Cholangitis (bile ducts infected)

Abdomen | Emergency Medicine | Cholangitis (bile ducts infected) (Disease)


Cholangitis is a disease of the bile ducts in the liver. Bile is a liquid made by the liver that helps digest food.

A person with cholangitis may complain of abdominal pain, particularly in the right upper quadrant of the abdomen, fever, rigors (uncontrollable shaking) and a feeling of uneasiness named malaise. Some may report jaundice (yellow discoloration of the skin and the whites of the eyes), clay-colored stools, dark urine, nausea and vomiting. In the elderly, the presentation may be atypical; they may directly collapse due to septicemia without first showing typical features. Those with an indwelling stent in the bile duct (see below) may not develop jaundice.

Causes and Risk factors

Cholangitis is usually caused by bacteria ascending from its junction with the first part of the small intestine called duodenum.

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.

Diagnosis and Treatment

Diagnosis is confirmed after the following investigation: blood test (bilirubin level, liver enzyme levels, liver function tests, white blood count) and medical imaging (abdominal ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTCA). Cholangitis can be life-threatening, and represents medical emergency.

Treatment involves medication such as fluids and antibiotics and surgical procedures like endoscopy and cholecystectomy. ...