Cholangitis diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Diagnostic criteria
An algorithm for diagnosis of cholangitis:[1][2]
| Diagnosis of acute cholangitis | |||||||||||||||||||||||||||||||||||||
| Definitive diagnosis Signs of infection and pus finding in bile during: •ERCP •PTCA •Surgery | Charcot triad •Fever •Jaundice •Abdominal pain Reynold's pentad (includes 2 extra features) •Sepsis •Mental confusion | Tokyo guidelines 2013(TG 13)‡ A.Systemic inflammation A-1. Fever and/or shaking chills A-2. Laboratory data: evidence of inflammatory response B.Cholestasis B-1. Jaundice B-2. Laboratory data: abnormal liver function tests C.Imaging C-1. Biliary dilatation C-2. Evidence of the etiology on imaging (stricture, stone, stent etc.) Suspected diagnosis: One item in A + one item in either B or C Definite diagnosis: One item in A, one item in B and one item in C | |||||||||||||||||||||||||||||||||||
Note: ERCP= Endoscopic retrograde cholangiopancreatography, PTCA =Percutaneous transhepatic cholangiography
A-2: Abnormal white blood cell counts, increase of serum C-reactive protein levels, and other changes indicating inflammation
B-2: Increased serum ALP, γGTP (GGT), AST and ALT levels.
| Thresholds TG-13‡ | |||
|---|---|---|---|
| Category‡ | Clinical/
Lab feature |
Test/Units | Value |
| A1 | Fever | Body temp | >38° C |
| A2 | Evidence of inflammatory response | WBC (x1000μ/L) | <4 or>10 |
| CRP (mg/dl) | ≥1 | ||
| B1 | Jaundice | Total bilirubin
(mg/dL) |
≥ 2 |
| B2 | Abnormal liver function test | ALP (IU) | >1.5 x STD |
| γGTP (IU) | >1.5 x STD | ||
| AST (IU) | >1.5 x STD | ||
| AST (IU) | >1.5 x STD | ||
STD=upper limit of normal value, ALP= alkaline phosphatase, γGTP (GGT)= γ-glutamyltransferase, AST= aspartate aminotransferase, ALT= alanine aminotransferase
- An algorithm showing course of management:
| Signs of acute cholangitis | |||||||||||||||||||||||||||||||||||||||
| •Hospitalization •IV fluids •Broad spectrum antibiotics | |||||||||||||||||||||||||||||||||||||||
| Improvement after hospitalization and/or hydration and/or broad spectrum antibiotics | |||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||
| Mild cholangitis | Organ dysfunction present? •Hypotension (which requires dobutamine or dopamine @ 5μg/kg/min) •Confusion •PaO2:FiO2 ratio<300 •Serum creatinine>177 μmol/L | ||||||||||||||||||||||||||||||||||||||
| Elective ERCP and stone clearance | |||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||
| Moderate cholangitis | Severe cholangitis | ||||||||||||||||||||||||||||||||||||||
| ERCP within 24-48 hours •Stone clearance if stable •Stent if unstable | Urgent ERCP and stent | ||||||||||||||||||||||||||||||||||||||
References
- ↑ Lee, John G. (2009). "Diagnosis and management of acute cholangitis". Nature Reviews Gastroenterology & Hepatology. 6 (9): 533–541. doi:10.1038/nrgastro.2009.126. ISSN 1759-5045.
- ↑ Kiriyama, Seiki; Takada, Tadahiro; Strasberg, Steven M.; Solomkin, Joseph S.; Mayumi, Toshihiko; Pitt, Henry A.; Gouma, Dirk J.; Garden, O. James; Büchler, Markus W.; Yokoe, Masamichi; Kimura, Yasutoshi; Tsuyuguchi, Toshio; Itoi, Takao; Yoshida, Masahiro; Miura, Fumihiko; Yamashita, Yuichi; Okamoto, Kohji; Gabata, Toshifumi; Hata, Jiro; Higuchi, Ryota; Windsor, John A.; Bornman, Philippus C.; Fan, Sheung-Tat; Singh, Harijt; de Santibanes, Eduardo; Gomi, Harumi; Kusachi, Shinya; Murata, Atsuhiko; Chen, Xiao-Ping; Jagannath, Palepu; Lee, Sung Gyu; Padbury, Robert; Chen, Miin-Fu; Dervenis, Christos; Chan, Angus C.W.; Supe, Avinash N.; Liau, Kui-Hin; Kim, Myung-Hwan; Kim, Sun-Whe (2013). "TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)". Journal of Hepato-Biliary-Pancreatic Sciences. 20 (1): 24–34. doi:10.1007/s00534-012-0561-3. ISSN 1868-6974.