatment typically involves: