Cholangitis

Cholangitis is an infection of the bile duct system, usually caused by the obstruction of bile flow, often due to gallstones, strictures, or tumors. This condition can lead to serious complications if not treated promptly.

Causes

The primary causes of cholangitis include:

  • Gallstones: These can block the bile duct, leading to infection.
  • Bile Duct Strictures: Narrowing of the bile duct due to inflammation or previous surgery.
  • Tumors: Biliary tract tumors can obstruct bile flow.
  • Biliary Atresia: A congenital condition in infants where bile ducts are absent or blocked.

Symptoms

The classic triad of symptoms for cholangitis includes:

  1. Fever and Chills: Often a sign of infection.
  2. Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels.
  3. Abdominal Pain: Typically located in the upper right quadrant.

Additional symptoms may include:

  • Nausea and vomiting
  • Dark urine and pale stools
  • Fatigue

Diagnosis

Diagnosis typically involves several methods:

  • Medical History and Physical Examination: Assessing symptoms and conducting an abdominal exam.
  • Blood Tests: To check for elevated liver enzymes, bilirubin levels, and signs of infection (elevated white blood cell count).
  • Imaging Studies:
    • Ultrasound: First-line imaging to identify bile duct obstructions.
    • CT Scan: Can provide detailed images to assess the extent of the condition.
    • MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive imaging to visualize the bile ducts.

Treatment

Treatment for cholangitis typically includes:

  1. Antibiotics: Immediate intravenous antibiotics to treat the infection.

  2. Biliary Drainage: If there is an obstruction:

    • Endoscopic Retrograde Cholangiopancreatography (ERCP): Used to remove stones and relieve bile duct obstruction.
    • Percutaneous Drainage: In cases where ERCP is not successful, a drain may be placed to relieve pressure.

  3. Surgery: If there are complications or if other treatments are unsuccessful, surgical intervention may be necessary to address the underlying cause.

Complications

If left untreated, cholangitis can lead to serious complications, including:

  • Sepsis: A life-threatening systemic infection.
  • Bile Duct Stricture: Can develop from chronic inflammation.
  • Liver Abscess: Infection can spread to the liver.

Prognosis

With prompt diagnosis and treatment, the prognosis for cholangitis is generally good. However, the outcome can vary based on the severity of the infection and any underlying conditions.