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Diagnostic criteria (acute cholangitis)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Diagnostic criteria for acute cholangitis have been producd (1) and are as follows:

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:

  • 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.
  • other factors which are helpful in diagnosis of acute cholangitis include abdominal pain [right upper quadrant (RUQ) or upper abdominal] and a history of biliary disease such as gallstones, previous biliary procedures, and placement of a biliary stent.
  • in acute hepatitis, marked systematic inflammatory response is observed infrequently. Virological and serological tests are required when differential diagnosis is difficult.

Thresholds
A-1

  • fever - BT >38°C

A-2

  • evidence of inflammatory response
    • WBC (x1000/µL) - <4 or>10
    • CRP (mg/dl) - ≥1

B-1

  • jaundice - T-Bil ≥2 (mg/dl)

B-2

  • abnormal liver function test
    • ALP (IU) - >1.5 x STD (upper limit of normal value)
    • γGTP (IU) - >1.5 x STD (upper limit of normal value)
    • AST (IU) - >1.5 x STD (upper limit of normal value)
    • ALT (IU) - >1.5 x STD (upper limit of normal value)

Reference:


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