Charcot triad
Summary
Charcot triad refers to the classic combination of fever/chills, right upper quadrant (RUQ) pain, and jaundice, which is associated with ascending cholangitis. It indicates biliary obstruction complicated by infection, typically due to choledocholithiasis. This is a medical emergency requiring prompt biliary decompression and antibiotics.
Detail
Charcot triad consists of: (1) fever with chills (due to bacteremia/systemic infection), (2) right upper quadrant abdominal pain, and (3) jaundice (due to biliary obstruction causing conjugated hyperbilirubinemia). It is classically seen in acute ascending cholangitis, most commonly caused by choledocholithiasis (gallstone obstructing the common bile duct), which leads to bile stasis and secondary bacterial infection (commonly E. coli, Klebsiella, Enterococcus). The pathophysiology involves biliary obstruction leading to increased intraluminal pressure, bacterial translocation, and bacteremia. When altered mental status and hypotension/shock are added to the triad, it becomes Reynolds pentad, indicating suppurative cholangitis and higher mortality. Diagnosis is supported by labs showing elevated bilirubin, alkaline phosphatase, and leukocytosis, with imaging (ultrasound or MRCP) showing bile duct dilation or stones. Treatment involves IV antibiotics and urgent biliary decompression, typically via ERCP with sphincterotomy and stone extraction, or percutaneous drainage if ERCP is unavailable. It's important to distinguish Charcot triad (cholangitis) from Charcot's neurologic triad (nystagmus, intention tremor, scanning speech - associated with multiple sclerosis) as these are commonly confused on exams.
Sources
- First Aid for the USMLE Step 1
- Harrison's Principles of Internal Medicine
- UpToDate: Acute cholangitis: Clinical manifestations, diagnosis, and management
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