Ascending cholangitis pentad. Dec 12, 2017 · Various type of cholangitis. The etiolog...

Charcot’s triad is the manifestation of biliary obstruction wit

By Perrine Juillion / May 11, 2019. Reynolds pentad is a collection of signs and symptoms suggesting the diagnosis obstructive ascending cholangitis, a serious infection of the biliary system. It is a combination of Charcot’s triad (right upper quadrant pain, jaundice, and fever) with shock (low blood pressure, tachycardia) and an altered ...obstructive ascending cholangitis. Reynolds' pentad is a collection of signs and symptoms consistent with obstructive ascending cholangitis, a serious infection of the biliary tract. It is a combination of Charcot's triad ( right upper quadrant pain, jaundice, and fever) with shock ( low blood pressure, tachycardia) and an altered mental status ...GW. Spectrum of cholangitis. Am J Surg 1975; 130(2):143-150. PMID 1098507. 2 Kinney TP. Management of ascending cholangitis. Gastrointest Endosc Clin N Am 2007; 17(2):289-306, vi. PMID: 17556149 . 3 Agarwal N, Sharma BC, Sarin SK. Endoscopic management of acute cholangitis in elderly patients. World JAcute cholangitis is the result of bacterial infection superimposed on partial or complete obstruction of the biliary system. It occurs in 6% to 9% of patients admitted with cholelithiasis. In the past, about 80% of cases were related to choledocholithiasis. However, due to the increase in endoscopic and radiological intervention and prolonged survival in …29) Cholangitis, ascending • Charcot’s triad: jaundice, fever, RUQ pain • Reynolds pentad: Charcot’s triad, altered mental status, hypotension • ↑ alkaline phosphatase and ↑ conjugated bilirubinReynolds pentad is a combination of clinical signs found in acute cholangitis.It consists of Charcot triad 2-4:. fever and/or chills; RUQ pain; jaundice; as well as: delirium or lethargy, and; shock; Usefulness. Sensitivity of Reynolds pentad from a large systematic review of nine studies was found to be 4.82%.3. Cholangitis. The findings of a jaundiced patient presenting with fevers and right upper quadrant pain (Charcot’s triad) should raise the suspicion of cholangitis, with an even higher index of suspicion when hypotension and altered mental status (Reynold’s pentad) are concomitantly present.suggested Reynold’s pentad or suppurative cholangitis. 4,5 We labeled the presentation of signs and symptoms as Pentad’s Triad because our patient truly manifested three of the five findings of Reynold’s pentad. Suppurative cholangitis may be associated with increased mortality, especially in the elderly population. 6,7Ascending cholangitis is an infection of the intrahepatic and extrahepatic biliary system that occurs as a consequence of stagnant bile. It is well established that both biliary obstruction and bacterobilia are necessary for clinical disease manifestation (Figure 43-1 ). Diminished biliary outflow, most commonly caused by stone disease ...Oct 1, 2023 · Ascending Cholangitis. Acute, life threatening infection of the biliary tree by Bacteria ascending from the Small Intestine (duodenum); Associated with bile duct obstruction (e.g. Common Bile Duct Stone) resulting in hepatic intraductal pressure increase Acute cholecystitis/acute ascending cholangitis: Cases of cholecystitis are commonly characterized by persistent abdominal pain in the right upper quadrant. ... comprise Reynold’s pentad. Obstruction of the biliary tree can occur due to stones or parasitic infection and is less likely due to tumors in patients younger than 32 years old ...Charcot's cholangitis triad is the combination of jaundice; fever, usually with rigors; and right upper quadrant abdominal pain. It occurs as a result of ascending cholangitis (an infection of the bile duct in the liver). When the presentation also includes low blood pressure and mental status changes, it is known as Reynolds' pentad. Acute cholangitis, or ascending cholangitis, is a form of cholangitis and refers to acute bacterial infection of the biliary tree secondary to bile duct obstruction. It is …Acute bacterial cholangitis for the most part owing to common bile duct stones is common in gastroenterology practice and represents a potentially life-threatening condition often characterized by fever, abdominal pain, and jaundice (Charcot's triad) as well as confusion and septic shock (Reynolds' pentad). ... ascending cholangitis, and ...Charcot triad is a set of three findings: abdominal pain, jaundice, and fever (occurs in 15-20%), and Reynolds' pentad which includes the findings of Charcot triad