What is the role of lab studies in the workup of acute cholangitis?

Updated: Dec 29, 2017
  • Author: Timothy M Scott, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Laboratory studies include the following:

  • CBC: Leukocytosis: In patients with cholangitis, 79% had a WBC greater than 10,000/mL, with a mean of 13.6. Septic patients may be leukopenic.

  • Electrolyte panel with renal function may be performed.

  • Calcium level is necessary to check if pancreatitis, which can lead to hypocalcemia, is a concern.

  • Expect liver function test results to be consistent with cholestasis, hyperbilirubinemia (88-100%), and increased alkaline phosphatase level (78%).

  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are usually mildly elevated.

  • Prothrombin time and activated partial thromboplastin time: Do not expect either to be elevated unless sepsis is associated with disseminated intravascular coagulation or underlying cirrhosis exists. A coagulation profile may be required if the patient needs operative intervention.

  • C-reactive protein level and erythrocyte sedimentation rate are typically elevated. [5]

  • Blood cultures (2 sets): Between 20% and 30% of blood cultures are positive. Many exhibit polymicrobial infections.

  • Urinalysis result is usually normal.

  • Blood type, screen, and crossmatch: With urgent operating room dispatch, patients need to have blood available.

  • Lipase: Involvement of the lower CBD may cause pancreatitis and an elevated lipase level. One third of patients have a mildly elevated lipase level.

  • Pancreatic enzyme elevations suggest that bile duct stones caused the cholangitis, with or without gallstone pancreatitis. [13]

  • Biliary cultures (not performed in the ED): Send biliary cultures if the patient has biliary drainage by interventional radiology or endoscopy.

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