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Cholangitis

Cholangitis is an infection of the bile ducts, the tubes that carry bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps digest food.

Bile

Bile is a fluid that is made and released by the liver and stored in the gallbladder. Bile helps with digestion. It breaks down fats into fatty acid...

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Causes

Cholangitis is most often caused by bacteria. This can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver.

Risk factors include a previous history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and rarely, travel to countries where you might catch a worm or parasite infection.

Gallstones

Gallstones are hard deposits that form inside the gallbladder. These may be as small as a grain of sand or as large as a golf ball.

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Video Transcript

Gallstones - Animation

Stones are great for tossing into a stream or using to line your flowerbeds. But they're not so great when they're trapped inside your gallbladder. If you've got pain in the upper part of your belly, a fever, or yellow skin, they could be signs that you've got gallstones. The stones that form in your gallbladder aren't made of rock. Usually, they're made of cholesterol, a type of fat in your blood. Or, they could be made from a substance called bilirubin, which is processed in your liver. Gallstones can be as small as a grain of sand, or as big as a golf ball. You're more likely to get gallstones if you're over age 40, or if you have a chronic condition like diabetes, anemia, or cirrhosis of the liver. People who've had weight-loss surgery, or who went on a crash diet and lost weight very quickly can also develop gallstones. Gallstones are more common in women than in men, and they may run in families. So, how do you know if you have gallstones? Well, you might not realize it, because often gallstones don't cause any pain. They're often found accidentally during an x-ray or surgery to treat another condition. If the gallstone is very large, though, it may get stuck in one of the tubes, called ducts, which connect to the gallbladder. Then you'll probably feel a sharp or cramping pain in the upper right or middle part of your abdomen. You may also have a fever and feel sick to your stomach. Your doctor can do an ultrasound, or other scan of the gallbladder area to find out if gallstones are causing your pain. You may also have blood tests to check your liver function and to see if your bilirubin levels are too high. You may not need to treat gallstones, unless they're causing symptoms. If that's the case, your doctor will recommend treatment which is usually surgery to remove them. Often, this is done with a laparoscopic procedure that removes the gallstone through very small cuts or incisions. Normally, you can go home the same day as your surgery, or the next day. Most people don't need to have their whole gallbladder removed, unless they have complications, like a blocked duct. There is also medicine that can dissolve cholesterol gallstones, but it isn't that effective because it can take two years or more to work, and often the stones form again after you're done taking it. You can't really prevent gallstones, except by avoiding rapid weight loss or health conditions that can cause gallstones such as obesity, diabetes, or cirrhosis. But if you do get them, gallstones are pretty easy to treat. Most people don't have any symptoms or complications from them, and those who do have symptoms usually recover completely and don't get gallstones again after their surgery. It's important that you call your doctor if you are having abdominal pain, yellow skin or eyes, so you can find out for sure whether you have gallstones, and get them treated.

Symptoms

The following symptoms may occur:

Pain on the upper right side or upper middle part of the abdomen. It may also be felt in the back or below the right shoulder blade. The pain may come and go and feel sharp, cramp-like, or dull.
Pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
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Fever and chills.
Dark urine and clay-colored or pale stools.
Nausea and vomiting.
Yellowing of the skin (jaundice), which may come and go.

Exams and Tests

You may have the following tests to look for blockages:

Abdominal ultrasound
Abdominal ultrasound
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, pancreas, and kidneys...
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CT scan
Endoscopic retrograde cholangiopancreatography (ERCP)
Magnetic resonance cholangiopancreatography (MRCP)
Percutaneous transhepatic cholangiogram (PTCA)
Percutaneous transhepatic cholangiogram
A percutaneous transhepatic cholangiogram (PTC) is an x-ray of the bile ducts. These are the tubes that carry bile from the liver to the gallbladder...
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You may also have the following blood tests:

Bilirubin level
Bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
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Liver enzyme levels
Liver function tests
Liver function tests
Liver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...
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White blood count (WBC)
White blood count
A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. It is a part of a complete blood count (CBC). WBCs are a...
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Treatment

Quick diagnosis and treatment are very important.

Antibiotics to cure infection are the first treatment done in most cases. ERCP or other surgical procedure is done when the person is stable. ERCP will drain the infection, which is usually needed along with antibiotics.

People who are very ill or are quickly getting worse may need surgery right away.

Outlook (Prognosis)

The outcome is very often good with treatment, but poor without it.

Possible Complications

Complications may include:

Sepsis
Sepsis
Sepsis is an illness in which the body has a severe, inflammatory response to bacteria or other germs.
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When to Contact a Medical Professional

Contact your health care provider if you have symptoms of cholangitis.

Prevention

Treatment of gallstones, tumors, and infestations of parasites may reduce the risk for some people. A metal or plastic stent that is placed in the bile system may be needed to prevent the infection from returning.

Stent

A stent is a tiny tube placed into a hollow structure in your body. This structure can be an artery, a vein, or another structure, such as the tube ...

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References

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 141.

Sifri CD, Madoff LC. Infections of the liver and biliary system (liver abscess, cholangitis, cholecystitis). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 75.

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Health exams for: #AGEGROUP#

Exam

Frequency

Cholangitis

Bile

Causes

Gallstones

Video Transcript

Symptoms

Pain

Exams and Tests

Abdominal ultrasound

Percutaneous transhepatic cholangiogram

Bilirubin

Liver function tests

White blood count

Treatment

Outlook (Prognosis)

Possible Complications

Sepsis

When to Contact a Medical Professional

Prevention

Stent

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Gallstones

Gallstones

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