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Cholangitis

Overview

Cholangitis refers to the inflammation of the bile duct system. The bile duct system carries bile from your liver and gall bladder to the digestive tract. This fluid helps in the digestion of food and absorption of fats. When the bile ducts get obstructed or inflamed, bile flows back into the liver, which can cause liver damage and other problems. For this reason, the American Liver Foundation classifies cholangitis as a type of liver disease. Cholangitis can be treated with the help of medications and surgery. 

Causes

There are various causes of cholangitis that can cause short-term or long-term disease. In majority of the cases, cholangitis is caused by a gallstone or narrowing of the bile ducts. Apart from gall stones, other obstructions of the bile ducts can lead to this condition. Other possible causes of cholangitis include strictures, tumors, blood clots, and swollen pancreas. Cholangitis can also occur due to a bacterial, viral or fungal infection. Environmental factors such as smoking or harsh chemicals may also be causative factors.

 

Long-term cholangitis can result from an autoimmune response. In this case, the cells of your immune system consider the bile ducts harmful and attack them. As a consequence, the bile ducts become inflamed. Consistent inflammation may also cause scarring and narrowing of the bile ducts, which increases the severity of the disease. 

Types

Based on the origin of this disease, it can be divided into four types:

Primary Biliary Cholangitis (PBC), Primary Sclerosing Cholangitis (PSC), secondary cholangitis, and immune cholangitis. Based on the onset and severity, cholangitis can be further divided into two types.

Acute cholangitis is a serious condition in which the symptoms appear within a small duration of time. It can be caused by gallstones, blood clots, bacterial infections, or tumors. It needs to be addressed as a medical emergency.

 

Chronic cholangitis can take months or years to develop. The common causes of chronic cholangitis are autoimmune diseases such as primary sclerosing cholangitis. It can also be caused by viral, parasitic, or bacterial infections. Treatment depends on the severity of the disease. 

Risk Factors And Epidemiology

The risk of autoimmune bile duct diseases is higher in those with other autoimmune diseases such as Crohn’s disease or ulcerative colitis. Cholangitis has also been linked with genetics, which means that positive family history can increase your risk. Those with Human immunodeficiency virus (HIV) or a weakened immune system can also develop cholangitis due to an increased risk of infections. Cholangitis can also occur if you travel to a region with high exposure to parasitic infections.

 

Cholangitis usually affects adults in the age range of 30 to 50 years. The incidence of cholangitis varies according to its different types. The prevalence of acute cholangitis is higher in regions with a higher number of gallstone cases. Primary sclerosing cholangitis is common among men, while primary biliary cholangitis is common among women. 

Signs And Symptoms

Symptoms of acute and chronic cholangitis are different. Acute cholangitis presents with severe symptoms that get worse in a short period of time. These may include high fever that persists for more than 24 hours, pain in the upper right side of the abdomen, nausea/vomiting, chills, back pain, jaundice, dark urine, reduced blood pressure, and confusion. Symptoms of chronic cholangitis take a long duration to appear. Early symptoms include itchy skin, dry eyes, dry mouth, and fatigue. If it has progressed, it can present with abdominal pain, night sweats, muscle pain, swollen feet, darkening of the skin, pain in bones and joints, fat deposits, diarrhea, clay-colored stools, and weight loss. 

Diagnosis

Cholangitis is diagnosed after a few tests confirm the inflammation or blockage of the bile ducts. Your doctor may require a brief history beforehand and perform a physical examination to notice abdominal pain and tenderness. Diagnostic tests include complete blood count (CBC), liver function tests (LFTs), blood culture for infection, and cholesterol tests. Different imaging tests can also be used to visualize the anatomy and abnormalities of your bile duct system. These may include abdominal ultrasound, CT scan, MRI, endoscopic retrograde cholangiopancreatography (ERCP,) and percutaneous transhepatic cholangiography (PTC). 

Differential Diagnosis

Cholangitis needs to be differentiated from other medical conditions presenting with similar symptoms, such as abdominal pain and fever. Common diseases resembling cholangitis symptoms include cholecystitis, diverticular disease, hepatitis, pancreatitis, and mesenteric ischemia. 

Treatment

Early treatment is necessary for cases of acute cholangitis. You will be admitted to a hospital where treatment and supportive care will be given. If you have cholangitis due to an infection, your doctor will prescribe antibiotics to relieve symptoms. Intravenous fluids are also provided, and the bile duct is drained. Chronic cholangitis cannot be treated with medications alone. If your bile ducts are severely damaged, your doctor may recommend surgery to put stents in the bile duct or remove the damaged portion. During the whole course of treatment, your liver profile is monitored. Your doctor may also use the balloon inflation technique to open up a blocked duct during diagnostic testing. In severe cases where the liver has been damaged beyond repair, a liver transplant is recommended as a last resort.

Medication

 

Antibiotics such as penicillin, metronidazole, and ciprofloxacin are used to treat acute cholangitis. Your doctor may also prescribe vitamin and calcium supplements to prevent vitamin deficiency and weakness of bones. 

Prognosis

The prognosis depends on the disease’s severity and intervention time. Early treatment can offer a better prognosis with much fewer complications. Both acute and chronic cholangitis can be fatal if left untreated. 

Prevention

It isn’t easy to prevent cholangitis because it can develop even if you’re otherwise healthy. If you develop symptoms such as upper right abdominal pain, fever, jaundice, dark urine, and clay-colored stools, visit your healthcare provider to receive an early diagnosis. 

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