Ascending Cholangitis

Key points

• Ascending cholangitis is a bacterial infection of the biliary tree. The most common predisposing factor is gallstones. Charcot's triad of right upper quadrant (RUQ) pain, fever and jaundice occurs in about 20-50% of patients
• fever is the most common feature, seen in 90% of patients
• hypotension and confusion are also common (the additional 2 factors in addition to the 3 above make Reynolds' pentad) Management
• intravenous antibiotics
• endoscopic retrograde cholangiopancreatography (ERCP) after 24-48 hours to relieve any obstruction