Ascending cholangitis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [[Mailto:charlesmichaelgibson@gmail.com|[1]]]; Associate Editor(s
Overview
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Differentiating [Disease name] from other Diseases
Ascending cholangitis must be differentiated from other diseases that cause right upper quadrant pain and fever, such as
- 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 ascending cholangitis from other diseases on the basis of abdominal pain, fever, and jaundice
| Classification of pain in the abdomen based on etiology | Disease | Clinical manifestations | Diagnosis | Comments | |||||||||||||||
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| Symptoms | Signs | ||||||||||||||||||
| Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | |||||
| Abdominal causes | Inflammatory causes | Pancreato-biliary disorders | Acute suppurative cholangitis | RUQ | + | + | + | + | − | − | − | − | + | + | + | N |
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| Acute cholangitis | RUQ | + | − | − | + | − | − | − | − | − | − | − | N |
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| Acute cholecystitis | RUQ | + | − | + | + | − | − | − | − | − | − | − | Hypoactive | Ultrasound shows:
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| Acute pancreatitis | Epigastric | + | − | + | ± | − | − | + | − | ± | − | − | N |
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| Primary sclerosing cholangitis | RUQ | + | − | − | + | − | − | − | − | − | − | − | N |
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ERCP and MRCP shows
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| Cholelithiasis | RUQ/Epigastric | ± | − | ± | ± | − | − | − | − | − | − | − | Normal to hyperactive for dislodged stone |
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| Gastric causes | Gastrointestinal perforation | Diffuse | + | ± | - | ± | − | − | − | + | + | + | ± | Hyperactive/hypoactive |
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| Intestinal causes | Disease | Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | Comments | ||
| Inflammatory bowel disease | Diffuse | ± | − | − | ± | − | + | + | + | − | − | − | Normal or hyperactive | Extra intestinal findings: | |||||
| Whipple's disease | Diffuse | ± | − | − | ± | − | + | + | − | ± | − | − | N | Endoscopy is used to confirm diagnosis.
Images used to find complications |
Extra intestinal findings: | ||||
| Hepatic causes | Viral hepatitis | RUQ | + | − | + | + | − | Positive in Hep A and E | + | − | Positive in fulminant hepatitis | Positive in acute | + | N |
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| Liver abscess | RUQ | + | + | + | + | − | ± | + | − | + | + | ± | Normal or hypoactive |
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| Hepatocellular carcinoma/Metastasis | RUQ | + | − | − | + | − | − | + | − | − | − | − |
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Other symptoms: | |||
| Budd-Chiari syndrome | RUQ | ± | − | − | ± | − | − | − | Positive in liver failure leading to varices | − | − | − | N |
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Ascitic fluid examination shows:
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| Peritoneal causes | Spontaneous bacterial peritonitis | Diffuse | + | − | − | Positive in cirrhotic patients | − | + | − | − | ± | + | + | Hypoactive |
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| Hollow Viscous Obstruction | Biliary colic | RUQ | − | − | + | + | − | − | − | − | − | − | − | N |
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