Cholangitis

What is cholangitis?

Cholangitis is an infection of the hepatic common bile duct, a tube that carries gall or bile juice from the liver to the gallbladder for storage and to the small intestines, where it provides an alkaline medium that is necessary for the digestive enzymes to work properly. Cholangitis is more prevalent in men than in women, and is often diagnosed between the ages of 30 and 45.[1][14][15]

Clinical picture

What are the symptoms and causes of cholangitis?

Cholangitis is usually caused by E coli infection of the biliary tree, especially in people with chronic inflammatory bowel disease, it is characterized by right upper quadrant (RUQ) pain, jaundice, and fever, which is referred to as the Charcot’s Triad. However, if hypotension, and mental confusion develop, the collection of signs and symptoms is then called Reynolds pentad. If left untreated, biliary obstruction can lead to shock, which is a life threatening medical condition.[16][17][18]

Complications

1. Cirrhosis and liver failure. [11][12][13]
2. Osteoporosis
3. Cancer of the colon or of the bile duct.[19][20]

Testing

How to diagnose cholangitis?

1. X-ray of the bile ducts
2. Blood tests
3. Magnetic resonance imaging (MRI) of the bile ducts
4. Endoscopic retrograde cholangiopancreatography (ERCP) is recommended to analyze the biliary tree.
5. Liver biopsy

Treatment

How to treat cholangitis?

Questran (4g sachets of cholestyramine powder for oral suspension), which is a Bile acid sequestrant used to lower cholesterol levels in the blood and treat itching caused by cholangitis.[21][22][23]

Benadryl is a first generation antihistamine mainly used to treat itching and other allergies caused by damage to bile ducts.[24][25]

Vitamin D supplements and calcium rich foods are often used to treat osteoporosis.

Endoscopic biliary drainage and decompression are often used for the treatment of severe cholangitis; however, surgical decompression is mandated for patients in whom endoscopic biliary drainage is unsuccessful. Surgical interventions for drainage include T-tube insertion, transhepatic intubation of bile duct, bilioenteric anastomosis, or percutaneous stone extraction.[2][3][4]

Percutaneous stent placement (duct balloon) across the cystic duct for the treatment of acute cholecystitis after common bile duct stent placement in patients with malignant biliary obstruction (MBO).[5][6][7]

Orthotopic liver transplantation (OLT) for hilar cholangiocarcinoma (CCA) is not recommended.[8][9][10]

References

Verified by: Dr.Diab (December 11, 2017)

Citation: Dr.Diab. (December 11, 2017). Cholangitis Symptoms Complications Testing and Treatment. Medcoi Journal of Medicine, 10(2). urn:medcoi:article3289.