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Acute Cholangitis Differential Diagnoses

  • Author: Timothy M Scott, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Dec 27, 2015
 
 

Diagnostic Considerations

Special concerns

Because pregnant women are prone to symptomatic gallstones, consider cholangitis in pregnant, febrile, or jaundiced patients. Differentiate cholangitis from HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) of preeclampsia, which also can cause abdominal pain and elevated LFTs. Blood pressure is elevated in preeclampsia and may be hypotensive in cholangitis.

Cholelithiasis and cholangitis are uncommon in children, except in those with underlying hemolytic disorders or biliary anomalies.

The incidence of cholangitis is higher in elderly persons, most likely due to the increased prevalence of common bile duct stones with age. As in other infections and abdominal processes, elderly patients frequently do not manifest pathology in a classic pattern. Consider cholangitis in febrile or hypotensive elderly patients.

Other conditions to be considered

Other conditions to consider in patients with suspected acute cholangitis include the following:

  • Cirrhosis
  • Liver failure
  • Liver abscess
  • Perforated peptic ulcer
  • Pyelonephritis
  • Right colon diverticulitis

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Timothy M Scott, DO Chief Resident, Department of Emergency Medicine, Detroit Medical Center, Wayne State University School of Medicine

Timothy M Scott, DO is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Osteopathic Association, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

Jeffrey A Manko, MD A ssistant Professor of Emergency Medicine, Director, Emergency Medicine Residency Program, Consulting Staff, Emergency Medicine Services, New York University/Bellevue Medical Center

Jeffrey A Manko, MD is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Sally Santen, MD Program Director, Assistant Professor, Department of Emergency Medicine, Vanderbilt University

Sally Santen, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Aron JH, Bowlus CL. The immunobiology of primary sclerosing cholangitis. Semin Immunopathol. 2009 Sep. 31(3):383-97. [Medline]. [Full Text].

  2. Kashyap R, Mantry P, Sharma R, et al. Comparative analysis of outcomes in living and deceased donor liver transplants for primary sclerosing cholangitis. J Gastrointest Surg. 2009 Aug. 13(8):1480-6. [Medline].

  3. van Erpecum KJ. Gallstone disease. Complications of bile-duct stones: Acute cholangitis and pancreatitis. Best Pract Res Clin Gastroenterol. 2006. 20(6):1139-52. [Medline].

  4. Rosing DK, De Virgilio C, Nguyen AT, El Masry M, Kaji AH, Stabile BE. Cholangitis: analysis of admission prognostic indicators and outcomes. Am Surg. 2007 Oct. 73(10):949-54. [Medline].

  5. Kinney TP. Management of ascending cholangitis. Gastrointest Endosc Clin N Am. 2007 Apr. 17(2):289-306, vi. [Medline].

  6. Jabara B, Fargen KM, Beech S, Slakey DR. Diagnosis of cholangiocarcinoma: a case series and literature review. J La State Med Soc. 2009 Mar-Apr. 161(2):89-94. [Medline].

  7. Shinya S, Sasaki T, Yamashita Y, et al. Procalcitonin as a useful biomarker for determining the need to perform emergency biliary drainage in cases of acute cholangitis. J Hepatobiliary Pancreat Sci. 2014 Oct. 21 (10):777-85. [Medline].

  8. Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Med Clin North Am. 2008 Jul. 92(4):925-60, x. [Medline].

  9. Rustemovic N, Cukovic-Cavka S, Opacic M, et al. Endoscopic ultrasound elastography as a method for screening the patients with suspected primary sclerosing cholangitis. Eur J Gastroenterol Hepatol. 2010 Jun. 22(6):748-53. [Medline].

  10. Iorgulescu A, Sandu I, Turcu F, Iordache N. Post-ERCP acute pancreatitis and its risk factors. J Med Life. 2013 Mar 15. 6(1):109-13. [Medline]. [Full Text].

  11. Zhang RL, Zhao H, Dai YM, et al. Endoscopic nasobiliary drainage with sphincterotomy in acute obstructive cholangitis: a prospective randomized controlled trial. J Dig Dis. 2014 Feb. 15 (2):78-84. [Medline].

  12. Sharma BC, Agarwal N, Sharma P, Sarin SK. Endoscopic biliary drainage by 7 Fr or 10 Fr stent placement in patients with acute cholangitis. Dig Dis Sci. 2009 Jun. 54(6):1355-9. [Medline].

  13. Itoi T, Kawai T, Sofuni A, et al. Efficacy and safety of 1-step transnasal endoscopic nasobiliary drainage for the treatment of acute cholangitis in patients with previous endoscopic sphincterotomy (with videos). Gastrointest Endosc. 2008 Jul. 68(1):84-90. [Medline].

  14. Park TY, Choi JS, Song TJ, et al. Early oral antibiotic switch compared with conventional intravenous antibiotic therapy for acute cholangitis with bacteremia. Dig Dis Sci. 2014 Nov. 59(11):2790-6. [Medline].

  15. Tabibian JH, Yang JD, Baron TH, Kane SV, Enders FB, Gostout CJ. Weekend admission for acute cholangitis does not adversely impact clinical or endoscopic outcomes. Dig Dis Sci. 2015 Sep 21. [Medline].

  16. Zimmer V, Lammert F. Acute bacterial cholangitis. Viszeralmedizin. 2015 Jun. 31 (3):166-72. [Medline].

 
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Sonogram of dilated intrahepatic ducts.
CT scan of common bile duct occluded by stone. Image courtesy of David Schwartz, MD, New York University Hospital.
CT scan of 1-cm dilated common bile duct at portal triad. Image courtesy of David Schwartz, MD, New York University Hospital.
CT scan of dilated intrahepatic bile ducts. Image courtesy of David Schwartz, MD, New York University Hospital.
Algorithm for management of patients with acute cholangitis.
 
 
 
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