Ascending cholangitis: Difference between revisions

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Revision as of 01:21, 30 August 2017

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Routine [[blood test]]s show features of acute inflammation (raised [[white blood cell]] count and elevated [[C-reactive protein]] level), and usually abnormal [[liver function tests]] (LFTs). In most cases the LFTs will be consistent with obstruction: raised [[bilirubin]], [[alkaline phosphatase]] and [[Gamma-glutamyl transpeptidase|γ-glutamyl transpeptidase]]. In the early stages, however, pressure on the liver cells may be the main feature and the tests will resemble those in [[hepatitis]], with elevations in [[alanine transaminase]] and [[aspartate transaminase]].<ref name=Kinney/>

[[Blood culture]]s are often performed in people with fever and evidence of acute infection. These yield the bacteria causing the infection in 36% of cases,<ref name="Sung">{{cite journal |vauthors=Sung JJ, Lyon DJ, Suen R, Chung SC, Co AL, Cheng AF, Leung JW, Li AK | title=Intravenous ciprofloxacin as treatment for patients with acute suppurative cholangitis: a randomized, controlled clinical trial |journal= J Antimicrob Chemother | volume=35 | issue=6 | pages=855–864 |date=June 1995 | pmid=7559196 | doi=10.1093/jac/35.6.855 }}</ref> usually after 24–48 hours of incubation. Bile, too, may be sent for culture during ERCP (see below). The most common bacteria linked to ascending cholangitis are [[Gram-negative bacteria|gram-negative]] [[bacilli]]: ''[[Escherichia coli]]'' (25–50%), [[Klebsiella]] (15–20%) and [[Enterobacter]] (5–10%). Of the [[gram-positive bacteria|gram-positive]] [[Coccus|cocci]], [[Enterococcus]] causes 10–20%.<ref>{{cite book|url=https://books.google.itcom/books?id=IcN-3S-tcvkC&pg=PA511|page=511|title=Infections of the Gastrointestinal System|author=Chetana Vaishnavi|publisher=JP Medical Ltd|year=2013|isbn=9789350903520}}</ref>

===Medical imaging===