Cholangitis: Causes, Symptoms, Diagnosis, Treatment, and Prevention
Symptoms of chollangitis include inflammation of the bile ducts, the tubes that carry bile from the liver and gallbladder to the small intestine. Bile is a fluid that helps digest and absorb fats, as well as remove waste from the liver. There are two types of cholangitis: acute (sudden and severe) and chronic (long-lasting and mild).
Causes of Cholangitis
Cholangitis can be caused by various factors that block or damage the bile ducts, such as:
-
Gallstones: hard deposits of cholesterol or bile salts that form in the gallbladder or bile ducts. They can obstruct the flow of bile and cause infection.
-
Tumors: abnormal growths of cells that can occur in the bile ducts, gallbladder, pancreas, or duodenum. They can compress or invade the bile ducts and cause obstruction or bleeding.
-
Strictures: narrowing of the bile ducts due to scarring, inflammation, or injury. They can result from previous surgery, trauma, infection, or autoimmune diseases.
-
Infections: bacteria, viruses, fungi, or parasites that can enter the bile ducts from the intestine or the bloodstream. They can cause inflammation and infection of the bile ducts and the liver.
-
Autoimmune diseases: conditions that cause the immune system to attack the body’s own tissues. Some examples are primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), which affect the small bile ducts inside the liver and cause chronic inflammation and scarring.
Symptoms of Cholangitis
The symptoms of cholangitis depend on the type, severity, and duration of the condition. Some people may not have any symptoms, while others may experience:
-
Pain in the upper right abdomen, which may radiate to the back or shoulder
-
Fever and chills
-
Jaundice (yellowing of the skin and eyes)
-
Dark urine and pale stools
-
Nausea and vomiting
-
Itching
-
Fatigue and weakness
-
Weight loss and loss of appetite
-
Swelling of the abdomen, feet, and ankles
-
Confusion and mental changes
Diagnosis of Cholangitis
As a first step in diagnosing cholangitis, the doctor will ask about the symptoms, medical history, and risk factors. He or she will also perform a physical examination and look for signs of jaundice, abdominal tenderness, and an enlarged liver or spleen.
-
Blood tests: to check for signs of infection, inflammation, liver function, and bile duct obstruction.
-
Urine tests: to check for signs of infection or bile in the urine.
-
Imaging tests: to visualize the bile ducts and the surrounding organs. Some examples are ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP).
-
Endoscopic tests: to examine the bile ducts and take samples of tissue or fluid. Some examples are endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and percutaneous transhepatic cholangiography (PTC).
Treatment of Cholangitis
Cholangitis is treated by relieving obstruction, treating infection, and preventing complications. Treatment may include:
-
The antibiotics are given intravenously (into a vein) at first, and then orally (by mouth) as the condition improves.
-
An endoscope or a needle can be used to insert a tube (stent) or a balloon (sphincterotomy) into the bile duct to remove blockages and restore the flow of bile.
-
In surgery, the source of obstruction is removed, such as gallstones, tumors, or strictures. When the liver is severely damaged or scarred, a liver transplant may be required. This can be done by removing the gallbladder (cholecystectomy), part of the bile duct (choledochectomy), or part of the liver (hepatectomy).
Prevention of Cholangitis
To prevent cholangitis, it is important to address the underlying causes and risk factors, such as:
-
For prevention of gallstones, it is recommended that you maintain a healthy weight, eat a balanced diet, avoid rapid weight loss, and exercise regularly. If gallstones cause symptoms or complications, they may need to be removed through medication, shock wave therapy, or surgery.
-
To prevent tumors, it is important to avoid smoking, limit alcohol consumption, and follow screening guidelines for cancers of the bile ducts, gallbladder, pancreas, and duodenum. Surgery, chemotherapy, radiation therapy, or targeted therapy may be necessary if a tumor is detected.
-
A precautionary measure for preventing strictures is to avoid injury or infection of the bile ducts, as well as to seek prompt treatment for any conditions that may cause inflammation or scarring, such as surgery, trauma, or an autoimmune condition. Dilation, stenting, or surgery may be needed if strictures cause symptoms or complications.
-
To prevent infections, practice good hygiene, avoid contaminated food and water, and get vaccinated for hepatitis A and B. If infections occur, antibiotics, antivirals, antifungals, or antiparasitics will be required.
-
It is recommended to follow the doctor's advice regarding medication, lifestyle, and monitoring in order to prevent autoimmune diseases. If autoimmune diseases result in symptoms or complications, immunosuppressants, steroids, or other drugs may be prescribed.
