Ascending cholangitis diagnostic study of choice: Difference between revisions

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Revision as of 16:50, 4 October 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP). However, ERCP is the gold standard test in diagnosis of ascending cholangitis and is the test of choice for patients who may need therapeutic drainage

Diagnostic Study of Choice

Study of choice

Magnetic resonance cholangiopancreatography (MRCP)

It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP).

Endoscopic retrograde cholangiopancreatography (ERCP):

ERCP is the gold standard test in diagnosis of ascending cholangitis
ERCP is a procedure to examine the pancreatic and bile ducts.
Direct observation of obstruction or bile duct stone is possible
Test of choice for patients who may need drainage
Also done directly in a patient with classic traid of acute cholangitis (fever, jaundice, abdominal pain)
Has both diagnostic and therapeutic efficacy
Can also be used as reference test to determine the efficacy of other methods like MRCP
Preferred as a therapeutic method for biliary drainage usually as compared to diagnostic
ERCP has a higher rate of complications as compared to other endoscopic procedures. Some common complications include bleeding, trauma, pancreatitis

TG-13 diagnostic criteria for acute cholangitis^[1]


		Description
A=Systemic Inflammation	A1	Fever >38C and/or Chills
A=Systemic Inflammation	A2	Laboratory evidence of inflammatory response WBC <4000 or >10,000/uL CRP more than or equal to 1mg/dl
B=Cholestasis	B1	Jaundice - Total bilirubin more than or equal to 2mg/dl
B=Cholestasis	B2	Abnormal liver function tests ALP - More than 1.5 times upper limit of normal AST - More than 1.5 times upper limit of normal ALT - More than 1.5 times upper limit of normal GGT - More than 1.5 times upper limit of normal
C= Imaging	C1	Biliary dilation
C= Imaging	C2	Evidence of etiology on the imaging (stricture, stone, stent)

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

References

↑ Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA; et al. (2012). "New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines". J Hepatobiliary Pancreat Sci. 19 (5): 548–56. doi:10.1007/s00534-012-0537-3. PMC 3429782. PMID 22825491.

Template:WH Template:WS

[pmid22825491-1] Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA; et al. (2012). "New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines". J Hepatobiliary Pancreat Sci. 19 (5): 548–56. doi:10.1007/s00534-012-0537-3. PMC 3429782. PMID 22825491.

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Ascending cholangitis}}
 {{CMG}}; {{AE}}
 == Overview ==
+It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP). However, ERCP is the gold standard test in diagnosis of ascending cholangitis and is the test of choice for patients who may need therapeutic drainage
 == Diagnostic Study of Choice ==
 === Study of choice ===
-[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
+'''Magnetic resonance cholangiopancreatography (MRCP)'''
+* It is the diagnostic study of choice for identifying lesions of the biliary tree with sensitivity comparable to that of endoscopic retrograde cholangiopancreaticography (ERCP).
+'''Endoscopic retrograde cholangiopancreatography (ERCP'''):
+* ERCP is the gold standard test in diagnosis of ascending cholangitis
+* ERCP is a procedure to examine the pancreatic and bile ducts.
+* Direct observation of obstruction or bile duct stone is possible
+* Test of choice for patients who may need drainage
+* Also done directly in a patient with classic traid of acute cholangitis (fever, jaundice, abdominal pain)
+* Has both diagnostic and therapeutic efficacy
+* Can also be used as reference test to determine the efficacy of other methods like MRCP
+* Preferred as a therapeutic method for biliary drainage usually as compared to diagnostic
+* ERCP has a higher rate of complications as compared to other endoscopic procedures. Some common complications include bleeding, trauma, pancreatitis
-OR
+=== TG-13 diagnostic criteria for acute cholangitis<ref name="pmid22825491">{{cite journal| author=Kiriyama S, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Pitt HA et al.| title=New diagnostic criteria and severity assessment of acute cholangitis in revised Tokyo Guidelines. | journal=J Hepatobiliary Pancreat Sci | year= 2012 | volume= 19 | issue= 5 | pages= 548-56 | pmid=22825491 | doi=10.1007/s00534-012-0537-3 | pmc=3429782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22825491  }}</ref> ===
+{| class="wikitable"
+|+
+!
+!
+!Description
+|-
+| rowspan="2" |'''A=Systemic Inflammation'''
+|A1
+|Fever >38C and/or Chills
+|-
+|A2
+|Laboratory evidence of inflammatory response
+WBC <4000 or >10,000/uL
-The following result of [gold standard test] is confirmatory of [disease name]:
+CRP more than or equal to 1mg/dl
-* [Result 1]
+|-
-* [Result 2]
+| rowspan="2" |'''B=Cholestasis'''
+|B1
+|Jaundice - Total bilirubin more than or equal to 2mg/dl
+|-
+|B2
+|Abnormal liver function tests
+ALP - More than 1.5 times upper limit of normal
-OR
+AST - More than 1.5 times upper limit of normal
-[Name of the investigation] must be performed when:
+ALT - More than 1.5 times upper limit of normal
-* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
-* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
-OR
+GGT - More than 1.5 times upper limit of normal
-[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
-OR
-The diagnostic study of choice for [disease name] is [name of the investigation].
-OR
-There is no single diagnostic study of choice for the diagnosis of [disease name].
-OR
-There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
-OR
-[Disease name] is primarily diagnosed based on the clinical presentation.
-OR
-Investigations:
-* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
-* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
-* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
-==== The comparison of various diagnostic studies for [disease name] ====
-{|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
+| rowspan="2" |'''C= Imaging'''
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+|C1
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+|Biliary dilation
 |-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
+|C2
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+|Evidence of etiology on the imaging
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
+(stricture, stone, stent)
 |}
-<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
+'''SUSPECTED DIAGNOSIS''' '''- One item in A + one item in either B or C'''
-===== Diagnostic results =====
-The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
-* [Finding 1]
-* [Finding 2]
-===== Sequence of Diagnostic Studies =====
-The [name of investigation] must be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-OR
-The various investigations must be performed in the following order:
-* [Initial investigation]
-* [2nd investigation]
-=== Name of Diagnostic Criteria ===
-'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
-[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-OR
-There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-OR
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-* Criteria 1
-* Criteria 2
-* Criteria 3
-OR
-'''IF there are clear, established diagnostic criteria'''
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-OR
-The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-'''IF there are no established diagnostic criteria'''
-There are no established criteria for the diagnosis of [disease name].
+'''DEFINITE DIAGNOSIS - One item in A, one item in B and one item in C'''
 ==References==