hepatic and biliary disorders
Choledocholithiasis and Cholangitis
Diagnosis of Choledocholithiasis and Cholangitis
Liver tests Ultrasonography Common duct stones should be suspected in patients with jaundice and biliary colic. Fever and leukocytosis further suggest acute cholangitis. Elevated levels of bilirubin and particularly alkaline phosphatase, alanine aminotransferase, and gamma-glutamyltransferase are consistent with extrahepatic obstruction, suggesting stones, particularly in patients with features of acute cholecystitis or cholangitis. Ultrasonography may show stones in the gallbladder and occasionally in the common bile duct (less accurate). The common bile duct is dilated ( For suspected acute cholangitis, complete blood count and blood cultures are essential. Leukocytosis is common, and aminotransferases may reach 1000 IU/L, suggesting acute hepatic necrosis, often due to microabscesses. Blood cultures guide antibiotic choice. 