Cholangitis

Overview

Cholangitis is an infection of the bile ducts, which are the tubes that transport bile — a digestive fluid made by the liver — from the liver to the intestines and gallbladder.

Cholangitis is usually caused by a bile duct blockage due to an obstruction such as a tumor, scar tissue or, most commonly, a gallstone. Gallstones are small, stone-like deposits, usually made primarily of cholesterol, that can naturally form inside the gallbladder. Left untreated, cholangitis can lead to serious, life-threatening conditions, including septic shock.

Why Hoag for Cholangitis Treatment In Orange County?

Cholangitis can be painful, and potentially dangerous if allowed to progress too far. When you need answers now for serious biliary conditions like cholangitis, trust the Hoag Digestive Health Institute to help you heal.

Hoag’s comprehensive Liver and Midgut programs offer the most advanced diagnosis and treatment in Orange County for conditions involving the liver, gallbladder, pancreas and biliary system. We’re leading the way in complex hepatobiliary care, with the accurate diagnosis you need for peace of mind and the next generation treatment options that can get you on the road to recovery fast. Meet Hoag’s dedicated Liver Program and Midgut Program teams.

Symptoms and Causes of Cholangitis

The symptoms of cholangitis are different for every patient, and may mimic those of less serious conditions. Because cholangitis is caused by an infection, symptoms can appear suddenly, come and go, or quickly increase in intensity. Common symptoms of cholangitis include:

• Unexplained fever and chills
• Unexplained weakness or fatigue
• Pain in the upper right abdomen
• Low blood pressure
• Confusion
• Dark urine
• Pale or clay-colored bowel movements

Risk Factors

There are a number of factors that can increase your risk of developing cholangitis. These include:

• A previous history of gallstones
• Obesity, which can increase your risk of developing gallstones
• HIV
• Certain parasitic infections
• Diabetes, which can increase your risk of developing gallstones
• Primary sclerosing cholangitis (PSC), which is a rare disease that causes scarring of the bile ducts

Diagnosis and Tests for Cholangitis

Cholangitis is most often initially diagnosed due to a cluster of symptoms that are known as “Charcot’s Triad,” which includes fever, upper abdominal pain and jaundice (a yellowish discoloration of the skin and the whites of the eyes).

Advanced cholangitis can quickly progress to what’s called “Reynold’s Pentad,” a group of symptoms that include fever, upper abdominal pain, jaundice, confusion and low blood pressure.

If you visit a doctor with these symptoms you may be referred for further diagnostic testing. This usually includes blood tests, including:

• a Complete Blood Count (CBC) which measures your white blood cell count. An elevated white blood cell count can indicate an infection.
• Liver function tests, which are specialized blood tests to check if your liver is functioning properly
• Blood cultures, which can reveal a blood infection

Advanced Diagnosis of Cholangitis at Hoag

In addition to blood testing, you may also be asked to undergo diagnostic imaging tests, which allow doctors to directly view issues and structures inside the body. At the Hoag Digestive Health Institute, these tests may include:

• Abdominal Ultrasound, which uses sound waves to create images of structures and tissues inside the body, including any obstructions of the bile ducts that might be causing cholangitis
• Endoscopic Retrograde Cholangiopancreatography (ERCP), in which doctors use X-rays, a radioactive tracer substance and a small, flexible camera called an endoscope to view the bile ducts and examine them for tumors, gallstones or narrowing. During the ERCP procedure, physicians pass an endoscope down your throat, through the stomach, into the small intestine and into the bile ducts.
• Endoscopic Ultrasound with Fine Needle Aspiration (EUS/FNA), which is an advanced technique that utilizes an endoscope fitted with an ultrasound probe and a biopsy needle to allow for more precise collection of tissue samples for study
• Hepatobiliary iminodiacetic acid (HIDA) Scan, which utilizes a harmless radioactive tracer that’s injected into your bloodstream. This allows the bile ducts and any obstructions in them to be more easily seen by imaging machines
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the gallbladder and bile ducts without the use of ionizing radiation

Management and Treatment for Cholangitis

If you are diagnosed with cholangitis, it’s likely you will need to be hospitalized, so you can be given intravenous fluids, pain medication and antibiotics to help your body fight the bacterial infection.

You may also need to undergo a procedure to remove gallstones and help drain fluid that has collected in your bile duct. This is usually done through Endoscopic Retrograde Cholangiopancreatography (ERCP).

During the ERCP procedure, which is performed under general anesthesia, physicians pass an endoscope down the throat, through the stomach, into the small intestine and into the bile ducts. Utilizing the camera and a tube attached to the endoscope, doctors can usually drain the accumulated bile from the affected bile duct so any infection can be more easily cleared up by antibiotics.

Gallstones that caused obstruction of the bile duct can often be removed during the ERCP procedure, via the endoscope. Your doctor may also use the endoscope to insert a small tube called a stent into the bile duct to keep it open while the infection heals.

If the ERCP procedure and antibiotics fail to fix the issue or the infection keeps getting worse, surgery may be required to remove the obstruction and drain excess bile from the bile ducts.

Prevention of Cholangitis

While we can’t yet explain why some people develop cholangitis while others don’t, one of the best ways to keep from developing the condition is to take steps to prevent yourself from developing gallstones. Ways to reduce your risk of developing gallstones may include:

• Maintain a healthy weight, as obesity — especially in women — is known risk factor for gallstones
• Monitor and manage your diabetes, as diabetics often have high levels of triglycerides, a fatty acid which can increase the risk of gallstones
• Avoid rapid weight loss, as fat metabolized during dieting or fasting can cause the liver to secrete more cholesterol into bile, which can increase the chance of developing gallstones