Definition

Cholangitis is an inflammation of the bile duct, primarily occurring in the liver. Several known types of cholangitis include primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), secondary cholangitis, and immune-related cholangitis.

The bile ducts carry bile fluid from the liver and gallbladder to the small intestine. This green to yellowish-brown fluid plays a crucial role in breaking down and absorbing fats in food. Additionally, bile fluid is involved in cleaning metabolic waste from the liver.

If the bile ducts become inflamed or blocked, bile fluid may flow back into the liver, leading to disorders and various other problems. Some types of cholangitis can be mild, while others can be severe and life-threatening.

There are two main types of cholangitis: chronic cholangitis, which develops gradually and may cause symptoms and complaints over several years, and acute cholangitis, which occurs suddenly and may cause symptoms and complaints over a short period.

Cholangitis tends to be rare, with fewer than 200,000 cases of acute cholangitis estimated yearly in the United States. Typically, those affected are around 50 to 60 years old on average.

Causes

Cholangiocarcinoma occurs when cells in the bile duct mutate or undergo genetic changes. These alterations lead to uncontrolled cell growth, forming masses that can invade healthy tissues. Usually, cholangiocarcinoma develops without a specific trigger or identifiable risk factors. However, some instances are associated with prolonged bile duct inflammation (cholangitis) and parasitic infections. Both conditions damage healthy cells, prompting the body to stimulate the production of new bile duct cells rapidly. The cells are forced to replicate quickly to replace the damaged ones, and at some point, faulty replication occurs, causing changes in the genetic sequence and altering cell function.

These cancerous cells typically grow slowly and initially attack the lining of the bile duct. Subsequently, they may spread to the liver, the portal vein in the liver, and the lymph nodes around it. In more severe cases, cancer cells may be found in other body parts, such as the lungs, spreading through the bloodstream or lymphatic system.

Risk factor

Several risk factors that can increase the risk of developing cholangitis, including:

• History of gallbladder stones
• History of sclerosing cholangitis
• HIV-AIDS or immunocompromised conditions
• Narrowing of the bile duct
• In rare cases, a history of travel to countries where there is a risk of infection with parasites or worms
• Age between 30-50 years
• Gender: Males are more at risk of primary sclerosing cholangitis, while women are at risk of primary biliary cholangitis.

Symptoms

The symptoms experienced by patients depend on the type of cholangitis and the disease duration. Each person may exhibit different symptoms and signs, and many individuals are unaware of the symptoms associated with cholangitis. Some early symptoms that may be observed in chronic cholangitis include:

• Easy fatigue
• Itchy skin
• Dry eyes
• Dry mouth

If chronic cholangitis persists for an extended period, additional symptoms may manifest, including:

• Pain in the upper right abdomen
• Night sweats
• Swelling of the legs and ankles
• Darkening of the skin
• Muscle pain
• Joint or bone pain
• Bloating (due to fluid accumulation in the abdominal area)
• Xanthomas (fat deposits) around the eyes and eyelids, elbows, knees, palms, and soles of the feet
• Diarrhea
• Pale-colored stools
• Decreased consciousness
• Mood changes
• Memory issues

If you have acute cholangitis, the symptoms may include:

• High fever lasting more than one day
• Abdominal pain or cramps in the upper right side
• Shivering
• Nausea or vomiting
• Back pain
• Yellowing of the skin or eyes (jaundice)
• Dark urine
• Low blood pressure
• Decreased consciousness

Diagnosis

The diagnosis of cholangitis is determined through a medical interview, physical examination, and, if necessary and available, additional tests.

During the medical interview, the doctor will inquire about the symptoms experienced. As symptoms can indicate specific diseases, providing detailed information about the symptoms and when they started is crucial. This information is vital for establishing a specific diagnosis. If the symptoms suggest cholangitis, the doctor will proceed to a physical examination and, if necessary, additional diagnostic tests.

During the physical examination, the assessment depends on the symptoms reported, leading to the identification of clinical signs, which are objective findings obtained through the examination.

In cholangitis, the doctor may observe swelling or enlargement of the liver or spleen during abdominal examination. Tender pain upon palpation in the upper right abdomen may also be present, and yellowing of the eyes can be noted.

Additional diagnostic tests play a crucial role in determining the diagnosis of cholangitis. These include laboratory tests to assess blood cholesterol levels, a complete blood test to evaluate elevated white blood cell levels indicating infection, and liver function tests to assess normal liver function or detect abnormalities, including anti-mitochondrial antibodies.

In addition to laboratory tests, ultrasonography can be performed to evaluate the liver, gallbladder, and bile duct condition. CT scans, MRCP (magnetic resonance cholangiopancreatography), ERCP (endoscopic retrograde cholangiopancreatography), or PTC (percutaneous transhepatic cholangiography) may be conducted if necessary.

• MRCP (magnetic resonance cholangiopancreatography) is an examination aimed at identifying problems in the abdomen and can detect stones in bile duct
• ERCP (endoscopic retrograde cholangiopancreatography) is performed to identify and manage issues in the liver, gallbladder, bile duct, and pancreas.
• PTC (percutaneous transhepatic cholangiography) uses a needle, which is injected through the skin and into the liver. Dye is then injected into the bile ducts to provide clear visualization through imaging

Management

Establishing the correct diagnosis is crucial because some individuals experience serious symptoms that necessitate visiting the doctor or the emergency department.

If diagnosed with cholangitis, hospitalization may be required. The doctor will administer fluid, analgesics, and antibiotics through intravenous infusion. If the cause of cholangitis is obstruction, the doctor may drain the bile to identify the cause. In many cases, doctors will use ERCP (endoscopic retrograde cholangiopancreatography).

Surgery may be necessary if the initial treatment does not yield positive results. The surgery aims to open the bile duct, draining and reducing the accumulation of fluid.

Complications

Complications that may arise include:

• Cirrhosis
• Liver failure
• Gallstones
• Enlargement of the spleen
• Blood infection or sepsis, which can occur if not treated early

Prevention

There are no specific prevention methods for cholangitis. However, a stent (tube) placed on the gallbladder can prevent the recurrence of infection in the bile duct. Treating gallbladder issues, tumors, or parasitic infections can reduce the risk of cholangitis in some individuals.

When to see a doctor?

If you experience symptoms of cholangitis, it is important to consult an internal medicine doctor. The doctor will conduct a medical interview, perform a physical examination, and order additional diagnostic tests to diagnose the underlying condition accurately. Based on the diagnosis, the doctor will prescribe the appropriate treatment

Looking for more information about other diseases? Click here!