Cholangitis Workup

Updated: Mar 11, 2020
  • Author: Homayoun Shojamanesh, MD; Chief Editor: Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS  more...
  • Print

Laboratory Studies

Note the following:

  • Obtain complete blood cell (CBC) count, liver function tests, coagulation profile, renal function tests, and blood cultures.

  • Common laboratory findings include polymorphonuclear leukocytosis, hyperbilirubinemia (patients with a malignant obstruction generally have a significantly higher bilirubin level than those with a benign obstruction), and elevated alkaline phosphatase and gamma glutamyl transpeptidase (GGTP)  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 (obtained at the time of biliary drainage—endoscopic or percutaneous) 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

Imaging modalities include abdominal ultrasonography and abdominal computed tomography (CT) scanning. [10]

The diagnosis of the cause of cholangitis can be made on magnetic resonance cholangiography (MRC) as it is noninvasive and involves no exposure to radiation, but diagnostic and therapeutic (drainage of the biliary system) modalities include endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC).

MRC is preferred before ERC or PTC, as it indicates the level of the block (eg, high or low) and the patency of the biliary ductal confluence; this helps in the selection of the therapeutic procedure for drainage of the biliary system (ie, ERC for low blocks and PTC for high blocks with confluence but not patency).