investigations
Last reviewed 01/2018
Immediate investigations in cholangitis include:
- blood cultures
- blood tests
- FBC
- urea and electrolytes
- LFTs - alkaline phosphatase, GGT, AST, ALT, and bilirubin
- G+S
- ultrasound imaging of biliary tree
These can be followed by:
- CT
- standard CT, and the more recently available helical (spiral) CT, can further assess the anatomy of underlying lesions and help clarify the site of obstruction, and may be needed to plan treatment
- ERCP
- the definitive investigation in acute cholangitis to elucidate the cause and site of obstruction
- may be therapeutic if the stone can be removed through a sphincterotomy or an obstruction stented
- PTC
- however, a drain must be left in the bile ducts
N.B. direct cholangiography is dangerous because it may worsen the sepsis.
Reference:
- (1) Miura F et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20(1):47-54
- (2) Drug and Therapeutics Bulletin 2005; 43(8):62-4