Cholangitis diagnostic criteria: Difference between revisions
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==Diagnostic criteria== | ==Diagnostic criteria== | ||
An algorithm for diagnosis of cholangitis:<ref name="Lee2009">{{cite journal|last1=Lee|first1=John G.|title=Diagnosis and management of acute cholangitis|journal=Nature Reviews Gastroenterology & Hepatology|volume=6|issue=9|year=2009|pages=533–541|issn=1759-5045|doi=10.1038/nrgastro.2009.126}}</ref><ref name="KiriyamaTakada2013">{{cite journal|last1=Kiriyama|first1=Seiki|last2=Takada|first2=Tadahiro|last3=Strasberg|first3=Steven M.|last4=Solomkin|first4=Joseph S.|last5=Mayumi|first5=Toshihiko|last6=Pitt|first6=Henry A.|last7=Gouma|first7=Dirk J.|last8=Garden|first8=O. James|last9=Büchler|first9=Markus W.|last10=Yokoe|first10=Masamichi|last11=Kimura|first11=Yasutoshi|last12=Tsuyuguchi|first12=Toshio|last13=Itoi|first13=Takao|last14=Yoshida|first14=Masahiro|last15=Miura|first15=Fumihiko|last16=Yamashita|first16=Yuichi|last17=Okamoto|first17=Kohji|last18=Gabata|first18=Toshifumi|last19=Hata|first19=Jiro|last20=Higuchi|first20=Ryota|last21=Windsor|first21=John A.|last22=Bornman|first22=Philippus C.|last23=Fan|first23=Sheung-Tat|last24=Singh|first24=Harijt|last25=de Santibanes|first25=Eduardo|last26=Gomi|first26=Harumi|last27=Kusachi|first27=Shinya|last28=Murata|first28=Atsuhiko|last29=Chen|first29=Xiao-Ping|last30=Jagannath|first30=Palepu|last31=Lee|first31=Sung Gyu|last32=Padbury|first32=Robert|last33=Chen|first33=Miin-Fu|last34=Dervenis|first34=Christos|last35=Chan|first35=Angus C.W.|last36=Supe|first36=Avinash N.|last37=Liau|first37=Kui-Hin|last38=Kim|first38=Myung-Hwan|last39=Kim|first39=Sun-Whe|title=TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)|journal=Journal of Hepato-Biliary-Pancreatic Sciences|volume=20|issue=1|year=2013|pages=24–34|issn=18686974|doi=10.1007/s00534-012-0561-3}}</ref> | An algorithm for diagnosis of cholangitis:<ref name="Lee2009">{{cite journal|last1=Lee|first1=John G.|title=Diagnosis and management of acute cholangitis|journal=Nature Reviews Gastroenterology & Hepatology|volume=6|issue=9|year=2009|pages=533–541|issn=1759-5045|doi=10.1038/nrgastro.2009.126}}</ref><ref name="KiriyamaTakada2013">{{cite journal|last1=Kiriyama|first1=Seiki|last2=Takada|first2=Tadahiro|last3=Strasberg|first3=Steven M.|last4=Solomkin|first4=Joseph S.|last5=Mayumi|first5=Toshihiko|last6=Pitt|first6=Henry A.|last7=Gouma|first7=Dirk J.|last8=Garden|first8=O. James|last9=Büchler|first9=Markus W.|last10=Yokoe|first10=Masamichi|last11=Kimura|first11=Yasutoshi|last12=Tsuyuguchi|first12=Toshio|last13=Itoi|first13=Takao|last14=Yoshida|first14=Masahiro|last15=Miura|first15=Fumihiko|last16=Yamashita|first16=Yuichi|last17=Okamoto|first17=Kohji|last18=Gabata|first18=Toshifumi|last19=Hata|first19=Jiro|last20=Higuchi|first20=Ryota|last21=Windsor|first21=John A.|last22=Bornman|first22=Philippus C.|last23=Fan|first23=Sheung-Tat|last24=Singh|first24=Harijt|last25=de Santibanes|first25=Eduardo|last26=Gomi|first26=Harumi|last27=Kusachi|first27=Shinya|last28=Murata|first28=Atsuhiko|last29=Chen|first29=Xiao-Ping|last30=Jagannath|first30=Palepu|last31=Lee|first31=Sung Gyu|last32=Padbury|first32=Robert|last33=Chen|first33=Miin-Fu|last34=Dervenis|first34=Christos|last35=Chan|first35=Angus C.W.|last36=Supe|first36=Avinash N.|last37=Liau|first37=Kui-Hin|last38=Kim|first38=Myung-Hwan|last39=Kim|first39=Sun-Whe|title=TG13 guidelines for diagnosis and severity grading of acute cholangitis (with videos)|journal=Journal of Hepato-Biliary-Pancreatic Sciences|volume=20|issue=1|year=2013|pages=24–34|issn=18686974|doi=10.1007/s00534-012-0561-3}}</ref> | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | |A01| | | | | |A01= '''Diagnosis of <br>acute cholangitis'''}} | {{familytree | | | | | | | | | |A01| | | | | |A01= '''Diagnosis of <br>acute cholangitis'''}} | ||
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| rowspan="2" |A2 | | rowspan="2" |A2 | ||
| rowspan="2" |Evidence of inflammatory response | | rowspan="2" |Evidence of inflammatory response | ||
|WBC (x1000μ/ | |WBC (x1000μ/L) | ||
|<4 or>10 | |<4 or>10 | ||
|- | |- | ||
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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 | ||
{{familytree/start}} | |||
{{familytree | | | | | | | | | |A01| | | | | |A01= '''Signs of acute cholangitis'''}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | |B01| | | | | | | |B01=•Hospitalization<br>•IV fluids<br>•Broad spectrum antibiotics }} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | |C01| | | | | | | |C01=Improvement after hospitalization and/or hydration and/or broad spectrum antibiotics}} | |||
{{familytree | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | |||
{{familytree | | |!| | | | | | | | | | | | | | |!| }} | |||
{{familytree | | |D01| | | | | | | | | | | | | |D02| }} | |||
{{familytree/end}} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 21:13, 14 December 2017
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Cholangitis diagnostic criteria On the Web |
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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
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, cGTP (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
| Signs of acute cholangitis | |||||||||||||||||||||||||||||||||||||||||||
| •Hospitalization •IV fluids •Broad spectrum antibiotics | |||||||||||||||||||||||||||||||||||||||||||
| Improvement after hospitalization and/or hydration and/or broad spectrum antibiotics | |||||||||||||||||||||||||||||||||||||||||||
| {{{D01}}} | {{{D02}}} | ||||||||||||||||||||||||||||||||||||||||||
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.