Cholangitis other diagnostic studies: Difference between revisions
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[[Blood tests]] to check levels of liver enzymes are the first step in diagnosing cholangitis. Doctors can confirm the diagnosis using a cholangiography, which provides pictures of the [[bile ducts]]. | [[Blood tests]] to check levels of liver enzymes are the first step in diagnosing cholangitis. Doctors can confirm the diagnosis using a cholangiography, which provides pictures of the [[bile ducts]]. | ||
==Other Diagnostic | ==Other Diagnostic Findings== | ||
[[ | ===Endoscopic Retrograde Cholangiopancreatography (ERCP)=== | ||
ERCP is a preferred imaging method as it is both diagnostic and therapeutic. ERCP involves the use of [[endoscopy]] to pass a small [[cannula]] into the [[bile duct]]. Radiocontrast is then injected to opacify the duct, and X-rays are taken to get a visual impression of the [[biliary system]]. Findings on an ERCP suggestive of/diagnostic of acute cholangitis include: | |||
*A protuberant ampulla from an impacted [[gallstone]] in the [[common bile duct]], or the frank extrusion of pus from the common bile duct orifice.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | |||
=== | === Percutaneous Transhepatic Cholangiography (PTCA) === | ||
In case the ERCP is unsuccessful, [[percutaneous transhepatic cholangiography]] (PTCA) can be used to allow access to the [[biliary tree]].<ref name="pmid13684978">{{cite journal |vauthors=ATKINSON M, HAPPEY MG, SMIDDY FG |title=Percutaneous transhepatic cholangiography |journal=Gut |volume=1 |issue= |pages=357–65 |year=1960 |pmid=13684978 |pmc=1413224 |doi= |url=}}</ref><ref name="urlPrimary Sclerosing Cholangitis">{{cite web |url=http://www.niddk.nih.gov/health-information/health-topics/liver-disease/primary-sclerosing-cholangitis/Pages/facts.aspx |title=Primary Sclerosing Cholangitis |format= |work= |accessdate=April 20 2016}}</ref> | |||
*The PTCA procedure involves inserting a needle through the skin and placing a thin tube into a [[duct]] in the [[liver]]. | |||
*Dye is injected through the tube and x-rays are then taken. | |||
For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable. | |||
*If the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | |||
===Magnetic Resonance Cholangiopancreatography (MRCP)=== | |||
| | *Useful in patients with postcholecystectomy and in patients with non-conclusive ERCP.<ref name="pmid16691174">{{cite journal |vauthors=Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM |title=[Acute cholangitis: imaging diagnosis and management] |language=French |journal=J Radiol |volume=87 |issue=4 Pt 2 |pages=430–40 |year=2006 |pmid=16691174 |doi= |url=}}</ref> | ||
| | **This safe and painless test is increasingly used for diagnosis. | ||
| | *The only disadvantage is that smaller stones can be missed on a MRCP.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | ||
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==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]
Overview
Blood tests to check levels of liver enzymes are the first step in diagnosing cholangitis. Doctors can confirm the diagnosis using a cholangiography, which provides pictures of the bile ducts.
Other Diagnostic Findings
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP is a preferred imaging method as it is both diagnostic and therapeutic. ERCP involves the use of endoscopy to pass a small cannula into the bile duct. Radiocontrast is then injected to opacify the duct, and X-rays are taken to get a visual impression of the biliary system. Findings on an ERCP suggestive of/diagnostic of acute cholangitis include:
- A protuberant ampulla from an impacted gallstone in the common bile duct, or the frank extrusion of pus from the common bile duct orifice.[1]
Percutaneous Transhepatic Cholangiography (PTCA)
In case the ERCP is unsuccessful, percutaneous transhepatic cholangiography (PTCA) can be used to allow access to the biliary tree.[2][3]
- The PTCA procedure involves inserting a needle through the skin and placing a thin tube into a duct in the liver.
- Dye is injected through the tube and x-rays are then taken.
For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable.
- If the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct.[1]
Magnetic Resonance Cholangiopancreatography (MRCP)
- Useful in patients with postcholecystectomy and in patients with non-conclusive ERCP.[4]
- This safe and painless test is increasingly used for diagnosis.
- The only disadvantage is that smaller stones can be missed on a MRCP.[1]
References
- ↑ 1.0 1.1 1.2 Kinney TP (2007). "Management of ascending cholangitis". Gastrointest. Endosc. Clin. N. Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
- ↑ ATKINSON M, HAPPEY MG, SMIDDY FG (1960). "Percutaneous transhepatic cholangiography". Gut. 1: 357–65. PMC 1413224. PMID 13684978.
- ↑ "Primary Sclerosing Cholangitis". Retrieved April 20 2016. Check date values in:
|accessdate=(help) - ↑ Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM (2006). "[Acute cholangitis: imaging diagnosis and management]". J Radiol (in French). 87 (4 Pt 2): 430–40. PMID 16691174.