The evaluation of cholangitis begins with a history and physical examination.

Physical findings in those with cholangitis include:

• Abdominal tenderness in the right-upper abdomen.
• Jaundice may be present if there is blockage of the bile duct.

Testing is usually required to confirm this diagnosis of cholangitis and determine the severity of the illness.

Tests that may be used to evaluate cholangitis include:

• Serum amylase
• Serum lipase
• Serum bilirubin
• Complete blood count
• Liver profile
• Kidney profile
• Urinalysis
• Blood cultures

Gallbladder imaging tests that may be used to evaluate cholangitis include:

• Abdominal x-rays
• Cholangiogram:
• A special x-ray that highlights the course of the common bile duct.
• Ultrasound of the abdomen
• CT scanning of the abdomen
• MRI scan of the abdomen
• Nuclear scanning of the gallbladder (HIDA scan)
• ERCP:
• Offers the additional benefit of allowing for the removal of gallstones from the common bile duct, thus avoiding the need for emergency surgery.