Cholangitis differential diagnosis

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

Overview

Cholangitis must be differentiated from other causes of infection in the common bile duct, as well as inflammation and infection of cholecystitis.

Differentiating Cholangitis from other Diseases

Cholangitis should be differentiated from the following:

• Acute cholecystitis
• Acute hepatitis
• Acute pancreatitis
• Biliary stricture
• Cancer of the common bile duct
• Cholestatic liver disease
• Cirrhosis
• Duodenal ulcer
• Gastic ulcer
• Pancreatic cancer

Differentiating acute cholangitis from other causes of acute abdomen

Acute/ Chronic	Disease	Clinical findings							Causes	Laboratory findings		Treatment
		Fever	Rigors and chills	Abdominal pain	Site of pain	Jaundice	Hypotension	Other findings
Acute	Acute cholangitis / Ascending cholangits	+	−	+	RUQ	+	−	Nausea and vomiting	Gall stones
	Acute suppurative cholangitis	++	+	+	RUQ	+	+	Confusion Nausea and vomiting	Gall stones
	Acute cholecystitis	±	−	+	RUQ	±	−	Nausea and vomiting	Gall stones
	Acute pancreatitis	±	−	+	LUQ, radiating to back	±	−	Nausea and vomiting	Gall stones
	Acute appendicitis	±	+ in pyogenic/ perforated type	+	Starts in umblical area and radiates to LLQ	−	+ in perforated appendix
	Acute hepatitis	+	−	+	RUQ	+
	Acute diverticulitis	+	−	+	LLQ	−
	Peptic Ulcer	±	−	+	Epigastrium or RUQ (in duodenal ulcer)	−
	Liver abscess	++	+	+	RUQ	±
	Choledocholithiasis	−	−	±	RUQ	+
	Ruptured ovarian cyst / Ovarian torsion	±	−	+	LLQ/ RLQ	−
	Tubo-ovarian abscess	+	+	+	LLQ/ RLQ	−
Chronic	Primary sclerosing cholangitis
	Primary biliary sclerosis
	Chronic pancreatitis
	Hepatitis
	Liver Cirrhosis
RUQ= Right upper quadrant of the abdomen, LUQ= Left Upper quadrant, LLQ = Left lower quadrant, RLQ= Right lower quadrant

References

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