Laboratory Findings in Cholangitis and Cholecystitis
The laboratory findings that indicate cholangitis include markers of inflammation (elevated white blood cell count and C-reactive protein >75 mg/L) and markers of biliary stasis (elevated alkaline phosphatase, bilirubin >2x upper limit of normal, and elevated aminotransferases), while cholecystitis typically presents with similar inflammatory markers but without the prominent biliary obstruction pattern. 1
Laboratory Findings in Acute Cholangitis
Inflammatory Markers
- Elevated white blood cell count (leukocytosis) is a key indicator of inflammation 1
- C-reactive protein >75 mg/L serves as an important inflammatory marker 1
Biliary Stasis Markers
- Elevated alkaline phosphatase is the most common biochemical abnormality in cholangitis 1
- Elevated bilirubin (>2x upper limit of normal) indicates biliary obstruction 1
- Elevated aminotransferases reflect hepatobiliary injury 1
Diagnostic Integration
The diagnosis of acute cholangitis requires a combination of clinical signs (jaundice, fever, chills, right upper quadrant pain), these laboratory findings indicating inflammation and biliary stasis, and imaging findings showing biliary dilatation or an obstructing etiology 2, 3
Laboratory Findings in Acute Cholecystitis
Key Differences from Cholangitis
While acute cholecystitis shares inflammatory markers with cholangitis, the pattern differs:
- Inflammatory markers are present (elevated WBC, fever) but typically without the marked biliary obstruction pattern 4
- The clinical presentation centers on right upper quadrant pain, fever, and nausea rather than the jaundice and biliary stasis pattern seen in cholangitis 4
Diagnostic Approach
Laboratory findings in cholecystitis are supportive but not definitive; ultrasonography with 81% sensitivity and 83% specificity remains the primary diagnostic modality, with hepatobiliary scintigraphy serving as the gold standard when ultrasound is equivocal 4
Critical Clinical Pitfall
Do not rely solely on laboratory values to distinguish between cholangitis and cholecystitis. The key differentiator is that cholangitis demonstrates prominent biliary stasis markers (elevated alkaline phosphatase, bilirubin >2x normal) alongside inflammation, while cholecystitis shows inflammation without significant biliary obstruction 2, 1. Both conditions require integration of clinical signs, laboratory findings, and imaging for accurate diagnosis 2, 3.