The gravid uterus can mask the signs of peritoneal irritation (guarding, rigidity and rebound tenderness) by preventing the inflamed organ from contacting the peritoneum. Due to increased white blood cells that naturally occur during pregnancy, leukocytosis is not helpful in identifying acute pathology. A relative increase in blood volume can delay the development of tachycardia […]
Always think about cholangitis in any ill-appearing patient with RUQ pain or undifferentiated sepsis. Charcot’s triad and Reynold’s pentad are not reliable. Absence of these clinical findings does not rule out cholangitis. Use the total picture with clinical exam, labwork, and imaging studies. Early antibiotics and consultation for biliary decompression are mainstays of therapy.