Cholangitis is an inflammation (swelling) in the bile duct, and it is a type of liver disease. The bile ducts are responsible for carrying bile, green or yellow or brown fluid from the liver and gallbladder to the small intestine. It supports the body in digesting and absorbing fat besides eliminating the waste from liver.

When these bile ducts get inflamed or blocked, the bile acid builds or backs up into the liver, leading to liver damage and other health issues. 
Cholangitis

Cholangitis is categorized as:

  • Primary biliary cholangitis (PBC)
  • Primary sclerosing cholangitis (PSC)
  • Secondary cholangitis

Some types of cholangitis are mild, while others can be severe and life-threatening.

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Types Of Cholangitis:

There are two main types of cholangitis which include:

Chronic Cholangitis: This develops slowly over time and can cause symptoms lasting for years.

Acute Cholangitis: This occurs suddenly and can cause symptoms over a short span of time.

Symptoms

Generally, symptoms depend on the type of cholangitis and how long a person has it. Every individual with this condition may have mildly different signs and symptoms. Moreover, most people with cholangitis may not even observe any symptoms.

Early symptoms of chronic cholangitis may include:

  • Fatigue
  • Itchy skin
  • Dry eyes
  • Dry mouth

If you have had chronic cholangitis for a long time, then you may have these symptoms:

  • Pain in the upper right side of the abdomen
  • Night sweats 
  • Swollen feet and ankles
  • Darkening of the skin
  • Muscle pain
  • Joint pain
  • Bloating 
  • Fat deposits in the skin around the eyes and eyelids
  • Fat deposits in the elbows, knees, and feet
  • Diarrhoea 
  • Weight loss
  • Mood changes and memory problems

With acute cholangitis, you may show sudden symptoms like:

  • High fever for more than a day
  • Pain in the upper right side of the abdomen
  • Chills
  • Nausea
  • Vomiting
  • Back pain
  • Yellowing of the skin and eyes (jaundice)
  • Dark urine
  • Low blood pressure
  • Confusion

Your physician may also notice signs of cholangitis in other parts of the body. These include:

  • Swollen or enlarged liver
  • Swollen or enlarged spleen
  • High cholesterol
  • Underactive thyroid gland 
  • Weak and brittle bones 

Causes

There is a wide range of causes for cholangitis, but at times the cause isn't clear. Chronic cholangitis may be an autoimmune disorder where immune system mistakenly attacks the bile ducts and causes inflammation. Over the period, inflammation can cause scars or the growth of hard tissue within the bile ducts, and scarring makes the bile ducts hard and narrow and blocks smaller ducts.

Also Read: Gallstones: Symptoms, Causes And Treatment

Acute cholangitis is due to:

  • Bacterial infection
  • Gallstones
  • Blockages and tumour
  • Infections (bacteria, viruses, fungi, or parasites)
  • Smoking
  • Chemicals

Diagnosis

The healthcare provider diagnoses cholangitis with several tests and scans; he may recommend one or more of the following blood works:

Complete blood count (CBC) to measure white blood cell count and see if you have any infection, as WBC count will be high when there is an infection.

Liver function tests evaluate the functioning of the liver and check if liver enzymes are within a normal range.

Also Read: Liver Function Tests: Know The Types, How It Is Done And What To Expect

Anti-mitochondrial Antibody Test: Presence of anti-mitochondrial antibodies (AMAs), along with the results from other blood works, may be an indication of cholangitis.

A cholesterol test can be beneficial in assessing a person's risk factor for gallstones, which can lead to cholangitis.

Blood culture can help doctors rule out any blood infection.

The healthcare provider may also recommend several types of imaging tests to see how the patient's liver and bile duct are functioning, which include: 

  • Ultrasound 
  • CT scan
  • Magnetic resonance cholangiopancreatography (MRCP).
  • Endoscopic retrograde cholangiopancreatography (ERCP
  • Percutaneous transhepatic cholangiography (PTC)

Treatment

Usually, treatment for chronic and acute cholangitis may vary based on the cause and how early it was diagnosed. Both acute and chronic cholangitis may lead to severe complications if left untreated.

Prompt treatment is mainly important for acute cholangitis, where the physician may prescribe antibiotics for up to 10 days. The patient may need to be hospitalized to get:

  • Intravenous (IV) Fluids
  • Bile Duct Drainage

Currently no medications are available to treat chronic cholangitis. The main aim of treatment for chronic cholangitis includes:

  • Managing symptoms
  • Monitoring liver function
  • Procedures to open blocked bile ducts

Certain procedures are suggested for both chronic and acute cholangitis, which include:

  • Endoscopic therapy
  • Percutaneous therapy
  • Surgery may help to remove the blocked parts of the bile duct

A liver transplant is needed for severe cases where the doctor will replace the damaged liver with a new one. Patients will have to take antirejection drugs for the rest of their life post-surgery to keep the new liver working well.

Patients may also have to manage and need treatment for some side effects of cholangitis:

Good Nutrition: 

As cholangitis impedes digestion and how the body absorbs vitamins, you may have to take vitamin A, D, E, and K supplements.

Bone Weakness: 

Your physician may prescribe medications for treating osteoporosis. Calcium and vitamin D supplements may also help enhance bone density and strength.

Blood pressure should be monitored and treated as it can lead to portal hypertension.