with the additional presence of septic shock and mental confusion., infection of the gallbladder. ... Ascending cholangitis. infection of the gallbladder. Patients may also have ...31‏/08‏/2022 ... ... pentad ~7% of cases Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications First published November 18, 2015; Updated ...Charcot’s triad is the manifestation of biliary obstruction with upper abdominal pain, fever and jaundice. The condition may progress rapidly to Reynold’s pentad, which consists of Charcot’s triad with confusion and hypotension. Acute cholangitis is a serious complication of biliary disease where the bile duct is obstructed by either ...Acute cholangitis is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture. . ... Management of ascending cholangitis. …PM Advances in intensive care, antibiotic treatment regimens, and biliary drainage techniques have dramatically improved the mortality rate from over 50% prior to the 1970s to less than 7% in the 1980s. However, the mortality rate due to cholangitis remains significant without appropriate management. Thus, early diagnosis of acute cholangitis ...Acute cholangitis (also called ascending cholangitis) — this occurs when there is complete obstruction of the bile duct resulting in cholestasis and infected bile which can be life threatening. Fistula formation — if a gallstone erodes through the gallbladder a fistula can develop causing duodenal obstruction (Bouveret's syndrome). Erosion ...Ascending Cholangitis: Pathogenesis and clinical findings Authors: Brandon Hisey, Neel Mistry Reviewers: Alec Campbell, Vina Fan, Ben Campbell, Kelly Burak*, Eldon Shaffer* * MD at time of publication Reflux of biliary contents into the vascular system (cholangiovenous reflux) Bacteria ascends into biliary tract from duodenum via Sphincter …Ascending cholangitis. Question 9 from the second paper of 2016, and the identical Question 21 from the second paper of 2018, presented the candidates with a scenario of an elderly woman with jaundice, confusion, hypotension, fever and abdominal pain. This describes Reynolds' Pentad, the constellation of clinical signs which is actually absent ...Definition of cholangitis. Cholangitis syndromes are complex end-stage hepatobiliary disorders.1 Given this broad concept, a wide range of abnormalities fall into the diagnostic criteria for cholangitis. These are generally associated with severe inflammation and fibrosis of the hepatobiliary system that is characterized by eventual narrowing and obstruction of the bile ducts.2 Therapeutic ...Reynold’s pentad is seen in suppurative cholangitis. ... [31] [32][33] Anemia and ascending cholangitis were the commonest complications in this study. Cholangitis following surgery can be ...急性胆管炎 (Acute cholangitis),也称为 上行性胆管炎 或简称 胆管炎 ,是 胆管 炎症 ,通常由 细菌 从 十二指肠 ( 小肠 的第一部分) 交界处 上行引起。. 如果胆管已经被 胆结石 部分阻塞,则容易发生。. [1] [2] 胆管炎可能危及生命,被视为 医疗紧急情况 ... Severe acute cholangitis is acute cholangitis associated with at least one of cardiovascular, neurological, respiratory, renal, hepatic and/or haematological dysfunction. 10-20% of patients also present with the additional features of hypotension due to septic shock and mental confusion - the Reynolds' pentad.This results in consecutive ascension of bacteria into the bile system causing ascending cholangitis.33,34 In patients who develop cholangitis before surgery, persistent obstruction causes bacterial overgrowth and increase of ductal pressure, which then leads to reflux of bacteria and toxins in the close-by veins and lymphatics, resulting in ...One such sequela is ascending cholangitis, with symptoms of right upper abdominal pain, fever, and jaundice (Charcot's triad). Progression of this condition is indicated by neurologic changes and hypotension (Reynold's pentad). Other sequelae are acute pancreatitis with symptoms of mid-epigastric pain and intractable vomiting.Diagnosis of Ascending Cholangitis The classic clinical characteristics of AC are fever, right-upper-quadrant (RUQ) abdominal pain, and jaundice (Charcot's triad). More severe cases may present with hypotension and altered mental status (Reynold's pentad). However, because few cases present with all of these features, standardized ...Cholecystitis and Cholangitis . Diagnosis. Author "Agency for Healthcare Research and Quality (AHRQ)" Created Date: 10/23/2019 10:32:00 Title: Cholecystitis and Cholangitis Subject: AHRQ Safety Program for Improving Antibiotic …suggested Reynold’s pentad or suppurative cholangitis. 