Cholangitis Treatment By Infection Type
Acute and Progressive Symptoms of Bile Duct Inflammation
Medically reviewed by Robert Burakoff, MD, MPH
Cholangitis is a liver disease that involves inflammation of your bile ducts. These tubes carry bile from your liver and gallbladder into your small intestine. Bile is a digestive liquid made by your liver that helps digest fats and fatty vitamins. As bile backs up, it harms your bile ducts, causing cirrhosis, or scars in your liver tissue. This permanently slows liver function.
Cholangitis can occur as a chronic or acute problem. Chronic cholangitis results in a slow decline of liver function leading to liver failure. The acute version needs urgent care. It can threaten your life if treatment is given too late.
This article describes cholangitis symptoms, types, treatments, and ways to manage this disease.
Symptoms of Cholangitis Bile Duct Inflammation
Symptoms of cholangitis bile duct inflammation can vary by individual. The most common symptoms of cholangitis are:
Pain in the upper right part of your abdomen that can range from intermittent discomfort to severe, debilitating pain
Pain that spreads to your back
Jaundice (a yellowing of the skin and whites of the eyes that occurs when there is too much bilirubin in your blood)
Hypotension (low blood pressure)
Clay-colored stool as a result of bile not exiting your body
Lethargy (a noticeable drop in your normal level of energy or difficulty getting out of bed)
Types of Cholangitis
Cholangitis includes a group of subtypes that occur in different ways. These diseases include the following:
Primary sclerosing cholangitis (PSC): A chronic autoimmune condition
Secondary (acute) cholangitis: An acute condition typically caused by an infection IgG4-associated cholangitis (IAC): An inflammatory multi-organ disorder related to high levels of immunoglobulin G4
Emergency Treatment for Cholangitis Complications
Cholangitis can occur as an acute and serious condition that requires emergency treatment. It develops as a result of an infection. Without treatment, it can lead to the following complications:
Sepsis (a very serious condition that can lead to organ failure, tissue damage, and potential death)
Vascular collapse
Multiorgan failure
Potential death
Acute cholangitis, also called ascending cholangitis, is characterized by the sudden onset of the following symptoms:
Fever and chills
Jaundice
Abdominal pain in the right upper quadrant
Having these symptoms requires immediate medical care. Treatment includes addressing the infection and obstruction of the bile duct. The following therapies are used:
Antibiotics to kill the bacteria
Treatment of the root cause of the infection:
Drainage of the bile duct with the placement of stents, often by endoscopic retrograde cholangiopancreatography (ERCP), a combination of an upper gastrointestinal (GI) endoscopy and X-ray within 48 hours of admission
Treatment of the source of the problem as needed with:
Removal of gallstones with ERCP
Laparoscopic cholecystectomy (gallbladder removal) for treatment of gallstone disease
Why Do Cholangitis Infections Develop?
Cholangitis infections can be a chronic or acute problem. Infections can be caused by one of the following problems:
Blockage in your bile duct system: A gallstone, blood clot, or inflammation can create a barrier in your bile duct system that makes it difficult to carry bile away from your liver and gallbladder.
Bacteria from your small intestine: Bacteria can back up into your bile duct system and cause an infection.
Blood infection: A blood infection can reach your bile duct system and cause an infection there.
You have a higher chance of getting cholangitis if you have one of the following risk factors:
A previous history of gallstones
Primary sclerosing cholangitis (PSC)
Narrowing of the bile duct, which can occur as a congenital condition
Travel to countries where you might catch a parasite or worm infection
Age between 50 and 60 years
Diagnosis of Cholangitis
If you have symptoms of cholangitis, your healthcare provider may use one or more of the following exams and tests to diagnose your condition:
Abdominal ultrasound
Endoscopic retrograde cholangiopancreatography (ERCP)
Blood tests:
Bilirubin level
Liver enzyme test
Recovering From an Acute Cholangitis Infection
Recovery from an acute cholangitis infection can vary based on the severity of the infection and the methods used to treat it. your prognosis depends on the timing of the administration of antibiotics, early drainage of blocked bile ducts, and other comorbidities. Early treatment can increase your chances of a rapid and full recovery.
Recovery typically involves the following outcomes with these treatments:
Antibiotics
People treated with antibiotics often feel better quickly. Hospitalization may be necessary if you require treatment with intravenous (IV) antibiotics.
The success of this treatment depends on how quickly the medications are administered after symptoms begin. The best results occur when antibiotics are started as soon as possible.
ERCP
After an ERCP, you may go home the same day or stay overnight in the hospital. You may feel the discomfort of bloating after the procedure. A hospital stay is likely if you have an infection so IV antibiotics can be administered.
Recovery from an ERCP usually involves rest for at least 24 hours after your procedure. You may be able to return to work or school the day after the procedure, but other factors, such as recuperation from infection, may require that you allow additional time to heal.
