What are the key clinical features to consider when diagnosing acute cholangitis in a primary care setting?

Key clinical features to consider when diagnosing acute cholangitis in primary care include:

• Systemic signs of infection such as fever and chills, indicating sepsis or systemic inflammatory response.
• Jaundice, which suggests biliary obstruction or liver dysfunction.
• Right upper quadrant abdominal pain or tenderness, reflecting biliary tract inflammation or obstruction.
• Signs of biliary obstruction such as dark urine, pale stools, or pruritus may also be present.
• Laboratory findings, if available, may show abnormal liver function tests, particularly elevated bilirubin and cholestatic enzymes.
• Because acute cholangitis is a serious complication of gallstone disease, any patient with known gallstones presenting with these features should be urgently referred for hospital assessment.
• In primary care, the presence of jaundice or systemic illness with suspected biliary obstruction mandates urgent referral to secondary care for further investigation and management.

These features align with the recommendations to urgently refer patients with suspected complications of gallstone disease such as cholangitis, especially if jaundice or abnormal liver function tests are present, as acute cholangitis requires hospital admission and specialist management ²,³.