4,5 We labeled the presentation of signs and symptoms as Pentad’s Triad because our patient truly manifested three of the five findings of Reynold’s pentad. Suppurative cholangitis may be associated with increased mortality, especially in the elderly population. 6,7One such sequela is ascending cholangitis, with symptoms of right upper abdominal pain, fever, and jaundice (Charcot's triad). Progression of this condition is indicated by neurologic changes and hypotension (Reynold's pentad). Other sequelae are acute pancreatitis with symptoms of mid-epigastric pain and intractable vomiting.Ascending cholangitis, also known as acute cholangitis or simply cholangitis, is inflammation of the bile duct, usually caused by bacteria ascending from its junction with …By Perrine Juillion / May 11, 2019. Reynolds pentad is a collection of signs and symptoms suggesting the diagnosis obstructive ascending cholangitis, a serious infection of the biliary system. It is a combination of Charcot’s triad (right upper quadrant pain, jaundice, and fever) with shock (low blood pressure, tachycardia) and an altered ...Diagnostic criteria for acute cholangitis. A variety of different names and definitions of acute cholangitis are found in the literature, depending on the authors.6,8,10–17 Some authors defined acute cholangitis based on clinical sign’s such as Charcot’s triad (fever and/or chills, abdominal pain, and jaundice),6,16–17 while others …... cholangitis, supportive cholangitis and ascending cholangitis). AC is ... The Reynolds' pentad is defined as the occurrence of confusion and shock along with ...In contrast to the intermittent obstruction that results in biliary colic, persistent CBD obstruction can result in cholangitis, which presents with Charcot's classic triad (fever/rigors, jaundice, and right upper quadrant pain) or Reynold's pentad (Charcot's triad plus hypotension and altered mental status) (see Chapter 43).Charcot triad is a set of three findings: abdominal pain, jaundice, and fever (occurs in 15-20%), and Reynolds' pentad which includes the findings of Charcot triad with the additional presence of septic shock and mental confusion., infection of the gallbladder. ... Ascending cholangitis. infection of the gallbladder. Patients may also have ...In a smaller study of 17 patients with cholangitis only, 4 patients (23.5%) presented with Charcot triad while only 1 patient presented with the complete pentad. 9 A similarly low prevalence was noted in a study that also included patients with biliary strictures and primary sclerosing cholangitis with only 15.6% of younger patients and 18.8% ...Cholangitis is also referred to as ascending cholangitis for this reason; biliary outflow is obstructed and inflammation occurs proximal to the obstruction in an ascending fashion. ... Reynold’s pentad may also be seen in cholangitis and includes Charcot’s triad plus hypotension and altered mental status. Charcot’s Triad in …In acute cholangitis, bile duct obstruction allows bacteria to ascend from the duodenum.Most (85%) cases (1 General reference Choledocholithiasis is the presence of stones in bile ducts; the stones can form in the gallbladder or in the ducts themselves.These stones cause biliary colic, biliary obstruction, gallstone... read more ) result from common …Purpose. Differentiating upper right quadrant pain. In medicine, Murphy's sign (also known as Sweeney’s sign) is a maneuver during a physical examination as part of the abdominal examination. [1] It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis, but negative in choledocholithiasis ...Mar 11, 2020 · Background. Cholangitis is an infection of the biliary tract with the potential to cause significant morbidity and mortality. Many patients with acute cholangitis respond to antibiotic therapy; however, patients with severe or toxic cholangitis may not respond and may require emergency biliary drainage. PM Advances in intensive care, antibiotic treatment regimens, and biliary drainage techniques have dramatically improved the mortality rate from over 50% prior to the 1970s to less than 7% in the 1980s. However, the mortality rate due to cholangitis remains significant without appropriate management. Thus, early diagnosis of acute cholangitis ...Apr 8, 2021 · In a smaller study of 17 patients with cholangitis only, 4 patients (23.5%) presented with Charcot triad while only 1 patient presented with the complete pentad. 