Biliary tract disorders

Cholangitis

portrait of Clara Boter Carbonell Ph.D.
Written by

Clara Boter Carbonell Ph.D.
Medically reviewed by our Medical staff

Last update: 21-01-2022

How else can it be called?

  • Acute cholangitis

  • Ascending cholangitis

  • CIE-9: 576.1

  • CIE-10: K83.0

What is cholangitis?

Cholangitis means inflammation of the bile ducts. It applies to the inflammation of any portion of the bile ducts, which carry bile from the liver to the gallbladder and intestine.

Bile is a bitter yellowish fluid produced by the liver. It is stored in the gallbladder and is released into the intestine to help in digestion, with the primary function of breaking down fats.

Cholangitis is a life-threatening bacterial infection of the biliary tract.

What is the cause of cholangitis?

Cholangitis refers to an infection of the bile ducts.

Some circumstances may increase the growth and accumulation of bacteria in the bile ducts:

  • Benign obstruction to bile flow, for example, a blockage due to bile duct stones or gallstones in the bile duct (choledocholithiasis).
  • Malign obstruction to the bile flow due to bile duct cancer (cholangiocarcinoma) or pancreatic cancer.
  • Ascent of germs from the duodenum.

The most common intestinal bacteria associated with infection of the bile ducts are Escherichia coli (25-50% of the cases) followed by Klebsiella (15-20% of the cases) and Enterobacter species (5-10%), although more than one type of bacteria may be present simultaneously.

Another source of inflammation of the bile ducts occurs in autoimmune diseases where the immune system fails to recognize certain cells as part of its normal composition. Primary sclerosing cholangitis is a typical example of an autoimmune disease involving the bile ducts.

The median age of patients with cholangitis is 50-60 years.

What are the main symptoms of cholangitis?

The main symptoms of cholangitis are the Charcot triad:

  • Fever and chills
  • Jaundice (yellow discoloration of the skin and eyes)
  • Right upper quadrant abdominal pain

However, the three symptoms at the same time are only present in 50% of the cases.

Other less specific symptoms may be:

  • Hypotension
  • Nausea
  • Vomiting
  • Dark urine
  • Discolored stools

In some severe cases, shock and altered mental status may occur.

How can it be diagnosed?

El The initial diagnosis is based on the clinical symptoms. In a blood test, it is common an abnormal elevation of WBCs (leukocytosis), elevated bilirubin (hyperbilirubinemia) and abnormal or elevated tests of liver function (alkaline phosphatase, GGT, lipase, amylase).

The specific bacteria are identified from blood cultures in approximately 70% of the cases.

In addition, imaging tests should be performed to locate a possible obstruction of the bile duct:

  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Endoscopic ultrasound

What is the recommended treatment?

The recommended treatment consists in:

  • Broad-spectrum antibiotics
  • Absolute diet
  • Intravenous fluids
  • Analgesics

Besides, it is necessary to treat the underlying cause of the infection.

In case of obstruction, endoscopic retrograde cholangiopancreatography (ERCP) has the advantage of being able to treat the cause of obstruction, by removing stones and dilating (stretching) structures.

If all the conservative treatments fail, it is necessary a surgical procedure of the bile duct.

Medically reviewed by our Medical staff on 21-01-2022

Bibliography

  • Mohammad Alizadeh AH. Cholangitis: Diagnosis, Treatment and Prognosis. J Clin Transl Hepatol. 2017 Dec 28;5(4):404-413. doi: 10.14218/JCTH.2017.00028. Epub 2017 Sep 7.
  • Fauci AS, Kasper DL, Braunwald E, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine. Vol 1. 17th ed. New York: Mc Graw Hill; 2008.
  • Textbook of Clinical Gastroenterology and Hepatology (2nd Ed) 2012, Sombat Treeprasertsuk and Keith D. Lindor, ISBN: 978-1-4051-9182-1, Pag. 573.
  • The Gale Encyclopedia of medicine. Second Edition. Jacqueline L. Longe. Vol 2. pag 773 ISBN 0-7876-5491-4.
  • Acute Care Surgery Handbook. Volume 2 Common Gastrointestinal and Abdominal Emergencies. Cap 12 Acute Cholecystitis and Cholangitis. Federico Coccolini, Andrea Allegri, Marco Ceresoli, Giuseppe D’Amico, Asaf Harbi, Giulia Montori, Gabriela Nita, Francesca ubertà, Michele Pisano, Luca Ansaloni. Pag 171. 2017. ISBN 978-3-319-15361-2.

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