Cholangitis is inflammation (swelling and redness) in the bile duct. The American Liver Foundation notes that cholangitis is a type of liver disease. It can also be broken down more specifically and known as the following:
- primary biliary cholangitis (PBC)
- primary sclerosing cholangitis (PSC)
- secondary cholangitis
- immune cholangitis
The bile ducts carry bile from the liver and gallbladder to the small intestine. Bile is a green to yellow-brown fluid that helps your body digest and absorb fats. It also helps to clear waste from the liver.
When the bile ducts get inflamed or blocked, bile can back up into the liver. This can lead to liver damage and other problems. Some types of cholangitis are mild. Other kinds can be serious and life-threatening.
There are two main types of cholangitis:
- Chronic cholangitis happens slowly over time. It can cause symptoms over 5 to 20 years.
- Acute cholangitis happens suddenly. It can cause symptoms over a short time period.
Symptoms depend on what kind of cholangitis you have and for how long. Every person with cholangitis may have slightly different signs and symptoms. More than 50 percent of people diagnosed with chronic cholangitis don’t have any symptoms.
Some early symptoms of chronic cholangitis may include:
- tiredness and fatigue
- itchy skin
- dry eyes
- dry mouth
If you have chronic cholangitis for a long time, you may have:
- pain in the upper right side
- night sweats
- swollen feet and ankles
- darkening of the skin (hyperpigmentation)
- muscle pain
- bone or joint pain
- bloating (fluid in the stomach area)
- fat deposits (xanthomas) in the skin around the eyes and eyelids
- fat deposits in the elbows, knees, palms, and soles of the feet
- diarrhea or greasy bowel movements
- clay-colored bowel movements
- weight loss
- mood changes and memory problems
If you have acute cholangitis, you may also have other symptoms. These include sudden symptoms like:
- high fever for more than
- back pain
- pain below the shoulder blades
- dull pain or cramps in the upper right side
- sharp or dull pain in the middle of the stomach
- low blood pressure
- yellowing of theskin and eyes (jaundice)
Your doctor may find signs of cholangitis in other parts of the body. These include:
- swollen or enlarged liver
- swollen or enlarged spleen
- high cholesterol
- underactive thyroid gland (hypothyroidism)
- weak and brittle bones (osteoporosis)
Treatment for chronic and acute cholangitis may be different. This is because the causes of cholangitis vary. Treatment also depends on how early you’re diagnosed with cholangitis. Both kinds can lead to serious complications if they’re not treated.
Early treatment is especially important for acute cholangitis. Your doctor may recommend antibiotics for up to (such as penicillin, ceftriaxone, metronidazole, and ciprofloxacin).
They may also recommend procedures in the hospital, such as:
- intravenous fluids
- bile duct drainage
Unlike acute cholangitis, no medications are available to treat chronic cholangitis. A drug called ursodeoxycholic acid may help protect the liver. It works by improving bile flow. It doesn’t treat cholangitis itself.
Treatment and care for chronic cholangitis include:
- managing symptoms
- monitoring liver function
- procedures to open blocked bile ducts
Procedures for both chronic and acute cholangitis are:
- Endoscopic therapy. Balloon dilation may be used to open up the ducts and increase bile flow. This helps to improve and prevent symptoms. You may need endoscopic therapy several times to treat cholangitis. You may have full or local anesthesia (numbing) before the procedure.
- Percutaneous therapy. This is similar to endoscopic therapy, but it’s through the skin. Your doctor will numb the area or put you to sleep before the procedure.
- Surgery. Your doctor may remove the blocked part of the bile duct. Or, you may have stents put in to open or drain the bile ducts. You’ll be under full anesthesia (asleep) for surgery.
- Liver transplant. In serious cases, you may need a liver transplant. Your doctor will replace your damaged liver with a new one. You’ll need to take antirejection drugs for the rest of your life after the surgery. This helps your body keep the new liver healthy.
You may also need treatment for some serious side effects of cholangitis:
- Nutrition. Cholangitis can affect digestion and how your body absorbs some vitamins. You may need to take vitamin A, D, E, and K supplements.
- Weak bones. Your doctor may prescribe medications for osteoporosis. Calcium and vitamin D supplements can help improve bone density and strength.
- High blood pressure. Your doctor may monitor and treat high blood pressure in the liver (portal hypertension).
There are a range of causes for cholangitis. Sometimes the cause isn’t known.
Chronic cholangitis may be an autoimmune disease. This means that your body’s own immune system mistakenly attacks the bile ducts. This causes inflammation.
Over time, inflammation can trigger scars or the growth of hard tissue inside the bile ducts. The scarring makes the ducts hard and narrow. They can also block smaller ducts.
Causes of acute cholangitis are:
- bacterial infection
Environmental causes of both types of cholangitis include:
- infections (bacteria, virus, fungi, or parasites)
Risk factors that might increase your chance of getting cholangitis:
- Being female. Chronic cholangitis is more common in women.
- Age. It usually occurs in adults between the ages of 30 and 60.
- Genetics. Cholangitis may run in your family.
- Location. The disease is more common in North America and northern Europe.
Your doctor can diagnose cholangitis with tests and scans. Several signs may show up in the following blood tests:
Scans help to show blood flow in the liver and other parts of the abdomen:
You might need other tests such as urine, bile, or stool samples.
Cholangitis can lead to serious health problems if it isn’t treated. Complications include:
- Liver problems. Cholangitis can cause liver scarring (cirrhosis). This can slow liver function or lead to liver failure. It also increases the risk of liver cancer. It can cause liver swelling and high blood pressure.
- Gallstones. Blocked bile can harden into stones. This may cause pain and infections.
- Enlarged spleen. If the liver isn’t working properly and can’t filter out wastes and toxins, old blood cells can collect in the spleen, causing it to swell.
- Enlarged veins. High blood pressure in the liver may put too much pressure on veins in the stomach. This can lead to swollen and broken veins. It may also cause bleeding.
- Blood infection. Acute cholangitis can lead to sepsis (a blood infection). This can damage several parts of the body and may be life-threatening if not treated.
Your signs and symptoms will vary from other people with cholangitis. In some cases, the cause may not be known. You can’t always prevent getting cholangitis.
Early treatment can help you have a better outcome. It also helps to prevent symptoms and complications. See your doctor urgently if you have any symptoms, including:
- abdominal pain
- yellowing of the eyes and skin
- changes in digestion and bowel movements
You may not have any symptoms at all. Regular checkups can help you learn about your liver health with a simple blood test.
Some types of cholangitis may be easier to clear up with treatment. Take all medications as prescribed and see your doctor for all follow-up appointments.
You can prevent complications with daily lifestyle changes like quitting smoking. A healthy, balanced diet with plenty of fiber may ease cholangitis symptoms and prevent complications. Talk to your doctor or nutritionist about the best diet plan for you.