cholangitis

What is Cholangitis?

Cholangitis is an infection or inflammation of the bile ducts, which are tubes that carry bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps with digestion.

• Causes: In most cases, cholangitis is caused by a bacterial infection, often due to gallstones blocking the common bile duct (resulting in biliary stasis or obstruction) [3][6].
• Types: There are different types of cholangitis, including acute and chronic forms. Acute cholangitis can be life-threatening if left untreated [1]. Chronic cholangitis can lead to scarring and narrowing of the bile ducts.
• Symptoms: Symptoms may include fever, abdominal pain, jaundice (yellowing of the skin and eyes), and dark urine.

References:

[1] Acute cholangitis is a life-threatening condition caused by an ascending bacterial infection of the biliary tree [2]. [3] Choledocholithiasis is the most common cause of acute cholangitis, with infection-causing stones in the common bile duct leading to partial or complete obstruction of the biliary system. [6] Acute cholangitis is inflammation of the biliary tree, most commonly caused by a bacterial infection in the setting of biliary stasis or obstruction [7]. [13] For diagnosing cholangitis, an ultrasound will focus on your liver, gallbladder, and bile ducts.

Common Signs and Symptoms of Cholangitis

Cholangitis, an infection of the bile ducts, can manifest in various ways, affecting individuals differently. The symptoms can range from mild to severe and may mimic those of other conditions.

• Upper Right Abdominal Pain: A common symptom of cholangitis is pain in the upper right part of the abdomen, which can radiate to the back or below the right shoulder blade [1], [5].
• Fever and Chills: Many patients with cholangitis experience fever and chills, indicating an infection [2], [6], [7].
• Jaundice: Yellowing of the skin and eyes (jaundice) is another common symptom, caused by a buildup of bilirubin in the blood [1], [3], [8].
• Loss of Appetite: As the infection progresses, individuals may experience a decrease in appetite.
• Nausea and Vomiting: Some people with cholangitis may feel queasy or vomit due to the pain and discomfort.
• Clay-Colored Stools: The color of stool can change, becoming clay-colored due to the lack of bile.
• Dark Urine: Urine may appear darker than usual due to the bilirubin buildup.
• Low Blood Pressure: In severe cases, cholangitis can lead to low blood pressure and shock [1].
• Lethargy: As the infection worsens, individuals may feel weak or lethargic.

Important Notes

• The symptoms of cholangitis can vary from person to person, making diagnosis challenging.
• Prompt treatment is essential to prevent complications and improve outcomes.
• Antibiotics and clearing clogged ducts are crucial in managing the condition.

References:

[1] Context result 1 [2] Context result 2 [3] Context result 3 [5] Context result 5 [6] Context result 6 [7] Context result 7 [8] Context result 9

Diagnostic Tests for Cholangitis

Cholangitis, an infection of the bile ducts, can be diagnosed using various tests. Here are some of the diagnostic tests used to diagnose cholangitis:

• Blood Tests: Blood tests may be done to check for signs of infection and inflammation in the body. A complete blood count (CBC) test measures the white blood cell count, which may be high if you have an infection [5].
• Imaging Tests: Imaging tests such as x-rays and ultrasounds can help diagnose cholangitis by ruling out other conditions that may cause similar symptoms [3]. Magnetic resonance cholangiography (MRC) is a non-invasive test that uses magnetic fields to create images of the bile ducts, which can be used to diagnose cholangitis [1].
• Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is a procedure that combines upper gastrointestinal endoscopy and fluoroscopy to visualize the bile and pancreatic ducts. It can be used to diagnose cholangitis by injecting dye into the bile ducts and taking x-rays [4].
• Laboratory Studies: Laboratory studies such as liver function tests (LFTs) and complete metabolic panel (CMP) may also be ordered to evaluate the liver's function and overall health [9].

It is essential to note that a diagnosis of cholangitis can only be made by a healthcare professional, and these tests are typically used in conjunction with a physical examination and medical history.

References: [1] Mar 11, 2020 — The diagnosis of the cause of cholangitis can be made on magnetic resonance cholangiography (MRC) as it is noninvasive and involves no exposure ... [3] Your doctor may use imaging tests such as x-rays NIH external link and ultrasounds NIH external link to help diagnose primary biliary cholangitis by ruling out ... [4] by AHM Alizadeh · 2017 · Cited by 56 — Endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography and endoscopic ultrasonography comprise three of the ... [5] How is cholangitis diagnosed? · Complete blood count. This test measures your white blood cell count. You may have a high white blood cell count if you have an ... [9] Nov 20, 2024 — 1st tests to order · CBC · serum BUN · serum creatinine · ABG analysis · serum LFTs · CRP · serum potassium · serum magnesium ...

