History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors for the development of cholangitis include: age over 50 years; history of cholelithiasis, primary or secondary sclerosing cholangitis, stricture of the biliary tree (benign or malignant), or post-procedure injury of bile ducts (surgical, endoscopic, or radiological intervention with resulting inadequate biliary drainage).

right upper quadrant (RUQ)/upper abdominal pain

Present in 80% or more of patients with cholangitis, although the symptom is non-specific.[1]

Patients with cholangitis typically have diffuse RUQ pain and not classic Murphy's sign.

RUQ/upper abdominal tenderness

Present in 65% of patients.[1]

jaundice

Obstructive jaundice secondary to biliary obstruction. Present in 60% to 70% of patients.[1]

fever

Present in 90% of patients. Fever can be absent in older patients (over 60 years of age).[1]

Other diagnostic factors

common

pale stools

Putty/clay coloured stools may be seen due to deficient bile secretion to the small intestine.

pruritus

Sensation of itch associated with any liver disease may be reported.

uncommon

hypotension

Indicative of severe disease and associated with a poor prognosis.[36]​ Present in 30% of patients.[1][29]

mental status changes

Indicative of severe disease and associated with a poor prognosis. Present in 15% of patients.[1][29]​

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