Ascending cholangitis laboratory findings

Certain laboratory tests may be helpful in the diagnosis of cholangitis. Some commonly conducted tests include complete blood count, basic metabolic panel, liver function tests, blood culture, and other body fluid cultures. Findings include leukocytosis, elevated liver enzymes, elevated CRP and ESR, abnormal serum electrolytes. Positive bile and blood cultures may also be seen

Laboratory findings consistent with the diagnosis of ascending cholangitis include^[1]:

• Complete blood count
  • WBC usually more than 10,000 – neutrophilic leukocytosis
  • Septic patients may have leukopenia
• Basic metabolic panel
  • Serum electrolyte abnormalities may be seen
• Liver function tests
  • Cholestatic pattern may be seen^[2]
  • Mildly elevated serum alkaline phosphatase (ALP) usually seen
  • Mildly elevated serum aspartate aminotransferase(AST) usually seen
  • Elevated gamma-glutamyl transpeptidase (GGT)
  • Elevated conjugated (direct) bilirubin (predominantly incase of obstruction)
  • Elevated aminotransferases (as high as 1000 IU/L), reflecting hepatocytes injury and microabscess formation – Liver abscess may be suspected in such cases
• Serum amylase^[3]
  • May be elevated in one third of the patients
  • Significantly raised in patients with concomitant acute pancreatitis
• ESR and CRP^[4]
  • Usually elevated
• Creatinine
  • May be elevated more than or equal to 1.5mg/dl
• Blood culture
  • Positive in the setting of bacteremia – May be polymicrobial
• Bile culture
  • Cultures are obtained from bile aspirated through percutaneous biliary catheters, obtained during biliary drainage, or from indwelling biliary prostheses
  • The infecting organisms are usually gram-negative bacilli (eg, E. coli, Klebsiella, Pseudomonas, Bacteroides and Enterococcus)^[5]