Cholangitis is inflammation (swelling) 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 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 for 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. Many people with cholangitis may not notice any symptoms.
Some early symptoms of chronic cholangitis may include:
- 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
- pain or cramps in the upper right side of your abdomen
- back pain
- yellowing of the skin and eyes (jaundice)
- dark urine
- low blood pressure
Your doctor may find signs of cholangitis in other parts of the body. These include:
There is a range of causes for cholangitis, but sometimes the cause isn’t known.
Chronic (long-term) 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 (sudden onset) cholangitis may be due to:
- a bacterial infection
Environmental causes of both acute and chronic cholangitis may be due to:
- infections (bacteria, virus, fungi, or parasites)
Risk factors that might increase your chance of getting cholangitis include:
Your doctor can diagnose cholangitis with various types of tests and scans. They may order one or more of the following blood tests:
- Complete blood count (CBC). A CBC blood test is used to measure your white blood cell count. If you have an infection, your white blood cell count will likely be elevated.
- Liver function tests. Liver function tests can help determine whether your liver is functioning properly and if your liver enzymes are within a normal range.
- Anti-mitochondrial antibody test. The presence of anti-mitochondrial antibodies (AMAs), along with the results from other blood work, may be an indication of cholangitis.
- Cholesterol test. A cholesterol test can be helpful in determining your risk factor for gallstones, which can lead to cholangitis.
- Blood culture. A blood culture test can tell your doctor if you have a blood infection.
Several types of imaging tests can help your doctor see how your liver and bile duct are working. Although imaging tests aren’t always needed, they can help your doctor confirm a diagnosis or rule out other conditions that may have similar symptoms.
These imaging tests may include:
- Ultrasound. An ultrasound uses high-frequency sound waves to capture live images from the inside of your body. It allows your doctor to see any potential issues with your organs and blood vessels without needing to make an incision. For diagnosing cholangitis, an ultrasound will focus on your liver, gallbladder, and bile ducts.
- CT scan. A CT scan is a form of X-ray that creates detailed images of your internal organs and body structures. For diagnosing cholangitis, a dye may be injected intravenously, which helps to show if there is a blockage in the bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP). This is a special type of magnetic resonance imaging (MRI) exam that produces detailed pictures of your liver, gallbladder, and bile ducts. It can also show if there are gallstones in your bile duct or any type of blockage.
- Endoscopic retrograde cholangiopancreatography (ERCP). This procedure combines an X-ray and the use of a long, flexible tube with a light and camera on the end, called an endoscope. Your doctor will guide the scope down your throat into your stomach and then into the first part of your intestine. This will allow them to view your organs for any problems. They will then inject a dye into your bile ducts and take an X-ray to see if there is a blockage.
- Percutaneous transhepatic cholangiography (PTC). With this procedure, a contrasting agent (dye) is injected through your skin into your liver or bile duct. Then, you’ll get an X-ray of the ducts to determine if there’s an obstruction. Because of the invasive nature of this procedure, it’s used a lot less frequently than the procedures listed above.
You might need other tests such as urine, bile, or stool samples.
Treatment for chronic and acute cholangitis may be different, based on the cause. Treatment also depends on how early you receive a diagnosis. Both chronic and acute cholangitis can lead to serious complications if they go untreated.
They may also recommend procedures in the hospital, such as:
- intravenous (IV) 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, but it doesn’t treat cholangitis itself.
Treatment and care for chronic cholangitis includes:
- 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 this therapy several times to treat cholangitis. Endoscopic therapy may also be used for sphincterotomy (a procedure that cuts the muscle between the common bile duct and pancreatic duct) or stent placement. With endoscopic therapy, you may need full anesthesia or a degree of sedation that sometimes requires intubation to protect the airway.
- 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.
- Bone weakness. 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, which is called portal hypertension.
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 cholangitis.
Early treatment can help you have a better outcome. It also helps to prevent symptoms and complications. Get medical attention as soon as possible if you have any symptoms, such as:
- 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 measures, such as not smoking. A balanced diet with plenty of fiber may ease cholangitis symptoms and prevent complications. Talk with your doctor or nutritionist about the best diet plan for you.
Cholangitis is a condition that involves the inflammation of the bile duct system. Some types of cholangitis are mild. Other kinds can be serious and life threatening.
Chronic cholangitis happens slowly over time. Acute cholangitis, on the other hand, happens suddenly and usually causes symptoms over a short period of time. These symptoms can include a high fever, nausea, chills, pain in the abdomen, and dark urine.
Cholangitis can lead to serious health problems if it goes untreated. That’s why it’s important to get medical attention if you have any symptoms and to have regular checkups with your doctor to ensure your liver and bile ducts are working properly.