Cholangitis or bile duct inflammation is an infection of the bile duct. Typically, affected individuals suffer from fever, upper abdominal pain, and jaundice. Treatment usually involves the administration of antibiotics.
What is cholangitis?
Schematic diagram showing the anatomy and structure of the gallbladder with gallstones. Click to enlarge. Cholangitis is an inflammation of the bile ducts. These canal-like structures are needed to transport bile from the liver through the gallbladder and into the duodenum. Among other things, toxins are removed in the bile. Its main task, however, is the digestion of fats. Characteristically, those affected suffer from severe pain in the upper abdomen, fever and jaundice, i.e. a yellowing of the skin. Cholangitis is often accompanied by vomiting and discoloration of the stool. Basically, a distinction is made between acute, purulent cholangitis, non-purulent cholangitis and sclerosing cholangitis. The different forms of cholangitis have different causes, but usually lead to the same symptoms.
Causes
Acute cholangitis is largely caused by bacteria. In many cases, the pathogenic bacteria originate in the small intestine, from which they enter the bile duct in an unexplained manner. In exceptional cases, viruses are responsible for the inflammatory reaction in the bile ducts. The most common cause of inflammation of the bile ducts is the formation of gallstones. Once they reach a certain size, these obstruct the bile ducts and thus prevent the transport of bile. Pathogens can then easily settle in the stagnated bile, causing an infection of the bile ducts. To date, it is not known what causes chronic cholangitis. In some cases, it is assumed to be an autoimmune disease in which the immune system recognizes the patient’s own cells as foreign bodies and damages them. Rare causes of inflammation of the bile duct include tumors in the bile ducts, parasite infestation, and diverticula. After operations on the liver, the duodenum or the bile ducts themselves, narrowing can sometimes occur, which facilitates the development of bile duct inflammation. Very rarely, genetic malformations of the bile ducts are triggers of cholangitis.
Symptoms, complaints, and signs
- Colicky pain in the upper abdomen
- Lassitude
- Fever
- Yellowing of the skin
- Yellowing of the eyes
- Rarely blood poisoning
Diagnosis and course
To diagnose acute cholangitis, the medical history is usually enough. During the patient interview, the attending physician elicits, among other things, since when the complaints exist and whether risk factors such as obesity or a biliary condition are present. This is followed by a physical examination. If bile duct inflammation is actually present, the physician can determine the so-called Charcot triad. This is a complex of three symptoms, namely fever, right-sided upper abdominal pain and jaundice. If these three symptoms occur together, the probability of cholangitis is very high. To confirm the suspected diagnosis, a blood test is usually performed. In the case of bile duct inflammation, the number of leukocytes is usually elevated, indicating an infection. Gallstones are diagnosed by ultrasound examination. Sclerosing cholangitis can often be detected by antibodies in the blood. The course of a bile duct infection depends on the severity of the disease. If acute bile duct inflammation is diagnosed and treated quickly, a complete recovery can be expected.
Complications
In most cases, complications occur only when bile duct inflammation is diagnosed too late or when treatment begins too late. The patient suffers mainly from pain in the upper abdomen and a general feeling of illness. The eyes and skin turn yellow and the patient is no longer able to perform physical activities. Likewise, very high fever may occur. If the bile duct inflammation is left untreated, it can also lead to blood poisoning, which in the worst case leads to the death of the patient. In many cases, there is also severe itching of the skin due to the bile duct inflammation.Treatment is usually with the help of antibiotics and painkillers. If this is started early, no further complications occur for the patient and the disease subsides after only a few days. If the bile duct inflammation has led to the formation of gallstones, these must also be removed. The life expectancy is not reduced by the bile duct inflammation if the treatment is successful. However, it cannot be ruled out that the disease will recur during life.
When should you see a doctor?
Acute cholangitis requires a prompt visit to the doctor. This is also quickly realized by those affected by the severe symptoms, as the sometimes severe pain is difficult to endure without medical treatment. The other signs of the inflammation of the bile ducts also make a visit to the doctor necessary, since neither jaundice nor fever or chills are compatible with the ability to work and significantly restrict the quality of life of those affected. There are two other reasons for a quick visit to the doctor: On the one hand, choalangits with all its unpleasant symptoms almost never regresses spontaneously without therapy. Secondly, a visit to the doctor can protect against serious complications such as shock or massive effects on the patient’s central nervous system or kidneys. The fact that cholangitis is often associated with severe courses means that seeing a doctor or even a hospital is justified even if the disease is merely suspected. This is because the earlier treatment begins, the quicker and more comfortable medical help often is. Therefore, even for patients with chronic biliary problems or a concomitant disease, for example, in the intestinal area, the visit to the doctor makes sense. Initial care for cholangitis does not have to be provided by the attending physician, but is available in any emergency department.