9 A similarly low prevalence was noted in a study that also included patients with biliary strictures and primary sclerosing cholangitis with only 15.6% of younger patients and 18.8% ... In cases of ascending cholangitis secondary to gallstones, sphincterotomy and stone extraction with or without trans-papillary biliary stent placement are recommended . Concurrent acute bacterial cholangitis with acute cholecystitis is also reported and considered a gastrointestinal emergency that warrants immediate treatment initiation [ 50 ].Ascending cholangitis. Question 9 from the second paper of 2016, and the identical Question 21 from the second paper of 2018, presented the candidates with a scenario of an elderly woman with jaundice, confusion, hypotension, fever and abdominal pain. This describes Reynolds' Pentad, the constellation of clinical signs which is actually absent ...Sclerosing cholangitis refers to swelling (inflammation), scarring, and destruction of the bile ducts inside and outside of the liver. Sclerosing cholangitis refers to swelling (inflammation), scarring, and destruction of the bile ducts ins...Etiology . Acute cholangitis requires the presence of two factors: (1) biliary obstruction and (2) bacterial growth in bile (bile infection). Frequent causes of biliary obstruction are choledocholithiasis, benign biliary stenosis, stricture of a biliary anastomosis, and stenosis caused by malignant disease (level 4).5,6 Choledocholithiasis used to be …In a smaller study of 17 patients with cholangitis only, 4 patients (23.5%) presented with Charcot triad while only 1 patient presented with the complete pentad. 9 A similarly low prevalence was noted in a study that also included patients with biliary strictures and primary sclerosing cholangitis with only 15.6% of younger patients and 18.8% ...Ascending Cholangitis •Charcot’s Triad • Jaundice • Fever • RUQ abdominal pain •Reynold’s Pentad • Altered mental status • Shock Treatment •Resuscitation in ICU setting •Antibiotics •Immediate Biliary Drainage • ERCP with stent or sphincterotomy • PTC (percutaneous transhepatic drainage) in poor procedural candidateAscending Cholangitis. Acute, life threatening infection of the biliary tree by Bacteria ascending from the Small Intestine (duodenum); Associated with bile duct obstruction (e.g. Common Bile Duct Stone) resulting in hepatic intraductal pressure increaseAscending cholangitis refers to infection of the biliary ducts most commonly seen in those >50 years old and caused by obstruction, which requires immediate diagnosis and treatment. ... This is known as Reynold's pentad and indicates worsening of the condition and development of sepsis.suggested Reynold’s pentad or suppurative cholangitis. 4,5 We labeled the presentation of signs and symptoms as Pentad’s Triad because our patient truly manifested three of the five findings of Reynold’s pentad. Suppurative cholangitis may be associated with increased mortality, especially in the elderly population. 6,705‏/03‏/2018 ... ... ascends to the biliary duct, resulting in acute ascending cholangitis. ... Reynolds' pentad: Described by B. M. Reynolds in 1959. In addition to ...Acute cholangitis (also called ascending cholangitis) — this occurs when there is complete obstruction of the bile duct resulting in cholestasis and infected bile which can be life threatening. Fistula formation — if a gallstone erodes through the gallbladder a fistula can develop causing duodenal obstruction (Bouveret's syndrome). Erosion ...Jan 28, 2021 · The severity of cholangitis is due to infection dissemination with risk of septic shock and organ failure. “The Reynolds pentad,” described in 1958 as Charcot triad-shock-confusion, was associated with high mortality in the absence of adequate treatment . Early diagnosis and recognition of severe presentations are therefore a challenging ... Apr 27, 2022 · Severe acute cholangitis is acute cholangitis associated with at least one of cardiovascular, neurological, respiratory, renal, hepatic and/or haematological dysfunction. 10-20% of patients also present with the additional features of hypotension due to septic shock and mental confusion - the Reynolds' pentad. May 13, 2017 · Charcot’s triad (fever, right upper quadrant pain, and jaundice) is present in 56-70% of patients. 1 Individuals with ascending cholangitis frequently report mild abdominal pain and nausea. Charcot’s triad + hemodynamic instability and altered mental status = Reynold’s pentad (5-7% of patients with ascending cholangitis; associated with ... 急性胆管炎 (Acute cholangitis),也称为 上行性胆管炎 或简称 胆管炎 ,是 胆管 炎症 ,通常由 细菌 从 十二指肠 ( 小肠 的第一部分) 交界处 上行引起。. 