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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The clinical features of cholangitis include:

  • Charcot's triad: all three symptoms are observed in about 50–70 % of patients
    • right upper quadrant pain (biliary colic)
    • fluctuating jaundice
    • swinging pyrexia (usuually with rigors)
  • additionally, Charcot’s triad plus hypotension and a decreased level of consciousness (Reynolds’ pentad) can be observed in a more severe form of acute cholangitis in septic shock (1)
  • leukocytosis
  • raised serum bilirubin and alkaline phosphatase
  • bacteraemia - involving the common bile organisms, in decreasing frequency, E. coli, Klebsiella, Pseudomonas, enterococci, and Proteus, and in about 25% of cases, Bacteroides fragilis and Clostridium perfringens.


  • Charcot's triad - less than one-third of patients present with this classical clinical picture
  • the majority of patients have fever
  • about two-thirds have jaundice; pain, if present, is often mild
  • acute cholangitis is more common in older people but can be difficult to diagnose
    • older patients may present with non-specific features such as confusion and malaise, without specific symptoms localised to the biliary tract


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