Cholangitis diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Diagnostic criteria

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, cGTP (GGT), AST and ALT levels.