diagnostic criteria (acute cholangitis)
Last reviewed 01/2018
Diagnostic criteria for acute cholangitis have been producd (1) and are as follows:
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:
- A-2: Abnormal white blood cell counts, increase of serum C-reactive protein levels, and other changes indicating inflammation
- B-2: Increased serum ALP, γGTP (GGT), AST and ALT levels.
- other factors which are helpful in diagnosis of acute cholangitis include abdominal pain [right upper quadrant (RUQ) or upper abdominal] and a history of biliary disease such as gallstones, previous biliary procedures, and placement of a biliary stent.
- in acute hepatitis, marked systematic inflammatory response is observed infrequently. Virological and serological tests are required when differential diagnosis is difficult.
Thresholds
A-1
- fever - BT >38°C
A-2
- evidence of inflammatory response
- WBC (x1000/µL) - <4 or>10
- CRP (mg/dl) - ≥1
B-1
- jaundice - T-Bil ≥2 (mg/dl)
B-2
- abnormal liver function test
- ALP (IU) - >1.5 x STD (upper limit of normal value)
- γGTP (IU) - >1.5 x STD (upper limit of normal value)
- AST (IU) - >1.5 x STD (upper limit of normal value)
- ALT (IU) - >1.5 x STD (upper limit of normal value)
Reference: