A man presented with (+) fever, chills and jaundice. Diagnosis:
Ans. (b) Acute CholangitisRef.: Harrison 18th edition, chapter 311Acute cholangitis* The characteristic presentation of acute cholangitis involves biliary pain, jaundice, and spiking fevers with chills (Charcot's triad).* Cholangitis may be acute or chronic, and symptoms result from inflammation, which usually is caused by at least partial obstruction to the flow of bile.* ERCP with endoscopic sphincterotomy is safe and the preferred initial procedure for both establishing a definitive diagnosis and providing effective therapy.* Blood cultures are frequently positive, and leukocytosis is typical.Acute Cholecystitis* Attack of biliary pain that progressively worsens. Approximately 60-70% of patients report having experienced prior attacks that resolved spontaneously.* As the episode progresses, however, the pain of acute cholecystitis becomes more generalized in the right upper abdomen, which may radiate to right shoulder.* Jaundice is unusual early in the course of acute cholecystitis but may occur when edematous inflammatory changes involve the bile ducts and surrounding lymph nodes.Acute viral hepatitisThis is the closest differential diagnosis and is ruled out because of the following points mentioned below.* The prodromal symptoms like anorexia, nausea and vomiting, fatigue, malaise, arthralgias, myalgias, headache, photophobia, pharyngitis, cough, and coryza may precede the onset of jaundice by 1-2 weeks.* The nausea, vomiting, and anorexia are frequently associated with alterations in olfaction and taste.* A low-grade fever between 38deg and 39degC (100deg-102<>F) is more often present in hepatitis A and E than in hepatitis B or C, except when hepatitis B is heralded by a serum sickness-like syndrome.* Dark urine and clay-colored stools may be noticed by the patient from 1-5 days before the onset of clinical jaundice
Acute Cholecystitis
Acute cholangitis
Choledocholithiasis
Acute viral hepatitis
Gall Bladder