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Investigations

Authoring team

Immediate investigations in cholangitis include:

  • blood cultures
  • blood tests
    • FBC
    • urea and electrolytes
    • LFTs - alkaline phosphatase, GGT, AST, ALT, and bilirubin
    • G+S
  • ultrasound imaging of biliary tree

These can be followed by:

  • CT
    • standard CT, and the more recently available helical (spiral) CT, can further assess the anatomy of underlying lesions and help clarify the site of obstruction, and may be needed to plan treatment
  • ERCP
    • the definitive investigation in acute cholangitis to elucidate the cause and site of obstruction
    • may be therapeutic if the stone can be removed through a sphincterotomy or an obstruction stented
  • PTC
    • however, a drain must be left in the bile ducts

N.B. direct cholangiography is dangerous because it may worsen the sepsis.

Reference:

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