如果胆管已经被 胆结石 部分阻塞,则容易发生。. [1] [2] 胆管炎可能危及生命,被视为 医疗紧急情况 ... The most frequent cause of cholangitis in industrialized countries is choledoco-lithiasis (>80% of cases), secondary to cholelithiasis; other possible causes are sclerosing cholangitis, neoplasia (10–20% of cases), ERCP, advanced age (>70 years), neurological diseases, the presence of peri-ampullary diverticula, fibrosis of the papilla, pancreatitis, bile duct neoplasia, and metastasis of ...Feb 9, 2016 · Background Acute cholangitis is a life-threatening bacterial infection of the biliary tract. Main focus of this study was to create a useful risk prediction model that helps physicians to assign patients with acute cholangitis into different management groups. Methods 981 cholangitis episodes from 810 patients were analysed retrospectively at a German tertiary center. Results Out of eleven ... Acute or ascending cholangitis is a potentially life-threatening systemic infection resulting from inflammation and infection of the biliary tree due to bacterial growth in the bile, usually in the context of biliary obstruction ... Reynold's pentad (~5% of cases): Charcot triad plus altered mental state and shock; INVESTIGATIONS. Bedside.Jul 3, 2023 · Acute cholangitis, also known as ascending cholangitis, is a life-threatening condition that is caused by an ascending bacterial infection of the biliary tree. Delay in diagnosis and treatment can lead to septic shock. The severity of cholangitis is due to infection dissemination with risk of septic shock and organ failure. “The Reynolds pentad,” described in 1958 as Charcot triad-shock-confusion, was associated with high mortality in the absence of adequate treatment . Early diagnosis and recognition of severe presentations are therefore a challenging ...Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It is also referred to as ascending cholangitis. Cholangitis was first described by Charcot as a serious and life-threatening illness; however, it is now recognized that the ...In cases of ascending cholangitis secondary to gallstones, sphincterotomy and stone extraction with or without trans-papillary biliary stent placement are recommended . Concurrent acute bacterial cholangitis with acute cholecystitis is also reported and considered a gastrointestinal emergency that warrants immediate treatment initiation [ 50 ].abdominal pain. jaundice. pale stools. diarrhea. Certain types of cholangitis may also cause joint pain. Cholangitis can also lead to a bile duct infection, which can cause the following symptoms ...Feb 7, 2023 · Patients can also present with Reynolds pentad, which is the Charcot triad (fever, pain and jaundice) plus shock and delirium (and/or lethargy) 1-3. Pathology. Gram-negative enteric bacteria, most commonly Escherichia coli, are the primary pathogens 3. Acute cholangitis is seen in the setting of biliary tree obstruction 1,2: Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It is also referred to as ascending cholangitis. Cholangitis was first described by Charcot as a serious and life-threatening illness; however, it is now recognized that the ...Cholangitis is a serious life-threatening situation affecting the hepatobiliary system. This review provides an update regarding the clinical and pathological features …Choledocholithiasis is the presence of stones in bile ducts; the stones can form in the gallbladder or in the ducts themselves. These stones cause biliary colic, biliary obstruction, gallstone pancreatitis, or cholangitis (bile duct infection and inflammation). Cholangitis, in turn, can lead to strictures, stasis, and choledocholithiasis. Ascending cholangitis. Ascending cholangitis also known as acute cholangitis, is a bacterial infection superimposed on an obstruction of the biliary tree most commonly from a gallstone, but it may be associated with neoplasm or stricture 1. The classic Charcot’s Triad of findings is right upper quadrant (RUQ) pain, fever, and jaundice.Excerpt. Acute cholangitis, also known as ascending cholangitis, is a life-threatening condition caused by an ascending bacterial infection of the biliary tree. Choledocholithiasis is the most common cause, with infection-causing stones in the common bile duct leading to partial or complete obstruction of the biliary system.Acute cholangitis is a clinical syndrome characterized by fever, jaundice, and abdominal pain that develops as a result of stasis and infection in the biliary tract. It is also referred to as ascending cholangitis. Cholangitis was first described by Charcot as a serious and life-threatening illness; however, it is now recognized that the ...02‏/05‏/2022 ... Confusion and hypotension can occur in patients with severe cholangitis (Reynolds pentad) ... 