Laboratory studies include the following:
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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.
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Electrolyte panel with renal function may be performed.
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Calcium level is necessary to check if pancreatitis, which can lead to hypocalcemia, is a concern.
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Expect liver function test results to be consistent with cholestasis, hyperbilirubinemia (88-100%), and increased alkaline phosphatase level (78%).
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Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are usually mildly elevated.
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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.
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C-reactive protein level and erythrocyte sedimentation rate are typically elevated. [5]
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Blood cultures (2 sets): Between 20% and 30% of blood cultures are positive. Many exhibit polymicrobial infections.
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Urinalysis result is usually normal.
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Blood type, screen, and crossmatch: With urgent operating room dispatch, patients need to have blood available.
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Lipase: Involvement of the lower CBD may cause pancreatitis and an elevated lipase level. One third of patients have a mildly elevated lipase level.
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Pancreatic enzyme elevations suggest that bile duct stones caused the cholangitis, with or without gallstone pancreatitis. [13]
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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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Sonogram of dilated intrahepatic ducts.
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CT scan of common bile duct occluded by stone. Image courtesy of David Schwartz, MD, New York University Hospital.
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CT scan of 1-cm dilated common bile duct at portal triad. Image courtesy of David Schwartz, MD, New York University Hospital.
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CT scan of dilated intrahepatic bile ducts. Image courtesy of David Schwartz, MD, New York University Hospital.
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Algorithm for management of patients with acute cholangitis.
