What Is Cholangitis?
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Medically reviewed by Kumkum S. Patel MD, MPH
Cholangitis is a condition that happens when your bile ducts become inflamed or infected. The bile ducts are thin tubes that carry bile from the liver to the intestines and gallbladder. Bile is a greenish-yellow fluid that your liver produces and stores in your gallbladder. The purpose of bile is to carry waste away from the bile ducts and help you break down fats when you digest food.
The most common symptoms of this infection are fever, abdominal pain, and jaundice (or, the yellowing of your eyes and skin). What exactly causes cholangitis is still unknown, but experts suspect that a combination of genetics, environmental factors, and injury to the bile ducts may lead to the condition.
Fortunately, treatment can help improve symptoms and prevent the risk of complications. But it's essential to seek out medical care from your provider if you have symptoms, as complications of cholangitis can be life-threatening.
Types of Cholangitis
There are four types of cholangitis, which include:
Acute bacterial cholangitis: The most common type of cholangitis, which often develops due to a bacterial infection in your bile ducts. This infection may be due to partial or complete obstruction of the bile ducts.
Primary biliary cholangitis: A chronic liver condition that causes scarring and inflammation of the small bile ducts. If left untreated, this condition can lead to cirrhosis (liver scarring) or liver failure.
Primary sclerosing cholangitis: A type of chronic liver disease that causes inflammation and scarring of the bile ducts that are located both inside and outside the liver. As a result, this can cause your bile ducts to become narrow or fully blocked.
IgG4-related autoimmune cholangitis: A form of cholangitis that causes an excess of IgG4-positive plasma cells and lymphocytes (which are two types of cells found in your immune system). Too many of these cells in your bile ducts can damage the bile duct wall and cause symptoms.
Symptoms
Cholangitis has three hallmark symptoms—which are known as "Charcot's triad." These symptoms are:
Jaundice
Other symptoms can also accompany Charcot's triad and may include:
Causes
The exact cause of cholangitis is still unclear. However, researchers believe the following factors may trigger the infection to develop:
History of bile duct obstruction or gallstones
Having a family member with bile duct or liver health problems
Environmental factors, like exposure to toxins or smoking cigarettes
Autoimmune disorders, such as rheumatoid arthritis or lupus
Injury to the bile ducts
Diagnosis
If you experience cholangitis symptoms, it's essential to reach out to your healthcare provider as soon as possible to prevent the risk of serious complications. At your appointment, you can expect your provider to ask you questions about your personal and family medical history. They'll also likely perform a physical exam to better understand your symptoms.
To confirm a cholangitis diagnosis, your provider may also order the following tests:
Blood tests: Requires taking a sample of your blood to test your liver function, the presence of anti-mitochondrial antibodies, bilirubin levels, and the overall health of your blood cells
Endoscopic retrograde cholangiopancreatography (ERCP): Combines X-rays and upper gastrointestinal endoscopy to examine your bile ducts and identify if your bile ducts are blocked or obstructed
Magnetic resonance cholangiopancreatography (MRCP): Uses magnetic resonance imaging (MRI) to take pictures of the bile ducts to detect injuries or abnormalities
Percutaneous transhepatic cholangiography (PTC): Involves injecting a dye through the skin into your bile duct so your providers can view your bile ducts more clearly on an X-ray
Abdominal ultrasonography: Creates images of the bile ducts with the use of ultrasound waves to check if your bile ducts are damaged
Treatment
The goal of treatment for cholangitis is to manage bile duct obstruction and reduce symptoms of the infection. The two most common treatment approaches for cholangitis include:
Antibiotics: Your healthcare provider may recommend antibiotics, which are drugs that help treat bacterial infections. The exact type of antibiotic you receive will be based on the type of cholangitis you have, the severity of your symptoms, the status of your liver health, and any underlying health conditions or drug allergies you have.
Biliary drainage: Healthcare providers recommend this procedure for people who do not respond well to antibiotics or don't see a change in symptoms even after taking medication. Biliary drainage is a procedure that drains bile from blocked bile ducts.
In rare and very severe cases, your provider may look at the possibility of a liver transplant if your infection has caused serious complications like liver damage that cannot be reversed.
How To Prevent Cholangitis
The following prevention strategies can help you reduce your risk of the infection or prevent serious complications from occurring:
Drinking plenty of water
Eating a more balanced, low-fat diet
Reducing alcohol intake
Making time for exercise or physical activity throughout the week
Practicing stress management techniques like yoga, mindfulness, or journaling
Complications
If cholangitis is left untreated, you may be at risk of experiencing serious complications like
Hepatic abscess: An infectious pus-filled lump or mass in your liver that can affect liver function
Portal vein thrombosis: The narrowing of your portal veins due to a blood clot, which can reduce blood flow to your liver and cause damage
Bacteremia: The presence of harmful bacteria in your blood which can lead to sepsis or organ dysfunction
Acute cholecystitis: Inflammation of the gallbladder which can cause your gallbladder to rupture
Acute biliary pancreatitis: Inflammation of the pancreas which may affect the functioning of your pancreas
Organ failure: Cholangitis may cause significant and irreversible damage to your liver and kidneys
Living with Cholangitis
The severity of cholangitis varies from person to person and the type of infection that you have. If you experience symptoms, early diagnosis and treatment can help you improve symptoms and prevent the risk of complications. Without treatment, cholangitis may increase your risk of life-threatening complications like kidney or liver failure.
Fortunately, practicing prevention strategies like exercising regularly, quitting smoking, and reducing alcohol intake can help you reduce the risk of infection. If you do develop symptoms, treatments like antibiotics or bile duct drainage can improve your condition
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