Have you ever heard of the medical condition cholangitis? Although the name may sound complicated, this article aims to address all your questions about this condition.
Cholangitis is a medical condition that refers to the inflammation of the bile ducts in the liver. The bile ducts are long tube-like structures responsible for transporting the bile (greenish-yellow fluid produced by the liver, consisting of waste products, cholesterol, and bile salts) to the gallbladder and small intestines to carry away waste and break down fats during digestion. Cholangitis is caused by a bacterial infection that can result in long-term complications if left untreated.1
Cholangitis can be categorised into four main types:
- Acute cholangitis
- Primary sclerosing cholangitis2
- Secondary sclerosing cholangitis3
- Recurrent pyogenic cholangitis4
Causes of cholangitis
The primary cause of acute cholangitis is bacterial infection. When bacteria travel through the bile ducts to the intestine, it triggers inflammation in the ducts. Various types of bacteria can be responsible for this infection, including:
- Escherichia coli
- Types of anaerobes
Infections in the bile ducts can lead to obstructions, potentially causing the formation of gallstones and even tumors. These blockages can prevent the normal flow of the bile.
However, cholangitis can also arise from factors other than bacterial infections. Previous trauma, surgical procedures, autoimmune conditions, and parasitic infections are additional causes of cholangitis.5
Signs and symptoms of cholangitis
Symptoms of cholangitis can vary according to the severity of infection and the type of cholangitis. However, the most common symptoms of acute cholangitis include:6
- Fatigue and weakness
- High fever for more than 24 hours
- Nausea and vomiting
- Dark urine and pale stools
- Yellowing of the skin and eyes (Jaundice)
- Pain in upper abdomen
- Low blood pressure (Hypotension)
Management and treatment for cholangitis
Managing and treating cholangitis is crucial in establishing an appropriate course of action for this condition. The treatment for cholangitis can vary depending on how early you receive a diagnosis and the severity of symptoms.
The key to effective treatment often lies in early intervention, and this is especially critical when dealing with acute cholangitis. Neglecting prompt treatment can potentially lead to serious complications. Treatment for cholangitis may include:
Penicillin, ciprofloxacin, ceftriaxone, or metronidazole, can be prescribed for up to 10 days to treat the bacterial infection.6
Intravenous (IV) fluids and antibiotics can be administered to treat the infection and manage the symptoms.6
Endoscopic retrograde cholangiopancreatography (ERCP), which combines the upper gastrointestinal (GI) endoscopy and x-rays might be used. The doctor will examine the bile ducts and look for narrowed areas or blockages. In addition, doctor can perform the ERCP to open blocked or narrowed ducts and break up or remove stones.7
Your doctor might perform surgery to either remove the blocked part of the bile duct or repair any damage.8
Diagnosis of cholangitis
If you have the common symptoms of cholangitis, your doctor will order a set of tests to diagnose the condition. These tests help to determine the presence of infection or any other issues, such as blockages or gallstones in the liver and bile ducts.
The blood tests used for diagnosing cholangitis, include:
- A complete blood count (CBC)
It is performed to assess the white blood cell count, which tends to be elevated in the presence of an infection.
- Blood culture
It is performed to determine the presence of blood infection.
- Liver function tests
These tests are performed to determine if your liver is working properly, and ensure that your liver enzymes fall within the normal range.
In addition to blood testing, several types of imaging tests may also be required to confirm the diagnosis. These imagaing tests include:9
- CT scans
- Magnetic resonance cholangiopancreatography (MRCP)
- Percutaneous transhepatic cholangiography (PTC)10
Some risk factors may put you at greater risk for developing cholangitis. These factors include:
- Recent medical surgery related to the liver or bile duct area
- Presecne of gallstones
- Autoimmune diseases like inflammatory bowel disease or ulcerative colitis
In rare cases, travel to certain countries where there is potential exposure to particular worms and parasites can result in acquiring an infection.11
There are a variety of complications and long-term health conditions that can arise if cholangitis is left untreated. These include:2
- Acute biliary pancreatitis
- Acute renal failure
- Liver failure
- Portal vein thrombosis
- Acute cholecystitis
- Biliary septicemia
- Hepatic abscesses
How common is cholangitis?
In the United Kingdom, it is estimated that cholangitis affects approximately 25 out of every 100,000 individuals, with around 17,000 patients currently diagnosed with the condition.12
How can I prevent cholangitis?
To prevent cholangitis, it is crucial to maintain optimal liver health and protect the bile ducts from damage. This can be achieved by avoid drinking alcohol, maintain a healthy diet, and exercise regularly. It's important to monitor individuals at higher risk of cholangitis, as those mentioned in the risk factors above, to prevent and manage the condition effectively.
When should I see a doctor?
If you have any signs and symptoms of cholangitis, seek medical attention immediately. Additionaly, if you belong to the group of individuals with risk factors such as recent liver surgery, a history of gallstones, or an immune disease, make sure to inform your doctor. This way, you can receive proper monitoring and promptly seek medical assistance if you exhibit any symptoms of cholangitis.
Cholangitis is a serious medical condition related to the liver. Swift diagnosis is crucial for the development of an effective treatment plan. Understanding the various aspects of this condition and taking appropriate measures for its management and treatment can significantly reduce the risk of long-term complications. For individuals at risk of developing cholangitis, prevention plays an important role in reducing that risk. This involves adopting a healthy lifestyle to promote optimal liver health.
- Sokal A, Sauvanet A, Fantin B, de Lastours V. Acute cholangitis: Diagnosis and management. Journal of Visceral Surgery [Internet]. 2019 Dec 1 [cited 2023 Oct 9];156(6):515–25. Available from: https://www.sciencedirect.com/science/article/pii/S1878788619300670
- Virgile J, Marathi R. Cholangitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK558946/
- Ruemmele P, Hofstaedter F, Gelbmann CM. Secondary sclerosing cholangitis. Nat Rev Gastroenterol Hepatol [Internet]. 2009 May [cited 2023 Oct 9];6(5):287–95. Available from: https://pubmed.ncbi.nlm.nih.gov/19404269/
- Gupta A, Simo K. Recurrent pyogenic cholangitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK564308/
- Zimmer V, Lammert F. Acute bacterial cholangitis. Viszeralmedizin [Internet]. 2015 Jun [cited 2023 Oct 9];31(3):166–72. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4569195/
- Ahmed M. Acute cholangitis - an update. World J Gastrointest Pathophysiol [Internet]. 2018 Feb 15 [cited 2023 Oct 9];9(1):1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823698/
- Meseeha M, Attia M. Endoscopic retrograde cholangiopancreatography. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK493160/
- Lavillegrand JR, Mercier-Des-Rochettes E, Baron E, Pène F, Contou D, Favory R, et al. Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study. Critical Care [Internet]. 2021 Feb 6 [cited 2023 Oct 9];25(1):49. Available from: https://doi.org/10.1186/s13054-021-03480-1
- Mohammad Alizadeh AH. Cholangitis: diagnosis, treatment and prognosis. J Clin Transl Hepatol [Internet]. 2017 Dec 28 [cited 2023 Oct 9];5(4):404–13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719198/
- Young M, Mehta D. Percutaneous transhepatic cholangiogram. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Oct 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK493190/