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:
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Cirrhosis
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Liver failure
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Liver abscess
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Perforated peptic ulcer
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Pyelonephritis
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Right colon diverticulitis
Differential Diagnoses
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Cholecystitis and Biliary Colic
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Sonogram of dilated intrahepatic ducts.
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CT scan of common bile duct occluded by stone. Image courtesy of David Schwartz, MD, New York University Hospital.
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CT scan of 1-cm dilated common bile duct at portal triad. Image courtesy of David Schwartz, MD, New York University Hospital.
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CT scan of dilated intrahepatic bile ducts. Image courtesy of David Schwartz, MD, New York University Hospital.
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Algorithm for management of patients with acute cholangitis.
