What is cholangitis?
Cholangitis is a redness and swelling (inflammation) of the bile duct system that
results from infection.
The bile duct system carries bile from your liver and gallbladder into the first part
of your small intestine (the duodenum).
In most cases cholangitis is caused by a bacterial infection. The infection often
happens suddenly. But in some cases it may be long-term (chronic).
What causes cholangitis?
There are several health problems that may cause an infection in your bile duct system.
In most cases cholangitis is caused by a blocked duct somewhere in your bile duct
system. The blockage may be from:
- Lumps of solid material (gallstones)
- A tumor
- Blood clots
- A narrowing of a duct that may happen after surgery
- Swollen pancreas
- Inflammatory conditions of the liver and bile ducts
- A parasite infection
Cholangitis may also be caused when you have:
- A backflow of bacteria from your small intestine
- A blood infection (bacteremia)
- A test done to check your liver or gallbladder (such as a test where a thin tube or
endoscope is put into your body)
The infection causes pressure to build up in your bile duct system. It may spread
to your liver if it’s not treated.
Who is at risk for cholangitis?
If you have had gallstones you are at greater risk for cholangitis. Other risk factors
- Having human immunodeficiency virus (HIV)
- Traveling to countries where you might be exposed to worms or parasites
- Having any recent medical procedures to your bile duct area
What are the symptoms of cholangitis?
Symptoms may be medium to severe. Each person’s symptoms may vary.
Symptoms may include:
- Pain in the upper right part of your belly (abdomen)
- Yellowing of the skin and eyes (jaundice)
- Nausea and vomiting
- Clay-colored stools
- Dark urine
- Low blood pressure
- Not as alert
The symptoms of cholangitis may look like other health problems. Always see your healthcare
provider to be sure.
How is cholangitis diagnosed?
The pain from cholangitis can feel a lot like the pain from gallstones.
To be sure you have cholangitis, your healthcare provider will look at your past health
and give you a physical exam. He or she may also use other tests.
You may have blood tests including:
- Complete blood count (CBC). This test measures your white blood cell count. You may have a high white blood cell
count if you have an infection.
- Liver function tests. A group of special blood tests that can tell if your liver is working properly.
- Blood cultures. Tests to see if you have a blood infection.
You may also have imaging tests including:
- Percutaneous transhepatic cholangiography (PTC). A needle is put through your skin and into your liver. Dye is put into your bile duct
so that it can be seen clearly on X-rays.
- ERCP (endoscopic retrograde cholangiopancreatography). This is used to find and treat problems in your liver, gallbladder, bile ducts, and
pancreas. It uses X-ray and a long flexible tube with a light and camera at one end
(an endoscope). The tube is put into your mouth and throat. It goes down your food
pipe (esophagus), through your stomach, and into the first part of your small intestine
(the duodenum). A dye is put into your bile ducts through the tube. The dye lets the
bile ducts be seen clearly on X-rays.
- CT scan. A CT scan may be done with a dye that is swallowed or injected through an IV. This
will show the abdomen and pelvis including the bile drainage area. It can help determine
why there is a blockage.
- Magnetic resonance cholangiopancreatography (MRCP). This test is used to look for any problems in your abdomen. It can show if there are
gallstones in your bile duct. The test is done from outside your body. It does not
involve putting a tube (endoscope) into your body. It uses a magnetic field and radio
frequency to make detailed pictures.
- Ultrasound (also called sonography). This test creates images of your internal organs on a computer screen using high-frequency
sound waves. It is used to see organs in your belly such as the liver, spleen, and
gallbladder. It also checks blood flow through different vessels. It can be done outside
the body (external). Or it may be done inside the body (internal). If internal, it
is called an endoscopic ultrasound (EUS).
How is cholangitis treated?
It is important to get a diagnosis right away. Most people with cholangitis feel very
sick. They see their healthcare provider or go to the emergency room.
If you have cholangitis, you will likely be in the hospital for a few days. You will
be given fluids by IV (intravenous) line through a vein. You will also have pain medicine
and bacteria-fighting medicine (antibiotics).
You may also need to drain the fluid in your bile duct and find the cause of any blockage.
In most cases, this is done by a method called ERCP (endoscopic retrograde cholangiopancreatography).
To drain your bile duct using ERCP, a long thin flexible tube (endoscope) is put in
your mouth. The scope goes down your food pipe (esophagus) and into your stomach.
It passes into the first part of your small intestine (the duodenum) and into the
bile ducts. The doctor can see the inside of these organs and ducts on a video screen.
The video screen is connected to a camera in the scope. Sometimes a tube is left to
the outside to drain bile. In this situation, a small tube (called a T-tube) is passed
into the ducts to drain fluid. This tube is brought out through the skin. This lets
fluid drain out until the infection and inflammation clear up.
You may also have firm tubes (stents) put into the bile ducts to keep them open. Gallstones
can also be removed. In most cases these things can be done using the ERCP scope.
You may need surgery if treatment doesn’t work or if you are getting worse. Surgery
will open your ducts to drain the bile and fluid that’s building up.
- Cholangitis is redness and swelling (inflammation) of the bile duct system.
- The bile duct system carries bile from the liver and gallbladder to the first part
of your small intestine (the duodenum).
- In most cases cholangitis is caused by a bacterial infection.
- People who have had gallstones are at greater risk for cholangitis.
- Surgery may be needed.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that
- Know how you can contact your provider if you have questions.