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Cholangitis

What is cholangitis?

Cholangitis is an inflammation of the bile duct system that is usually related to a bacterial infection. The bile duct system is the drainage system that carries bile from the liver and gallbladder into the area of the small intestine called the duodenum. The infection may occur suddenly or may be chronic.

What causes cholangitis?

There are several conditions that may trigger an infection in the bile duct system. The primary cause of cholangitis is an obstruction or blockage somewhere in the bile duct system. The blockage may be from stones, a tumor, blood clots, a narrowing that may occur after a surgical procedure, swelling of the pancreas, or from parasite invasion. Other causes include a backflow of bacteria from the small intestine, a blood infection (bacteriemia), or following a diagnostic procedure such as an endoscopic examination. The infection causes pressure to build-up in the bile duct system.

What are the symptoms of cholangitis?

Symptoms for cholangitis may be moderate to severe. The following are the most common symptoms of cholangitis. However, each individual may experience symptoms differently. Symptoms may include:

  • Pain in the right upper quarter of the abdomen
  • Fever
  • Chills
  • Jaundice (yellowing of the skin and eyes)
  • Clay-colored stools
  • Dark urine
  • Low blood pressure
  • Lethargy
  • Decreased level of alertness

The symptoms of cholangitis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.

Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.

But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

Who is at risk for cholangitis?

Cholangitis occurs more commonly in women than men. The onset is usually after age 55. Individuals who are at greater risk are those who have previously suffered from gallstones.

How is cholangitis diagnosed?

The pain associated with cholangitis often mimics gallstones. In addition to a complete medical history and physical examination, diagnostic procedures for cholangitis may include the following:

  • Blood tests, including the following:
    • Complete blood count (CBC). This test measures the white blood cells which can be elevated with an infection.
    • Liver function tests. A series of special blood tests that can determine if the liver is functioning properly.
    • Blood cultures. Tests to determine if there is a blood infection
  • Cholangiography. An X-ray examination of the bile ducts using an intravenous (IV) dye (contrast).
  • Percutaneous transhepatic cholangiography (PTC). A needle is introduced through the skin and into the liver where the dye (contrast) is deposited into the bile ducts and the bile duct structures can be viewed by X-ray.
  • Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, which is a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum. The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected which will allow the internal organs to appear on an X-ray.
  • Magnetic resonance cholangiopancreatography (MRCP). A procedure that uses magnetic resonance imaging (MRI) to obtain pictures of the bile ducts. The machine uses radio waves and magnets to scan internal organs and tissues.
  • Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen, such as the liver spleen, and kidneys, and to assess blood flow through various vessels.

Treatment for cholangitis

Specific treatment for cholangitis will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your tolerance of specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

The goal for treating cholangitis is to attack the bacterial infection with antibiotics and also to identify the blockage in the bile duct system and manage it.

Treatment may include:

  • Intravenous (IV) antibiotics
  • Surgery or an X-ray procedure, such as endoscopy (to decompress the bile duct system and remove the blockage)
  • Treatment of blood pressure if it is too low

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