Cholangitis diagnostic criteria: Difference between revisions
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Note: ERCP= [[Endoscopic retrograde cholangiopancreatography]], PTCA =[[Percutaneous transhepatic cholangiography]]<br> | Note: ERCP= [[Endoscopic retrograde cholangiopancreatography]], PTCA =[[Percutaneous transhepatic cholangiography]]<br> | ||
A-2: Abnormal white blood cell counts, increase of serum C-reactive protein levels, and other changes indicating inflammation<br> | A-2: Abnormal white blood cell counts, increase of serum [[C-reactive protein]] levels, and other changes indicating inflammation<br> | ||
B-2: Increased serum ALP, | B-2: Increased serum [[ALP]], γGTP ([[GGT]]), [[AST]] and [[ALT]] levels. | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="4" |Thresholds TG-13<sup>‡</sup> | ! colspan="4" |Thresholds TG-13<sup>‡</sup> | ||
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STD=upper limit of normal value, ALP= alkaline phosphatase, γGTP (GGT)= γ-glutamyltransferase, AST= aspartate aminotransferase, ALT= alanine aminotransferase | 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: | |||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | |A01| | | | | |A01= '''Signs of acute cholangitis'''}} | {{familytree | | | | | | | | | |A01| | | | | |A01= '''Signs of acute cholangitis'''}} | ||
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{{familytree |boxstyle=text-align: left | | | | | E01 | | | | | | | | E02 | E01=Mild cholangitis| E02='''Organ dysfunction present?''' <br> •[[Hypotension]] <br>(which requires [[dobutamine]] or [[dopamine]]<br> @ 5μg/kg/min)<br> •[[Confusion]] <br> •PaO2:FiO2 ratio<300<br>•Serum [[creatinine]]>177 μmol/L}} | {{familytree |boxstyle=text-align: left | | | | | E01 | | | | | | | | E02 | E01=Mild cholangitis| E02='''Organ dysfunction present?''' <br> •[[Hypotension]] <br>(which requires [[dobutamine]] or [[dopamine]]<br> @ 5μg/kg/min)<br> •[[Confusion]] <br> •PaO2:FiO2 ratio<300<br>•Serum [[creatinine]]>177 μmol/L}} | ||
{{familytree | | | | | |!| | | | | | | | | |!| | | }} | {{familytree | | | | | |!| | | | | | | | | |!| | | }} | ||
{{familytree | | | | | F01 | | | | | | | | |!| |F01=Elective[[ERCP]] and stone clearance}} | {{familytree | | | | | F01 | | | | | | | | |!| |F01=Elective [[ERCP]] and stone clearance}} | ||
{{familytree | | | | | | | | | | | | | | | |!| | | }} | {{familytree | | | | | | | | | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | | | |,|-|-|-|-|-|^|-|.}} | {{familytree | | | | | | | | | |,|-|-|-|-|-|^|-|.}} | ||
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{{familytree | | | | | | | | |H01| | | | | |H02| H01=Moderate cholangitis|H02=Severe cholangitis }} | {{familytree | | | | | | | | |H01| | | | | |H02| H01=Moderate cholangitis|H02=Severe cholangitis }} | ||
{{familytree | | | | | | | | | |!| | | | | | | |!| | }} | {{familytree | | | | | | | | | |!| | | | | | | |!| | }} | ||
{{familytree | | | | | | | | |I01 | {{familytree |boxstyle=text-align: left | | | | | | | | |I01| | | | | |I02|I01=[[ERCP]] within 24-48 hours<br>•Stone clearance if stable<br>•Stent if unstable|I02= Urgent [[ERCP]] and stent }} | ||
{{familytree/end}} | {{familytree/end}} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 16:01, 15 December 2017
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Cholangitis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Cholangitis diagnostic criteria On the Web |
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American Roentgen Ray Society Images of Cholangitis diagnostic criteria |
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Risk calculators and risk factors for Cholangitis diagnostic criteria |
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.