Cholangitis – Causes, Symptoms and Treatment
Cholangitis is an inflammation of the bile ducts, most often caused by a bacterial infection. It can be acute or chronic and requires prompt medical attention.
Things worth knowing about "Cholangitis"
Cholangitis is an inflammation of the bile ducts, most often caused by a bacterial infection. It can be acute or chronic and requires prompt medical attention.
What is Cholangitis?
Cholangitis refers to an inflammation of the bile ducts, the channels that carry bile from the liver to the small intestine. It can occur in acute or chronic form and is often associated with impaired bile flow. Without timely treatment, acute cholangitis can become life-threatening, making early diagnosis and therapy essential.
Causes
The most common cause of cholangitis is a bacterial infection, typically triggered by an obstruction (blockage) of the bile ducts. Common causes include:
- Gallstones (choledocholithiasis): Stones lodged in the bile duct that block bile flow
- Bile duct strictures: Narrowing caused by scar tissue or tumors
- Tumors: Such as cholangiocarcinoma (bile duct cancer) or pancreatic head cancer
- Parasitic infections: In certain parts of the world (e.g., liver flukes)
- Primary sclerosing cholangitis (PSC): A chronic inflammatory autoimmune disease of the bile ducts
- Primary biliary cholangitis (PBC): An autoimmune disease affecting the small intrahepatic bile ducts
Symptoms
The classic symptom triad of acute cholangitis is known as Charcot's triad:
- Fever with chills
- Jaundice: Yellowing of the skin and eyes
- Right upper abdominal pain: Below the right rib cage
In severe cases, this may expand to the Reynolds pentad, which additionally includes altered mental status and septic shock. Chronic forms often progress more gradually, presenting with fatigue, itching, and slowly worsening jaundice.
Diagnosis
Diagnosis of cholangitis is based on a combination of clinical examination, laboratory tests, and imaging:
- Blood count and liver function tests: Elevated inflammatory markers (CRP, leukocytes) and cholestasis parameters (bilirubin, alkaline phosphatase, GGT)
- Blood cultures: To detect bacteria in the bloodstream (bacteremia/sepsis)
- Ultrasound (sonography): The first-line imaging method for evaluating the bile ducts and liver
- MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive visualization of the bile ducts using MRI
- ERCP (Endoscopic Retrograde Cholangiopancreatography): An invasive procedure that can also be used therapeutically
Treatment
Treatment depends on the underlying cause and the severity of the condition:
Medical Treatment
- Antibiotics: Intravenous antibiotics to combat bacterial infection (e.g., cephalosporins, piperacillin/tazobactam)
- Ursodeoxycholic acid: Used in chronic forms such as PBC to slow disease progression
- Immunosuppressants: For autoimmune bile duct diseases
Interventional and Surgical Treatment
- ERCP with stone extraction or stent placement: To remove gallstones or bridge strictures
- Percutaneous transhepatic cholangiodrainage (PTCD): Bile drainage through the skin when endoscopic therapy is not feasible
- Surgery: For tumors or complex anatomical situations
Liver Transplantation
In the end stage of primary sclerosing cholangitis or primary biliary cholangitis, a liver transplant may be the only curative treatment option available.
Prognosis
The prognosis of acute cholangitis depends critically on the speed of treatment. When treated early, outcomes are generally good. However, severe cases involving sepsis can be life-threatening. Chronic forms such as PSC and PBC can lead to liver cirrhosis over many years and require long-term medical management.
References
- European Association for the Study of the Liver (EASL): EASL Clinical Practice Guidelines on Cholestatic Liver Diseases. Journal of Hepatology, 2022.
- Kiriyama S. et al.: Tokyo Guidelines 2018: Diagnostic criteria and severity grading of acute cholangitis. Journal of Hepatobiliary Pancreatic Sciences, 2018.
- Longo DL et al.: Harrison's Principles of Internal Medicine, 21st Edition. McGraw-Hill Education, 2022.
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