Cholangitis is an inflammation of the bile duct system. Bile ducts carry bile from the liver and gallbladder to the duodenum (first part of the small intestine). Bile is a green to yellow-brown fluid that contains bile acids and bile salts that help in the digestion and absorption of fats (emulsification of fats). It also helps get rid of waste products from the body. Cholangitis is developed by biliary outflow obstruction and biliary infection. Any factors that contribute to the obstruction of biliary duct flow lead to Cholangitis. The main factors that play role in the pathogenesis of Cholangitis are biliary tract obstruction, elevated intraluminal pressure, and infection of bile.

During an obstruction, stasis of fluid within the biliary tree (duct) combined with increased intra-luminal pressure promotes the growth (colonization) of bacteria. This can occur when the duct is occluded by gallstone, common bile duct stones (CBD) or cholangiocarcinoma, etc.

It is also believed that bacteria gains access to the biliary tract ascends from the duodenum to the biliary tree (CBD) causing serious infection.

Cholangitis is classified into the following categories:

• Acute cholangitis or ascending cholangitis

• Primary sclerosing cholangitis (PSC)

• Secondary sclerosing cholangitis (SSC)

• Immune cholangitis

 

 

Cholangitis Causes

 

Any condition that causes blockage of the biliary tract has the potential to cause cholangitis. Impeded bile drainage due to occlusion of biliary duct promotes colonization of bacteria causes serious infection.

The main causes are gallstones, common bile duct (CBD) stones, bacterial infection (backflow of bacteria from the intestine to the biliary tree), cholangiocarcinoma, chronic pancreatitis, and following ischemic damage. Autoimmune diseases like primary sclerosing cholangitis can cause inflammation of the bile ducts which can lead to liver cirrhosis and be complicated by cholangiocarcinoma.

 

 

 

 

Cholangitis Symptoms

The most common presenting symptoms are Charcot’s cholangitis triad manifested as;

•  Right upper quadrant (RUQ) pain in the abdomen

• Fever chills with sometimes rigors

• Jaundice

The patient may also complain of itching, as a result of bile accumulation, and pale stool with dark urine, from obstructive jaundice.

Other symptoms include

• Confusion

• Low blood pressure

• Tachycardia

 

 

How is Cholangitis diagnosed?

 

• Complete Blood Count: Leucocytosis (increased white blood cell count) is found in the majority of patients indicating infection.

• Liver Function Tests: showing a raised ALP ± GGT with a raised bilirubin.

• Ultrasound Imaging: Ultrasound imaging may also demonstrate the presence of an underlying cause (e.g. gallstones).

• The gold standard investigation for cholangitis is ERCP (endoscopic cholangiopancreatography), as it is both diagnostic and therapeutic. Many endoscopists may require an MRCP (magnetic resonance cholangiopancreatography) before investigation while some use PTC (percutaneous transhepatic cholangiography)

 

 

 

Treatment for Cholangitis

 

In most cases, fluid resuscitation, correction of electrolyte imbalance, and treatment with broad-spectrum antibiotics and an endoscopic procedure are necessary. Bile duct drainage is also crucial. Surgery may be required.

Vitamin K or fresh frozen plasma (FFP) may be used for the correction of coagulopathy when needed.

Procedures to open blocked ducts include:

• Endoscopic therapy (ERCP)

• Percutaneous therapy (PTC)

• Surgery

 

 

References

Cholangitis. (n.d.). Retrieved from Johns Hopkins Medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/cholangitis

Cholangitis. (2019, September 26). Retrieved from TeachMe Surgery: https://teachmesurgery.com/hpb/gall-bladder/cholangitis/

Homayoun Shojamanesh, M. (2020, March 11). Cholangitis Treatment & Management. Retrieved from Emedicine: https://emedicine.medscape.com/article/184043-treatment

Noreen Iftikhar, M. (2019, February 21). What Is Cholangitis and How’s It Treated? Retrieved from Healthline: https://www.healthline.com/health/cholangitis

Ramirez, J. A. (n.d.). Cholangitis. Retrieved from Cancer Therapy Advisor: https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/cholangitis/

William C. Shiel Jr., M. F. (n.d.). Medical Definition of Cholangitis, primary sclerosing. Retrieved from MedicineNet: https://www.medicinenet.com/script/main/art.asp?articlekey=8043

 

 

 

 

 

 

 

 

 

---

Find articles related to: Medicine Telehealth Health Cholangitis PSC Cholangitis Triad Symptoms


More articles about Digestive System

Back to the Health Tips Index