Diagnostic criteria (acute cholangitis)

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:

• (1) Kiriyama S et al. TG13 guidelines for diagnosing and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2013;20(1):24-34