Symptoms and Causes of Cholangitis | Gastroenterology

Cholangitis

What is cholangitis?

Cholangitis is an irritation of the bile duct system. The bile duct system carries bile from the liver and gallbladder to the first part of the small intestine (the duodenum). In most cases, this is caused by a bacterial infection and often occurs suddenly. But in some cases, it can be long-term (chronic). Some people develop inflammation and cholangitis as part of an autoimmune disease.

Symptoms of cholangitis

Symptoms depend on the type of cholangitis you have and for how long. Each person with this disease may have slightly different signs and symptoms. More than 50 percent of people diagnosed with chronic cholangitis do not have any symptoms. Some of the early symptoms of chronic cholangitis may include:

  • Tiredness and fatigue
  • Skin itch
  • Dry eyes
  • Dry mouth

If you have chronic cholangitis for an extended time, you may have:

  • Pain in the upper right side
  • Night sweats
  • Swollen feet and ankles
  • Darkening of the skin (hyperpigmentation)
  • Muscle pain
  • Bone or joint pain
  • Bloating (fluid in the stomach area)
  • Fatty deposits (xanthomas) on the skin around the eyes and eyelids
  • Fat deposits on the elbows, knees, palms, and soles of the feet
  • Diarrhea or greasy stools
  • Clay-colored bowel movements
  • Weightloss
  • Mood swings and memory problems

If you have acute cholangitis, you may have other symptoms as well. These include sudden symptoms like:

  • High fever for more than 24 hours’ Reliable source
  • Cold
  • Nausea
  • Throwing up
  • Back pain
  • Pain under the shoulder blades
  • Dull pain or cramping in the upper right side
  • Sharp or dull pain in the internal the stomach
  • Low blood pressure
  • Confusion
  • Yellowing of the skin and eyes (jaundice)

Your doctor may find signs in other portions of the body. These include:

  • Swollen or enlarged liver
  • Swollen or enlarged spleen
  • High cholesterol
  • Underactive thyroid gland (hypothyroidism)
  • Weak and brittle bones (osteoporosis)

Causes of cholangitis

Cholangitis is most often caused by bacteria. This can happen when the duct is blocked by something, such as a gallstone or tumor. The infection that causes this condition can also spread to the liver.

Risk factors comprise a history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and, infrequently, traveling to republics where you could get a worm or parasite infection.

Risk factors for cholangitis

The risk of emerging cholangitis will depend on several factors, but some conditions can make this infection more probable. People who are at higher risk of developing a bile duct infection include anyone who has:

  • A history of gallstones3
  • A diagnosis of sclerosing cholangitis
  • Recently traveled to areas where parasitic or bacterial infections can occur
  • A recent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement (risk was 13.2 percent in one study).

Diagnosis of cholangitis

Cholangitis is not a complete diagnosis, as there is almost always an underlying cause that must be identified and treated.

The clinical characteristics of cholangitis are very similar to other biliary pathologies. Biliary colic will present with a crampy RUQ pain but without fever, leukocytosis, or jaundice. Cholecystitis will present with RUQ pain and fever, but there will be no jaundice.

Lab tests

Routine blood samples should be taken, especially BCF (leukocytosis is found in the vast majority of patients) and LFT (showing elevated ALP ± GGT with elevated bilirubin).

Blood cultures should always be performed in suspected cases, even though they are only positive in 20% of cases. The best chance to obtain a positive blood culture is early, before the start of broad-spectrum antibiotics.

Images

An ultrasound of the biliary tract will show a dilated bile duct. The common bile duct is usually less than 6 mm in size (it may be larger in the elderly and in those who have had a previous cholecystectomy), so any larger diameter suggests dilation. Ultrasound can also show the presence of an underlying cause (for example, gallstones).

The gold standard investigation for cholangitis is ERCP, as it is together diagnostic and therapeutic. Many endoscopists may require MRCP before surgery, however, to obtain detailed images of the biliary system before the examination.

Treatment for cholangitis

Once the diagnosis is made, treatment should start promptly. Because cholangitis is caused by an infection, treatment will contain antibiotics to kill the bacteria. Secondarily, the root cause needs to be treated. In the case of gallstones, the power of the stone is treated by removing them with an ERCP, melting them, or breaking them up with shock waves. In many cases, gallbladder elimination surgery might be done.

For strictures in the bile channel, a procedure might be complete to place a stent and to keep the duct open. 8 In the case where there’s a narrowing of the bile ducts because of a tumor (which is not common), that could require surgery or other forms of treatment.

Prevention

  • Quit smoking, stop drinking alcohol, and stopover using illegal drugs
  • Income all medicines as directed by your doctor
  • Eat a healthy, well-balanced diet
  • Get regular exercise, such as walking

Complications

Sepsis is one potential complication of cholangitis, and it is a serious condition. Sepsis happens when an infection isn’t preserved and causes organ failure, tissue damage, and possibly death. 9 Sepsis is treated with antibiotics and sometimes other measures are needed to help remove infected tissue. Sepsis can be insidious and life-threatening, which is why it’s significant to alert medical professionals right away if it’s suspected that an infection has turned into this disorder.

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