Treatment and therapy
To prevent serious complications such as sepsis, cholangitis must be treated by a physician as soon as possible. Because acute bile duct inflammation is usually caused by bacteria, therapy involves the administration of antibiotics. Which antibiotic is prescribed by the doctor depends on the type of bacteria. Cephalosporin is often used. Effective treatment of the infection is usually only possible if the affected person takes two different antibiotics at the same time. In the majority of cases, the patient’s health improves within a few days after antibiotics are administered. Since inflammation of the bile ducts is not infrequently very painful, painkillers can be used in addition to antibiotics. Particularly suitable are agents that also have an antispasmodic effect, as many sufferers experience colicky pain. If the fever is very high, antipyretic drugs must be taken to maintain bodily functions. If gallstones are the trigger of the infection, they usually have to be removed. The inflammation of the bile duct subsequently resolves on its own in many cases. If there is a general disturbance in the flow of bile, a stent can be inserted, which has a supporting function for the bile duct. The goal of therapy is to restore the flow of bile. In the case of sclerosing cholangitis, this is hardly possible because the causes are unknown and therefore cannot be treated. In these cases, treatment consists of purely symptomatic therapy that increases general well-being.
Outlook and prognosis
Cholangitis has a favorable prognosis in adults with a stable immune system and no other diseases. Cure and permanent freedom from symptoms is tied to early treatment and therapy of the symptoms. With the use of medications, recovery from cholangitis is achieved within a few weeks in most cases. A recurrence of the disease is possible in principle, but is rarely observed. A prerequisite for a cure of cholangitis is the removal of any gallstones that may be present. These prevent the recovery of the patient until their complete disappearance. Without medical care, the patient’s health may deteriorate significantly. In addition, there is a risk that the inflammation will change from a recurrent to a chronic course. The longer cholangitis remains untreated, the higher the risk of secondary diseases.Frequently, this results in changes in the bile ducts. Scarring and narrowing of the bile ducts are to be expected in these patients. These complications worsen the prognosis and can lead to further diseases. In severe cases, there is a risk of biliary backlog, liver cirrhosis, and the development of bile duct cancer. This increases the patient’s risk of shortening normal life expectancy. The healing path is basically delayed in patients with a weakened immune system.
Prevention
It is not possible to specifically prevent cholangitis. Nevertheless, there are several measures that can significantly reduce the risk of developing acute cholangitis. Since gallstones are the most common cause of bile duct infection, they should be prevented. The best prophylactic measure is a healthy diet. The best diet is one that is low in fat and rich in fiber. In addition, it is important to consume enough fluids. The chronic form of cholangitis cannot be prevented.
Aftercare
In most cases of cholangitis, only a few measures of aftercare are available to the affected person. First and foremost, the affected person must see a doctor for this disease so that there is no further worsening of the symptoms or other complications. The earlier a doctor is consulted, the better the further course of the disease usually is, so that the affected person should contact a doctor at the first signs and symptoms of bile duct inflammation. Self-healing cannot occur in this case. The disease itself is usually treated by taking antibiotics. It is always important to take the correct dosage and to take them regularly in order to alleviate the symptoms. It should also be noted that the antibiotics should not be taken together with alcohol, otherwise their effect is weakened. In children, parents must monitor and control the intake. Even after treatment, further regular examinations by a doctor are very important in order to detect damage to the internal organs at an early stage. As a rule, the patient’s life expectancy does not decrease if bile duct inflammation is detected and treated in time.
What you can do yourself
When bile duct inflammation occurs, the affected person feels very sick. Treatment should be given quickly to minimize the risk of secondary damage. Failure to treat or self-treatment alone can result in a life-threatening condition. Strict bed rest is usually observed on its own. Depending on the cause of the disease, it is recommended to combine an ordered antibiotic therapy with a probiotic treatment of the intestine. In the acute stage, food should be avoided completely in order to relieve the bile ducts. Later, the diet should be changed to a light diet – also to relieve the liver, which is usually involved. Sufficient intake of fluids is also beneficial for the recovery process. In this context, still mineral waters and unsweetened herbal teas should be preferred. Even after successful treatment, the liver is usually severely stressed, so alcohol and fats should be avoided in the subsequent period. If an autoimmune disease is the cause of the inflammation, it is important to constantly strengthen the immune system by avoiding stress and ensuring balanced relaxation, a balanced diet and regular exercise. Micronutrient therapy (selenium, minerals) has also proven beneficial in inflammatory processes. Homeopathically prepared Colocynthis (C6), Magnesium phosphoricum (C6), Bryonia album (C6), or Chamomilla vulgaris (C6) taken hourly can help with the pain in the acute stage of the disease.
