Cholangitis

Did you know that Cholangitis can be a serious threat to your health? This condition, which affects the bile ducts, can cause severe discomfort and lead to life-threatening complications if left untreated. Cholangitis symptoms often include fever, abdominal pain, and jaundice, making early diagnosis and proper care crucial for recovery.

This article aims to shed light on the causes of Cholangitis, its symptoms, and various cholangitis treatment options. 

What is Cholangitis?

Cholangitis is an inflammation or swelling of the bile duct system (the system is responsible for carrying bile from the liver & gallbladder to the small intestine). This condition occurs when the bile ducts become irritated, swollen, and potentially infected. The bile, a substance made up of waste products from blood and bile acids, plays a crucial role in digestion and waste elimination. Cholangitis can be of two types:

• Acute Cholangitis, or ascending Cholangitis, is a fatal condition caused by an ascending bacterial infection in the biliary tree. 
• Chronic Cholangitis, on the other hand, is a long-term condition that doesn't go away. It can result from various chronic diseases affecting the bile duct system. 

Symptoms of Cholangitis

The most common signs include pain in the upper right abdomen, fever, and jaundice, known as Charcot's Triad. This pain may be sharp or dull, sometimes radiating to the right shoulder blade or back. It often comes in episodes, especially after heavy meals, a condition called biliary colic.

Other symptoms include:

• Chills and loss of appetite
• Nausea and vomiting
• Clay-coloured stools and dark urine
• Low blood pressure and lethargy
• Confusion and disorientation

Causes of Cholangitis

Cholangitis can result from various factors, including: 

• The most common cause of obstruction in the biliary system is choledocholithiasis, which involves the presence of gallstones in the bile ducts. 
• Other causes are benign or malignant strictures of biliary ducts, pancreatic cancer, and various tumours. 
• Parasitic infections, such as those caused by Clonorchis sinensis or Fasciola hepatica, can also lead to Cholangitis.
• A swollen pancreas, gallstone, blood clots, inflammatory conditions affecting the liver and bile ducts, parasite infections, or abdominal trauma can also lead to Cholangitis.
• Acute Cholangitis typically occurs due to bacterial infection of the bile ducts. The pathogens commonly responsible include Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, and Citrobacter. 
• The iatrogenic introduction of bacteria, often followed by procedures like endoscopic retrograde cholangiopancreatography (ERCP), can also cause Cholangitis in individuals with biliary obstruction.

Risk Factors for Cholangitis

Several factors increase the risk of developing Cholangitis. 

• A history of gallstones tops the list
• A sedentary lifestyle
• Increased triglyceride intake
• A body mass index (BMI) over 30 
• People with HIV 
• Recent procedures involving the bile duct area 
• Exposure to worms or parasites in some regions can lead to Cholangitis. 

Diagnosis of Cholangitis

Doctors diagnose Cholangitis through a combination of clinical presentation, laboratory tests, and imaging studies. 

• Blood investigations play a crucial role in identifying infection and liver function abnormalities. These include a complete blood count, which often shows more than the normal white blood cell count range, and liver function tests that reveal increased levels of bilirubin, alkaline phosphatase, and gamma-glutamyl transferase.
• Abdominal ultrasound is typically the first-line imaging method due to its accessibility and ability to detect bile duct dilatation and gallstones. 
• Magnetic resonance cholangiopancreatography (MRCP) has become the preferred non-invasive imaging method. 
• Endoscopic retrograde cholangiopancreatography (ERCP) remains the gold standard for diagnosis and treatment. It allows direct visualisation of the bile ducts and can be used to remove obstructions or take biopsy samples.
• In some cases, doctors may ask for a liver biopsy to analyse the extent of damage that has happened to the liver. 
• Endoscopic ultrasound (EUS) is emerging as a valuable diagnostic tool, offering high-resolution images of the biliary system and potentially replacing ERCP in some situations.

Treatment for Cholangitis

Doctors carry out chronic and acute cholangitis treatment by addressing the infection and the bile duct obstruction. They start by giving antibiotics to fight the infection. 
Clearing the blocked bile duct is crucial. Doctors often use a procedure called ERCP (Endoscopic Retrograde Cholangiopancreatography) to do this. It's less invasive than surgery and allows them to place a stent or drain in the bile duct. If ERCP isn't possible, they might use a technique called PTC (Percutaneous Transhepatic Cholangiography).

Complications of Cholangitis

Cholangitis can lead to severe consequences if left untreated or if treatment is delayed. 

In acute cases, patients may experience gallbladder rupture or necrosis, bile infiltration into the peritoneum, and bleeding in the biliary tract. These complications can quickly escalate to biliary shock and sepsis, posing a significant threat to life.

Chronic complications include the formation of abscesses in the biliary tract and liver. Patients may develop hepatic abscesses, which are pockets of pus in the liver. Portal vein thrombosis, the development of a blood clot in the portal vein, is another serious complication. Acute cholecystitis and gallbladder inflammation can also occur.

When to See a Doctor

Individuals should go for medical help if they experience any symptoms that worry them, particularly those associated with Cholangitis. The most common signs include upper right quadrant abdominal pain, fever, and jaundice, known as Charcot's Triad. 

Other symptoms that may be a cause of concern include:

• Changes in digestion and bowel movements
• Biliary colic (episodic abdominal pain, often after heavy meals)
• Yellowing of the eyes and skin

Prevention

While it's not always possible to prevent Cholangitis, one can take measures to decrease the risk and improve outcomes. 

• A balanced diet with abundant fibre and low fat can ease symptoms and prevent complications. Doctors recommend choosing reduced-sodium foods to minimise tissue swelling and fluid buildup in the abdomen.
• For those with a history of gallstones or biliary ductal diseases, education is key. They should familiarise themselves with the signs of Cholangitis and seek immediate medical attention if symptoms arise. Early identification & treatment of symptomatic cholelithiasis in high-risk patients can significantly decrease the risk of Cholangitis.
• Regular exercise, most days of the week, can help reduce the risk of bone loss. It's crucial to avoid smoking and alcohol consumption, as these habits can cause additional stress on the liver. People with primary biliary Cholangitis should generally abstain from alcohol completely.
• Individuals undergoing ERCP procedures can benefit from prophylactic antibiotics to decrease the risk of Cholangitis. For those with recurrent acute Cholangitis, ongoing antibiotic treatment may help reduce the incidence and severity of the disease.
• Patients should consult their doctor before starting new medicines or dietary supplements, as their liver's compromised function may increase sensitivity to these substances.

Conclusion

Cholangitis presents a significant health challenge that requires prompt attention and proper care. Understanding its symptoms, causes, and treatment modalities is crucial for managing this condition effectively. Early diagnosis and intervention play a vital role in preventing severe complications and improving outcomes for those affected.

FAQ's

1. What happens when you have Cholangitis?

Cholangitis causes inflammation in the bile ducts, which carry bile from the liver to other digestive organs. This inflammation can lead to several serious complications. The swelling may obstruct bile flow, causing it to back into organs and breed bacteria. 

2. What is the difference between Cholangitis vs. cholecystitis?

While both conditions affect the biliary system, they involve different parts:

• Cholangitis is inflammation of the bile ducts
• Cholecystitis is inflammation of the gallbladder

3. Is Cholangitis a liver disease?

Cholangitis is primarily a biliary tract infection rather than a liver disease. However, it can significantly impact liver health over time. 

CARE Medical Team