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{{Cholangitis}} | {{Cholangitis}} | ||
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== | ==Overview== | ||
[[Endoscopic retrograde cholangiopancreatography]] ([[ERCP]]) is considered a gold standard test for diagnosing [[biliary obstruction]]. [[Magnetic resonance cholangiopancreatography]] (MRCP) and [[percutaneous transhepatic cholangiography]] ([[PTCA]]) are the most [[Sensitivity (tests)|sensitive]] techniques to correctly determine the underlying cause and level of [[biliary obstruction]] in patients with acute cholangitis when [[Endoscopic retrograde cholangiopancreatography|ERCP]] fails. | |||
==Other Diagnostic Findings== | |||
* [[ | ===Endoscopic retrograde cholangiopancreatography (ERCP)=== | ||
ERCP is the preferred imaging method for diagnosing [[biliary obstruction]] as it is both diagnostic and therapeutic. [[Endoscopic retrograde cholangiopancreatography|ERCP]] involves the use of [[endoscopy]] to pass a small [[cannula]] into the [[bile duct]]. [[Radiocontrast]] is then injected to opacify the duct, and [[x-rays]] are taken to get a visual impression of the [[biliary system]]. Findings on an [[Endoscopic retrograde cholangiopancreatography|ERCP]] suggestive of/diagnostic of acute cholangitis include: | |||
*A protuberant ampulla from an impacted [[gallstone]] in the [[common bile duct]], or the frank extrusion of [[pus]] from the [[common bile duct]] orifice.<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | |||
=== Percutaneous transhepatic cholangiography (PTCA) === | |||
In case the [[Endoscopic retrograde cholangiopancreatography|ERCP]] is unsuccessful, [[percutaneous transhepatic cholangiography]] (PTCA) can be used to allow access to the [[biliary tree]].<ref name="pmid13684978">{{cite journal |vauthors=ATKINSON M, HAPPEY MG, SMIDDY FG |title=Percutaneous transhepatic cholangiography |journal=Gut |volume=1 |issue= |pages=357–65 |year=1960 |pmid=13684978 |pmc=1413224 |doi= |url=}}</ref><ref name="urlPrimary Sclerosing Cholangitis">{{cite web |url=http://www.niddk.nih.gov/health-information/health-topics/liver-disease/primary-sclerosing-cholangitis/Pages/facts.aspx |title=Primary Sclerosing Cholangitis |format= |work= |accessdate=April 20 2016}}</ref> | |||
*The PTCA procedure involves inserting a needle through the skin and placing a thin tube into a [[duct]] in the [[liver]]. | |||
*Dye is injected through the tube and [[x-rays]] are then taken. | |||
For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable. | |||
*If the index of suspicion for cholangitis is high, an [[Endoscopic retrograde cholangiopancreatography|ERCP]] is typically done to achieve drainage of the obstructed [[common bile duct]].<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | |||
===Magnetic resonance cholangiopancreatography (MRCP)=== | |||
*Useful in patients with postcholecystectomy and in patients with non-conclusive [[Endoscopic retrograde cholangiopancreatography|ERCP]].<ref name="pmid16691174">{{cite journal |vauthors=Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM |title=[Acute cholangitis: imaging diagnosis and management] |language=French |journal=J Radiol |volume=87 |issue=4 Pt 2 |pages=430–40 |year=2006 |pmid=16691174 |doi= |url=}}</ref> | |||
**This safe and painless test is increasingly used for [[diagnosis]]. | |||
*The only disadvantage is that smaller stones can be missed on a [[MRCP]].<ref name="pmid17556149">{{cite journal |vauthors=Kinney TP |title=Management of ascending cholangitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=17 |issue=2 |pages=289–306, vi |year=2007 |pmid=17556149 |doi=10.1016/j.giec.2007.03.006 |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Endoscopic retrograde cholangiopancreatography (ERCP) is considered a gold standard test for diagnosing biliary obstruction. Magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiography (PTCA) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis when ERCP fails.
Other Diagnostic Findings
Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP is the preferred imaging method for diagnosing biliary obstruction as it is both diagnostic and therapeutic. ERCP involves the use of endoscopy to pass a small cannula into the bile duct. Radiocontrast is then injected to opacify the duct, and x-rays are taken to get a visual impression of the biliary system. Findings on an ERCP suggestive of/diagnostic of acute cholangitis include:
- A protuberant ampulla from an impacted gallstone in the common bile duct, or the frank extrusion of pus from the common bile duct orifice.[1]
Percutaneous transhepatic cholangiography (PTCA)
In case the ERCP is unsuccessful, percutaneous transhepatic cholangiography (PTCA) can be used to allow access to the biliary tree.[2][3]
- The PTCA procedure involves inserting a needle through the skin and placing a thin tube into a duct in the liver.
- Dye is injected through the tube and x-rays are then taken.
For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable.
- If the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct.[1]
Magnetic resonance cholangiopancreatography (MRCP)
- Useful in patients with postcholecystectomy and in patients with non-conclusive ERCP.[4]
- This safe and painless test is increasingly used for diagnosis.
- The only disadvantage is that smaller stones can be missed on a MRCP.[1]
References
- ↑ 1.0 1.1 1.2 Kinney TP (2007). "Management of ascending cholangitis". Gastrointest. Endosc. Clin. N. Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
- ↑ ATKINSON M, HAPPEY MG, SMIDDY FG (1960). "Percutaneous transhepatic cholangiography". Gut. 1: 357–65. PMC 1413224. PMID 13684978.
- ↑ "Primary Sclerosing Cholangitis". Retrieved April 20 2016. Check date values in:
|accessdate=(help) - ↑ Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM (2006). "[Acute cholangitis: imaging diagnosis and management]". J Radiol (in French). 87 (4 Pt 2): 430–40. PMID 16691174.