Gallbladder Surgery
Recovery from gallbladder surgery varies depending on the type of surgery used. This procedure can be performed via open surgery or with minimally invasive approaches like laparoscopy or robotic-assisted techniques.
Open surgery always requires a hospital stay and about four to six weeks to return to normal activities. Minimally invasive treatments may allow you to go home the same day or reduce the length of your hospital stay. These procedures may allow you to return to normal activities within one to two weeks.
Managing Chronic Cholangitis and Comorbidities
Chronic cholangitis, also called primary biliary cholangitis or PBC disease, occurs as a chronic, incurable autoimmune disease that can progress to end-stage liver disease without treatment.
Alone, chronic cholangitis progresses gradually, often leading to liver failure within about 10-15 years after diagnosis. However, commodities can worsen this prognosis.
Research indicates that the following comorbidities are most common with cholangitis:
Hypertension (high blood pressure)
Dyslipidemia (an abnormal amount of blood lipids)
Viral hepatitis and/or chronic hepatitis
Alcoholic liver disease
At least half of the people with chronic cholangitis have at least one other autoimmune condition. Of these people up to 20% will have two or more additional autoimmune conditions. Three of the most commonly involved include the following:
Generally, chronic cholangitis is accompanied by lifelong symptoms that can worsen with age. People with a PBC liver often have a quality of life that is lower than others. Having another disease at the same time can trigger problems that don't involve the liver in symptoms such as the following:
Management of chronic cholangitis and commodities requires speaking up about physical as well as emotional aspects of your conditions with your healthcare providers. Vigilant follow-up and adherence to treatment regimens prevent complications from one condition that could trigger new symptoms in the other one.
Liver Health With Cholangitis
Your healthcare provider can give you direction on ways to protect your liver health and manage cholangitis complications as they arise. The following strategies are often advised:
Eat a healthy, well-balanced diet that includes fruits, vegetables, and whole grains.
Choose unsaturated fats like Omega 3s, extra virgin olive oil, nuts, and fatty fish.
Avoid foods high in sugar.
Reduce sodium.
Maintain a healthy weight.
Exercise daily to help remove toxins from your body.
Stop smoking.
Take supplements of vitamins which you are lacking, usually vitamins A, D, E, and/or K if advised by your healthcare provider.
Avoid raw or undercooked shellfish, fish, meat, and unpasteurized milk.
Stop drinking alcohol.
Get vaccinated against hepatitis A and hepatitis B.
Treatment of gallstones, tumors, and parasites may reduce the risk of cholangitis recurring for some people. The insertion of a stent in the bile duct can aid in bile duct drainage and prevent an infection from returning.
Chronic cholangitis leads to liver failure. A liver transplant can be a lifesaving treatment for people with end-stage liver disease, Without a liver transplant, liver failure can lead to death.
Learn More: How to Choose Good Foods for Your Liver
Getting on the Liver Transplant List for Cholangitis
Liver transplantation can save your life, and it is typically indicated if your cholangitis has progressed to one of the following circumstances:
Acute deterioration of liver function
Recurrent cholangitis or severe bile duct infections that require repeated hospitalizations
Symptoms that include weight loss and uncontrollable itching
Risk of cholangiocarcinoma, bile duct cancer
Getting on the liver transplant list often requires that you have exhausted all other treatments and remain healthy enough for surgery. The criteria for getting on a liver transplant list can vary by transplant center.
If you qualify for a liver transplant based on a thorough exam, laboratory tests, and other assessments, and do not have a living donor willing and eligible to donate a liver to you, your transplant center submits your name on the national waiting list for a liver from a deceased donor.
The people with the most urgent need for a new liver are at the top of the national waiting list. The severity of your condition is assessed based on the Model for End-Stage Liver Disease (MELD) score. The sickest people have the highest MELD scores.
The following values are considered in calculating your MELD score:
Creatinine level
Bilirubin level
Serum sodium level
International Normalized Ratio (INR; a measure of your liver's clotting factors)
The length of your wait for a liver transplant can range from less than 30 days to longer than five years based on the urgency of your need. When a liver becomes available, factors such as your age, location, blood type, body size, and overall health are also used to determine whether it is an appropriate match.
Learn More: What to Expect From a Liver Transplant
Summary
Cholangitis describes an acute or chronic disease that damages your bile ducts. These issues cause scars to form inside the tubes that allow the flow of bile from your liver. In its chronic form, the problem slowly leads to liver failure. When it occurs as an acute problem, it needs emergency care to prevent sepsis, a life-threatening illness.
Symptoms of abdominal pain, jaundice, and fever can be signs of an acute problem. Prompt treatment can improve your outcomes for any form of this disease. The earlier antibiotics are given and clogged ducts are cleared, the better your chances of avoiding sepsis. Early diagnosis and treatment can also help protect liver health and possibly slow disease progress of the chronic form.
Read the original article on Verywell Health.
