Causes and Risks:

A bacterial infection in the bile duct and its bile is the usual cause of cholangitis. Bacterial infection is caused by obstruction of the duct by a gallstone; stricture or tumor; or in some parts of the world, by a fluke or a worm.

The infection may spread to the liver. The risk factor is a previous history of cholelithiasis (gallstones), biliary diseases such as sclerosing cholangitis (primary or secondary), and HIV.  Cholangitis occurs in approximately 1 out of 10,000 people.

Prevention: Treatment of gallstones, tumors, and infestations (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.

Symptoms:

• recurrent jaundice
• abdominal pain
  • in the right upper quadrant or middle of the upper abdomen
  • may be recurrent
  • sharp or cramping or dull
  • may radiate to the back or below the right shoulder blade
• chills
• fever
• stools, clay colored (may occur)

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, abnormal
• WBC, increased

Treatment: Antibiotic therapy can eliminate the infection. Obstructed bile ducts may be drained by endoscopy (ERCP) or by percutaneous transhepatic cholangiogram (PTCA).

Prognosis: The outcome is usually good with treatment, but poor without it.

Complications:

• sepsis

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

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