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| __NOTOC__ | | __NOTOC__ |
| {{Cholangitis}} | | {{Cholangitis}} |
| {{CMG}}; {{AE}} {{FH}} | | {{CMG}}; {{AE}}{{ADS}} |
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| ==Overview== | | ==Overview== |
| [[Magnetic resonance cholangiopancreatography]] (MRCP) and endoscopic sonography (EUS) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis. [[Endoscopic retrograde cholangiopancreatography]] (ERCP) is also considered a gold standard test for biliary obstruction.
| | There are no other imaging findings associated with cholangitis. |
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| ==Other Imaging Findings== | | ==Other Imaging Findings== |
| ===Endoscopic Retrograde Cholangiopancreatography (ERCP)===
| | There are no other imaging findings associated with cholangitis. |
| ERCP is a preferred imaging method as it is both diagnostic and therapeutic. ERCP involves the use of [[endoscopy]] to pass a small [[cannula]] into the [[bile duct]]. Radiocontrast is then injected to opacify the duct, and X-rays are taken to get a visual impression of the [[biliary system]]. Findings on an ERCP suggestive of/diagnostic of acute cholangitis include:
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| *A protuberant ampulla from an impacted [[gallstone]] in the [[common bile duct]], or the frank extrusion of pus from the common bile duct orifice.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref>
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| === Percutaneous Transhepatic Cholangiography (PTCA) ===
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| In case the ERCP is unsuccessful, [[percutaneous transhepatic cholangiography]] (PTCA) can be used to allow access to the [[biliary tree]].<ref name="pmid13684978">{{cite journal |vauthors=ATKINSON M, HAPPEY MG, SMIDDY FG |title=Percutaneous transhepatic cholangiography |journal=Gut |volume=1 |issue= |pages=357–65 |year=1960 |pmid=13684978 |pmc=1413224 |doi= |url=}}</ref><ref name="urlPrimary Sclerosing Cholangitis">{{cite web |url=http://www.niddk.nih.gov/health-information/health-topics/liver-disease/primary-sclerosing-cholangitis/Pages/facts.aspx |title=Primary Sclerosing Cholangitis |format= |work= |accessdate=April 20 2016}}</ref>
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| *The PTCA procedure involves inserting a needle through the skin and placing a thin tube into a [[duct]] in the [[liver]].
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| *Dye is injected through the tube and x-rays are then taken.
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| For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable.
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| *If the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref>
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| ===Magnetic Resonance Cholangiopancreatography (MRCP)===
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| *Useful in patients with postcholecystectomy and in patients with non-conclusive ERCP.<ref name="pmid16691174">{{cite journal |vauthors=Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM |title=[Acute cholangitis: imaging diagnosis and management] |language=French |journal=J Radiol |volume=87 |issue=4 Pt 2 |pages=430–40 |year=2006 |pmid=16691174 |doi= |url=}}</ref>
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| **This safe and painless test is increasingly used for diagnosis.
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| *The only disadvantage is that smaller stones can be missed on a MRCP.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref>
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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