How is dx of acute cholangitis?

Labs: Leukocytosis with increased Bilirubin, ALP, and LFTs, Creatinin, PTT TP INR. Ultrasound: Should be the initial study; dilation of common and intrahepatic bile ducts is suggestive. MRCP, ERCP: Provides a definitive diagnosis; can also be therapeutic. Bile cultures: Obtain to facilitate proper antibiotic treatment; offending organisms are usually enteric gram negatives and enterococci.