You may be familiar with the word ‘jaundice’, a condition where a patient often has a yellowish tinge on their skin. Do you know that there are many other conditions that could be causing such an appearance of the abnormal yellowish skin or yellowish of the white eyes? One of them is cholangitis. Medicine is certainly needed to treat cholangitis. This article will elaborate on cholangitis.
Cholangitis is a condition where there is inflammation to the bile duct. Bile ducts are tubes that bring bile originating from the liver into the gallbladder. Bile also will go into the intestine. Bile is a greenish yellow fluid that functions in digestion and eliminating waste products such as excess cholesterol and haemoglobin from the body. Bile flows out of the liver through left and right hepatic cuts which come together to form a common hepatic duct. Then, to create a common bile duct, this tube will be joined with the cystic pipe connected to the gallbladder. Bicarbonate and water will be released into bile by common bile ducts. Bile juice gets mixed with food in the duodenum and enters the small intestine through a pyloric valve. The pyloric valve is slightly open to enable liquified food entering the stomach.
Cholangitis is often the infection of the bile ducts. It is also known as an ascending bacterial infection of the biliary tract caused by infected gall stones that blocks the flow of bile. In other words, the common cause for cholangitis is choledocholithiasis. The biliary system obstruction by the infection-causing stone can be partial or complete. Beside the obstruction of the gallstone, it may also be caused by malignancy.
Cholangitis is relatively uncommon with the average of less than 200 000 cases every year. People the age of 50 to 60 years old are the common one affected by cholangitis. Apart from history of gallstone increasing risk for cholangitis, other risk factors include high fat intake, obesity, sedentary lifestyle of physical inactivity and recent medical procedures involving the bile duct area. Most common organism to be causing cholangitis is Escherichia coli.
The three signs of cholangitis are pain in the upper right of the abdomen, fever and jaundice. These signs are also known as the Charcot triad. Jaundice in cholangitis is seen with yellow tinge to the skin and white of the eye, complaint of itching, pale stool and dark colour urine. Patients may also have chills and feel sick (malaise). Nausea and vomiting can also be present. Patients may be presented with low blood pressure (hypotension) due to sepsis and altered mental status (these are known as Reynolds pentad). Reynolds pentad are the additional two signs added into the Charcot triad.
Doctors will diagnose cholangitis based on medical history, physical examination and tests. Among medical history that plays a role in determining cholangitis is the history of inflammatory diseases such as ulcerative colitis, family history with cholangitis or inflammatory bowel disease, previous surgery to the bile duct area and history of infections. Physical examination is done to check for indicators for jaundice and liver problems. Blood tests are helpful in evaluating the liver function and signs of inflammation such as the level of white blood cells. Blood cultures are done before patients are given antibiotics as this will help to give information on what bacteria that cause symptoms. Imaging test that is usually done is ultrasound to check for dilation of the bile duct and to also determine the underlying cause such as the gallstones. CT scan may be done in cases where there is suspected of malignancy. Magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP) may be the imaging test used in cases where it is feasible as it acts as diagnostic tools and therapeutic management.
The aim of treatment is to manage the infection and the obstruction. Antibiotics are the mainstay for eliminating the infection which is the source of the problems. Emergency management is often used to treat patients with cholangitis as the condition itself can be life-threatening. Hospitalisation is necessary in most cases to provide the best for the patient. Mild cases may not require surgery as long they are responsive to medical therapy. Surgery through ERCP is effective in biliary drainage and usually done when the patient is stable. Surgery is usually reserved for patients who do not respond well with medical therapy. Early antibiotic therapy is important but the best treatment in many cases is often obtained through ERCP.
Patients with mild cases and respond well with medical therapy often have good outcomes. Patients with early signs of multiple organ failure and not responding well to medical therapy often need to go for biliary drainage. Without immediate treatment, patients are at high risk for death as high as 50%. This is why it is important for patients that have symptoms of cholangitis to get immediate medical attention as the condition can be lethal. Elderly people with kidney failure, malignancy or liver abscess are at high risk of dying from cholangitis.