How to Diagnose Cholangitis

Cholangitis is any infection of the biliary system. It may affect only one bile duct or the entire biliary tree. This condition has a significant mortality rate if left untreated. Gallstones have historically been the most common cause of cholangitis, but manipulations, stents and other types of intervention also cause the condition. Cancers of the liver and biliary system are rare causes of cholangitis. The following steps will show how to diagnose cholangitis.

Instructions

Difficulty: Challenging

1. Take the patient history. Previous gallstones or recent manipulation of the biliary tract should strongly suggest cholangitis.
2. Examine the patient physically. Abdominal pain in the upper right quadrant, fever, jaundice and pain are common symptoms of cholangitis. Consider specific variants at this stage, if possible. These include AIDS-related cholangitis, Asian cholangitis and sclerosing cholangitis.
3. Obtain a blood culture, complete blood cell counts and liver function tests. Patients with cholangitis always test positive for bile culture and multiple infections occur in approximately 60 percent of patients. Common aerobic bacteria include Enterococcus, Escherichia coli and Klebsiella. The most common anaerobic organism is Bacteroides fragilis. Cholangitis also frequently causes elevated levels of bilirubin, leukocytes and alkaline phosphatase.
4. Examine less common laboratory findings. A blood culture is positive in almost half of the cases. Elevated serum amylase and transaminases may indicate a concurrent stone impaction at the ampulla of Vater.
5. Perform an abdominal ultrasound to assist in the diagnosis. An endoscopic retrograde radiographic examination of the bile and pancreatic ducts with a contrast medium also may be needed.