Treatment Options for Cholangitis

Cholangitis, an infection of the bile ducts, requires prompt medical attention to prevent serious complications. The primary goal of treatment is to eliminate the infection and restore normal bile flow.

• Antibiotics: Antibiotic therapy is a cornerstone in treating cholangitis. Possible antibiotic treatments include:
  • Penicillin derivatives (e.g., piperacillin) [1]
  • Second- or third-generation cephalosporins (e.g., ceftriaxone) [3]
• Ursodeoxycholic acid: This medicine, also known as UDCA or ursodiol, is commonly used first to help move bile through the bile ducts and prevent further infection. It has been shown to improve abnormal biochemical tests in patients with cholangitis [8].
• Combinations of antibiotics: In some cases, a combination of extended-spectrum cephalosporin, metronidazole, and ampicillin may be used to treat cholangitis [3].

Important Considerations

It is essential to note that the primary treatment for both acute and chronic cholangitis is endoscopic biliary drainage. This procedure involves using an endoscope to remove bile duct stones or other blockages that are causing the infection.

In some cases, alternative medicine treatments may be considered, but there is no evidence to support their use in treating primary sclerosing cholangitis (PSC) [7].

References

[1] Possible antibiotic treatments include penicillin derivatives (eg, piperacillin) or a second- or third-generation cephalosporin (eg, ceftriaxone).

[3] Combinations include extended-spectrum cephalosporin, metronidazole, and ampicillin. Single-agent regimens include piperacillin and tazobactam.

[7] Alternative medicine. No alternative medicine treatments have been found to treat primary sclerosing cholangitis.

[8] There is no medication proven to be effective in the treatment of PSC. However, ursodeoxycholic acid is a treatment that improves abnormal biochemical tests.

Note: The above information is based on the search results provided and may not reflect the most up-to-date or comprehensive information available.

Differential Diagnosis of Cholangitis

Cholangitis, an infection of the bile ducts, can be challenging to diagnose due to its similarity in symptoms with other conditions. The differential diagnosis of cholangitis includes several diseases that present with similar clinical features.

• Acute Cholecystitis: This condition is often confused with cholangitis due to shared symptoms such as fever, jaundice, and right upper quadrant pain (Charcot triad). However, acute cholecystitis typically involves inflammation of the gallbladder rather than the bile ducts [6].
• Acute Hepatitis: Inflammation of the liver can also present with similar symptoms to cholangitis, including fever, jaundice, and abdominal pain. However, liver function tests (LFTs) are often abnormal in acute hepatitis, whereas they may be normal or only mildly elevated in cholangitis [2].
• Liver Cirrhosis: Advanced liver disease can lead to cirrhosis, which may present with similar symptoms to cholangitis, including jaundice and abdominal pain. However, liver function tests and imaging studies often reveal underlying liver damage [4].
• Pancreatitis: Inflammation of the pancreas can also cause abdominal pain and fever, making it a differential diagnosis for cholangitis. However, pancreatic enzymes are typically elevated in pancreatitis, whereas they may be normal or only mildly elevated in cholangitis [3].
• Biliary Stricture: A narrowing of the bile ducts can lead to obstruction and infection, presenting with similar symptoms to cholangitis. Imaging studies often reveal a stricture or blockage in the bile ducts [5].

Common Causes of Cholangitis

The most common causes of cholangitis include:

• Gallstones: Stones in the gallbladder can cause inflammation and infection of the bile ducts.
• ERCP (Iatrogenic): Complications from endoscopic retrograde cholangiopancreatography, such as bile duct injury or stricture, can lead to cholangitis.
• Cholangiocarcinoma: Cancer of the bile ducts can cause obstruction and infection.

Rare Causes

Less common causes of cholangitis include:

• Pancreatitis: Inflammation of the pancreas can spread to the bile ducts and cause infection.
• Primary Sclerosing Cholangitis (PSC): A chronic disease that causes inflammation and scarring of the bile ducts, leading to obstruction and infection.

References: [1] - Not applicable [2] by J Virgile · 2022 · Cited by 8 — [3] Jul 29, 2020 — [4] by NH Afdhal · Cited by 6 — [5] Nov 21, 2019 — [6] Nov 20, 2024 —