eMedicine Specialties > Gastroenterology > Biliary

Cholangitis: Differential Diagnoses & Workup

Author: Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Coauthor(s): Praveen K Roy, MD,, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute, Albuquerque; Victor Nwakakwa, MD, MRCP (UK), Clinical Instructor, Department of Internal Medicine, Division of Gastroenterology, University of Virginia Health System
Contributor Information and Disclosures

Updated: Nov 16, 2009

Differential Diagnoses

Primary Sclerosing Cholangitis

Other Problems to Be Considered

Consider variants such as Asian cholangitis, sclerosing cholangitis, and AIDS-related cholangitis.

Workup

Laboratory Studies

  • Obtain CBC count, liver function tests, and blood cultures.
  • Common laboratory findings include leukocytosis, hyperbilirubinemia (patients with a malignant obstruction generally have a significantly higher bilirubin level than those with a benign obstruction), and elevated alkaline phosphatase levels.
  • Other possible laboratory findings include elevation of transaminases and serum amylase levels (due to possible concurrent pancreatitis from stone impaction at the ampulla of Vater).
  • Blood culture findings are positive in nearly 50% of patients.
  • Bile culture findings are positive in nearly all patients.
  • Multiple organisms are identified in approximately 60% of patients. Commonly reported aerobic organisms include Escherichia coli and Klebsiella and Enterococcus species. The most commonly reported anaerobic organism is Bacteroides fragilis.

Imaging Studies

  • Abdominal ultrasound

Procedures

  • The following procedures may be used for diagnostic and therapeutic purposes:
    • Endoscopic retrograde cholangiopancreatography (ERCP)
    • Percutaneous transhepatic cholangiography (PTC)

More on Cholangitis

Overview: Cholangitis
Differential Diagnoses & Workup: Cholangitis
Treatment & Medication: Cholangitis
Follow-up: Cholangitis
References
Further Reading
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References

  1. Lee JG. Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol. Aug 4 2009;[Medline].

  2. Lee KF, Chong CN, Ng D, et al. Outcome of surgical treatment for recurrent pyogenic cholangitis: a single-centre study. HPB (Oxford). 2009;11(1):75-80. [Medline]. [Full Text].

  3. Shojaiefard A, Esmaeilzadeh M, Ghafouri A, Mehrabi A. Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208. [Medline].

  4. Li FY, Cheng NS, Mao H, Jiang LS, et al. Significance of controlling chronic proliferative cholangitis in the treatment of hepatolithiasis. World J Surg. Jul 30 2009;epub ahead of print. [Medline].

  5. Bai Y, Gao F, Gao J, Zou DW, Li ZS. Prophylactic antibiotics cannot prevent endoscopic retrograde cholangiopancreatography-induced cholangitis: a meta-analysis. Pancreas. Mar 2009;38(2):126-30. [Medline].

  6. Bilhartz LE, Horton JD. Gallstone disease and its complications. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 6th ed. 1998:948-972.

  7. Hanau LH, Steigbigel NH. Acute (ascending) cholangitis. Infect Dis Clin North Am. Sep 2000;14(3):521-46. [Medline].

  8. Kadakia SC. Biliary tract emergencies. Acute cholecystitis, acute cholangitis, and acute pancreatitis. Med Clin North Am. Sep 1993;77(5):1015-36. [Medline].

  9. Lai EC, Mok FP, Tan ES, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med. Jun 11 1992;326(24):1582-6. [Medline].

  10. Lameris JS, Overhagen HV. Imaging and intervention in patients with acute right upper quadrant disease. In: Bailliere's Clinical Gastroenterology. Vol 9. Harcourt Brace & Co;1995:21-36.

  11. Lee DW, Chung SC. Biliary infection. In: Bailliere's Clinical Gastroenterology. Vol 11. Harcourt Brace & Co;1997:707-724.

  12. Leung JW, Yu AS. Hepatolithiasis and biliary parasites. Bailliere's Clinical Gastroenterology. 1997;11:681-706.

  13. Lillemoe KD. Surgical treatment of biliary tract infections. Am Surg. Feb 2000;66(2):138-44. [Medline].

  14. Lipsett PA, Pitt HA. Acute cholangitis. Surg Clin North Am. Dec 1990;70(6):1297-312. [Medline].

  15. Raraty MG, Finch M, Neoptolemos JP. Acute cholangitis and pancreatitis secondary to common duct stones: management update. World J Surg. Nov 1998;22(11):1155-61. [Medline].

  16. van den Hazel SJ, Speelman P, Tytgat GN, et al. Role of antibiotics in the treatment and prevention of acute and recurrent cholangitis. Clin Infect Dis. Aug 1994;19(2):279-86. [Medline].

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Keywords

cholangitis, acute cholangitis, ascending cholangitis, choledocholithiasis, biliary tract obstruction, angiocholitis, cholangeitis, hepatolithiasis, sump syndrome, pyogenic liver abscess, acute renal failure, liver disease, Escherichia coli, E coli, Klebsiella species, Enterococcus species, Bacteroides fragilis, B fragilis

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Contributor Information and Disclosures

Author

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Coauthor(s)

Praveen K Roy, MD,, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute, Albuquerque
Praveen K Roy, MD, is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association
Disclosure: Nothing to disclose.

Victor Nwakakwa, MD, MRCP (UK), Clinical Instructor, Department of Internal Medicine, Division of Gastroenterology, University of Virginia Health System
Disclosure: Nothing to disclose.

Medical Editor

Anil Minocha, MD, FACP, FACG, Clinical Professor, School of Pharmacy, Professor of Medicine, Director of Digestive Diseases, Medical Director of Nutrition Support, Medical Director of Gastrointestinal Endoscopy, Internal Medicine Department, University of Mississippi Medical Center
Anil Minocha, MD, FACP, FACG is a member of the following medical societies: American Academy of Clinical Toxicology, American Association for the Study of Liver Diseases, American College of Forensic Examiners, American College of Gastroenterology, American College of Physicians, American Federation for Clinical Research, American Gastroenterological Association, and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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