Acute Cholangitis Differential Diagnoses

Updated: Dec 29, 2017
  • Author: Timothy M Scott, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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DDx

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