Ascending cholangitis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Ascending cholangitis}} | {{Ascending cholangitis}} | ||
{{CMG}}; {{AE}} {{AHS}} | {{CMG}}; {{AE}} {{AHS}} | ||
== Overview | == Overview== | ||
Certain laboratory tests may be helpful in the [[diagnosis]] of [[cholangitis]]. Some commonly conducted tests include [[complete blood count]], [[basic metabolic panel]], [[liver function tests]], [[blood culture]], and other body fluid cultures. Findings include [[Leucocytosis,|leukocytosis,]] elevated liver enzymes, elevated [[C-reactive protein|CRP]] and [[Erythrocyte sedimentation rate|ESR]], abnormal serum electrolytes. Positive bile and blood cultures may also be seen | Certain laboratory tests may be helpful in the [[diagnosis]] of [[cholangitis]]. Some commonly conducted tests include [[complete blood count]], [[basic metabolic panel]], [[liver function tests]], [[blood culture]], and other body fluid cultures. Findings include [[Leucocytosis,|leukocytosis,]] elevated liver enzymes, elevated [[C-reactive protein|CRP]] and [[Erythrocyte sedimentation rate|ESR]], abnormal serum electrolytes. Positive bile and blood cultures may also be seen | ||
== Laboratory Findings | == Laboratory Findings == | ||
Laboratory findings consistent with the diagnosis of ascending cholangitis include<ref name="pmid172522972">{{cite journal| author=Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M et al.| title=Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. | journal=J Hepatobiliary Pancreat Surg | year= 2007 | volume= 14 | issue= 1 | pages= 52-8 | pmid=17252297 | doi=10.1007/s00534-006-1156-7 | pmc=2784515 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17252297 }}</ref>: | Laboratory findings consistent with the diagnosis of ascending cholangitis include<ref name="pmid172522972">{{cite journal| author=Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M et al.| title=Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. | journal=J Hepatobiliary Pancreat Surg | year= 2007 | volume= 14 | issue= 1 | pages= 52-8 | pmid=17252297 | doi=10.1007/s00534-006-1156-7 | pmc=2784515 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17252297 }}</ref>: | ||
* '''Complete blood count''' | * '''Complete blood count''' | ||
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** Elevated [[gamma-glutamyl transpeptidase]] ([[GGT]]) | ** Elevated [[gamma-glutamyl transpeptidase]] ([[GGT]]) | ||
** Elevated conjugated (direct) [[bilirubin]] (predominantly incase of obstruction) | ** Elevated conjugated (direct) [[bilirubin]] (predominantly incase of obstruction) | ||
** Elevated [[aminotransferases]] (as high as 1000 IU/L), reflecting [[hepatocytes]] injury and microabscess formation - Liver abscess may be suspected in such cases | ** Elevated [[aminotransferases]] (as high as 1000 IU/L), reflecting [[hepatocytes]] injury and microabscess formation - Liver abscess may be suspected in such cases | ||
* '''Serum [[amylase]]'''<ref>Liu, Chi-Leung. & Fan, Sheung-Tat. (2001), ''Surgical Treatment: Evidence-Based and Problem-Oriented.'', Munich, Germany: Zuckschwerdt Verlag</ref> | * '''Serum [[amylase]]'''<ref>Liu, Chi-Leung. & Fan, Sheung-Tat. (2001), ''Surgical Treatment: Evidence-Based and Problem-Oriented.'', Munich, Germany: Zuckschwerdt Verlag</ref> | ||
** May be elevated in one third of the patients | ** May be elevated in one third of the patients | ||
| Line 28: | Line 25: | ||
* '''ESR and CRP'''<ref name="pmid17127193">{{cite journal| author=van Erpecum KJ| title=Gallstone disease. Complications of bile-duct stones: Acute cholangitis and pancreatitis. | journal=Best Pract Res Clin Gastroenterol | year= 2006 | volume= 20 | issue= 6 | pages= 1139-52 | pmid=17127193 | doi=10.1016/j.bpg.2006.03.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17127193 }}</ref> | * '''ESR and CRP'''<ref name="pmid17127193">{{cite journal| author=van Erpecum KJ| title=Gallstone disease. Complications of bile-duct stones: Acute cholangitis and pancreatitis. | journal=Best Pract Res Clin Gastroenterol | year= 2006 | volume= 20 | issue= 6 | pages= 1139-52 | pmid=17127193 | doi=10.1016/j.bpg.2006.03.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17127193 }}</ref> | ||
** Usually elevated | ** Usually elevated | ||
* '''Creatinine''' | * '''Creatinine''' | ||
** May be elevated more than or equal to 1.5mg/dl | ** May be elevated more than or equal to 1.5mg/dl | ||
* '''Blood culture''' | * '''Blood culture''' | ||
Latest revision as of 23:10, 15 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
Certain laboratory tests may be helpful in the diagnosis of cholangitis. Some commonly conducted tests include complete blood count, basic metabolic panel, liver function tests, blood culture, and other body fluid cultures. Findings include leukocytosis, elevated liver enzymes, elevated CRP and ESR, abnormal serum electrolytes. Positive bile and blood cultures may also be seen
Laboratory Findings
Laboratory findings consistent with the diagnosis of ascending cholangitis include[1]:
- Complete blood count
- WBC usually more than 10,000 - neutrophilic leukocytosis
- Septic patients may have leukopenia
- Basic metabolic panel
- Serum electrolyte abnormalities may be seen
- Liver function tests
- Cholestatic pattern may be seen[2]
- Mildly elevated serum alkaline phosphatase (ALP) usually seen
- Mildly elevated serum aspartate aminotransferase(AST) usually seen
- Elevated gamma-glutamyl transpeptidase (GGT)
- Elevated conjugated (direct) bilirubin (predominantly incase of obstruction)
- Elevated aminotransferases (as high as 1000 IU/L), reflecting hepatocytes injury and microabscess formation - Liver abscess may be suspected in such cases
- Serum amylase[3]
- May be elevated in one third of the patients
- Significantly raised in patients with concomitant acute pancreatitis
- ESR and CRP[4]
- Usually elevated
- Creatinine
- May be elevated more than or equal to 1.5mg/dl
- Blood culture
- Positive in the setting of bacteremia - May be polymicrobial
- Bile culture
- Cultures are obtained from bile aspirated through percutaneous biliary catheters, obtained during biliary drainage, or from indwelling biliary prostheses
- The infecting organisms are usually gram-negative bacilli (eg, E. coli, Klebsiella, Pseudomonas, Bacteroides and Enterococcus)[5]
References
- ↑ Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M; et al. (2007). "Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 52–8. doi:10.1007/s00534-006-1156-7. PMC 2784515. PMID 17252297.
- ↑ Cameron, John L. & Cameron, Andrew M. (2014), Current Surgical Therapy: Expert Consult, Philadelphia, PA: Elsevier, Inc.
- ↑ Liu, Chi-Leung. & Fan, Sheung-Tat. (2001), Surgical Treatment: Evidence-Based and Problem-Oriented., Munich, Germany: Zuckschwerdt Verlag
- ↑ van Erpecum KJ (2006). "Gallstone disease. Complications of bile-duct stones: Acute cholangitis and pancreatitis". Best Pract Res Clin Gastroenterol. 20 (6): 1139–52. doi:10.1016/j.bpg.2006.03.012. PMID 17127193.
- ↑ Lipsett PA, Pitt HA (1990). "Acute cholangitis". Surg Clin North Am. 70 (6): 1297–312. PMID 2247816.