37 : Ascending cholangitis: surgery versus endoscopic ...Reynolds pentad is a collection of signs and symptoms suggesting the diagnosis obstructive ascending cholangitis, a serious infection of the biliary system. It is a combination of Charcot’s triad (right upper quadrant pain, jaundice, and fever) with shock (low blood pressure, tachycardia) and an altered mental status.Choledocholithiasis is the presence of stones in bile ducts; the stones can form in the gallbladder or in the ducts themselves. These stones cause biliary colic, biliary obstruction, gallstone pancreatitis, or cholangitis (bile duct infection and inflammation). Cholangitis, in turn, can lead to strictures, stasis, and choledocholithiasis. Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States. These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur. Bile flows out the gallbladder, down the ...Check us out on Facebook for DAILY FREE REVIEW QUESTIONS and updates! (https://www.facebook.com/medschoolmadeeasy) Check out our website for TONS OF FREE REV...Reynold’s pentad – Charcot’s triad, mental status changes and septic shock. ... If patient with high fever, chills, jaundice and is toxic appearing, suspect ascending cholangitis.Mar 14, 2017 · 3.Definition acute, ascending bacterial infection of the biliary tree caused by an obstruction Bile duct inflammation a spectrum of disease presents variably with a wide range of severity Charcot triad with fever, jaundice, and right upper quadrant pain mental status changes and hypotension join Charcot triad to become Reynolds pentad 3 components 1. obstruction of bile flow 2. colonization of ... Ascending Cholangitis or acute cholangitis is an infection of the bile duct, usually ... The Reynolds pentad adds mental status changes and sepsis to the triad. A spectrum of cholangitis exists, ranging from mild symptoms to fulminant overwhelming sepsis. With septic shock, the diagnosis can be missed in up to 25% of patients.Ascending Cholangitis. A 56-year-old woman presents to the emergency room for skin discoloration, fevers, and abdominal pain. Her past medical history includes hyperlipidemia, obesity, diabetes, and gallstones. On physical exam, she is febrile, tachycardic, and jaundiced. She is tender to palpation in the right upper quadrant.Charcot's cholangitis triad is the combination of jaundice; fever, usually with rigors; and right upper quadrant abdominal pain. It occurs as a result of ascending cholangitis (an infection of the bile duct in the liver). When the presentation also includes low blood pressure and mental status changes, it is known as Reynolds' pentad. It is named for Jean-Martin Charcot. Feb 7, 2023 · Patients can also present with Reynolds pentad, which is the Charcot triad (fever, pain and jaundice) plus shock and delirium (and/or lethargy) 1-3. Pathology. Gram-negative enteric bacteria, most commonly Escherichia coli, are the primary pathogens 3. Acute cholangitis is seen in the setting of biliary tree obstruction 1,2: In a smaller study of 17 patients with cholangitis only, 4 patients (23.5%) presented with Charcot triad while only 1 patient presented with the complete pentad. 9 A similarly low prevalence was noted in a study that also included patients with biliary strictures and primary sclerosing cholangitis with only 15.6% of younger patients and 18.8% .... Nov 30, 2018 · Diagnosis of Ascending CholangFeb 7, 2023 · Patients can also present with Reynolds pe Charcot's triad: fever, RUQ pain and jaundice; Reynold's pentad: as above + hypotension and AMS; a retrospective review of 108 pts with a diagnosis of acute ...Acute Cholangitis. One of the most feared complications of biliary obstruction is acute ascending cholangitis, which is an infection of the biliary tree due to obstruction, which can quickly lead to systemic sepsis and resultant multi-organ failure. ... fever, and jaundice) or Reynold’s pentad (Charcot's triad with mental status change and ... Cholangitis is an inflammation of the bile duct syst Ascending Cholangitis. A 56-year-old woman presents to the emergency room for skin discoloration, fevers, and abdominal pain. Her past medical history includes hyperlipidemia, obesity, diabetes, and gallstones. On physical exam, she is febrile, tachycardic, and jaundiced. She is tender to palpation in the right upper quadrant.Acute cholangitis, also referred to as ascending cholangitis, is an infection of the biliary tree characterized by fever, jaundice, and abdominal pain, which in most cases is the consequence of biliary obstruction. 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