Cholangitis

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Definition
Cholangitis is an infection of the common bile duct, which carries bile (which helps in digestion) from the liver to the gallbladder and then to the intestines.

Causes, incidence, and risk factors

Cholangitis is usually caused by a bacterial infection, which can occur when the duct is obstructed by a gallstone, stricture, or tumor. Flukes and worms can sometimes become lodged in the bile duct and lead to this problem, but this is not common in the United States.

The infection causing this condition may also spread to the liver. Risk factors include a previous history of gallstones, biliary diseases such as sclerosing cholangitis (primary or secondary), HIV, and rarely, travel to countries where a worm or fluke infection can be contracted.

Symptoms

• Recurrent jaundice
  
• Abdominal pain
  o In the right upper quadrant or middle of the upper abdomen
  o May be recurrent
  o Sharp or cramping or dull
  o May radiate to the back or below the right shoulder blade
  
• Chills
  
• Fever
  
• Clay-colored stools (may occur)
  
• Dark urine (may occur)
  
• Nausea and vomiting

Signs and tests

Tests that show obstruction or infection of the bile duct:

• ERCP (endoscopic retrograde cholangiopancreatography) examines the biliary (liver secretion) system and the pancreatic duct
  
• Percutaneous transhepatic cholangiogram (PTCA)
  
• Abdominal ultrasound
  
• MRCP (magnetic resonance cholangiopancreatography)

Blood tests that may be affected include:

• Liver function tests
  
• Bilirubin levels
  
• WBC—increased white blood cells

Treatment
Antibiotic therapy can eliminate the infection. Obstructed bile ducts may be drained by ERCP or by PTCA. Flukes and worms can be eliminated with appropriate medications.

Expectations (prognosis)
The outcome is usually good with treatment, but poor without it.

Complications

• Sepsis

Calling your health care provider

Call for an appointment with your health care provider if symptoms suggestive of cholangitis develop.

Call your provider if cholangitis symptoms worsen or do not improve with treatment, or if new symptoms develop.

Prevention
Treatment of gallstones, tumors, and infestations of flukes and worms may reduce the risk for some people. The placement of metal or plastic stents within the bile system may be necessary to prevent recurrence.

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