Cholangitis is an infection of the common bile duct, the channel that transmits bile from the gallbladder and liver to the duodenum of the small intestine to aid in the digestion of food.
Cholangitis is a life-threatening form of intra-abdominal sepsis , it is an emergency condition and its effective management requires the immediate administration of broad-spectrum antibiotics and early decompression of the biliary tract . Decompression of the biliary tract can be carried out by surgery , by percutaneous biliary transhepatic drainage or by Endoscopic Retrograde Cholangiopancreatography .
This disease was described by Jean-Martin Charcot in 1877 .
Summary
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- 1 Symptoms
- 2 Epidemiology
- 3 Etiology
- 4 Causes
- 5 risk factors
- 6 Types of cholangitis
- 7 Diagnosis
- 8 Treatment
- 9 Sources
- 10 Reference
Symptoms
Some of the symptoms of this disease are pain in the upper right quadrant of the abdomen , fever and low blood pressure. In addition to the following symptoms:
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- Abdominal pain
- in the right upper quadrant or in the center of the upper abdomen
- can be intermittent
- acute, colic or dull
- may radiate to the back or below the right shoulder blade
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- Shaking chills
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- Fever
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- Clay-colored stools
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- Dark urine
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- Nauseaand vomiting
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- Yellowing of the skin ( jaundice) that may come and go
epidemiology
Cholangitis is a result of the complication of 1% of cholelithiasis cases , with a peak incidence in people older than 70 years.
Acute cholangitis secondary to gallstones is predominant in women, while acute cholangitis secondary to malignant obstruction and HIV infection . The predominant age for this disorder is in people over 70 years old, being an unusual disorder in people under 50 years old.
Etiology
Blockage of the common bile duct causes a rapid growth of bacteria in the biliary tree. The most common causes of bile duct obstruction are stones that migrate from the gallbladder , secondary causes include stenosis , which form after surgery or endoscopy or which may be secondary to sclerosing cholangitis, cysts , diverticula , congenital malformations ; choledochoceles , pancreatitis , neoplasms of the pancreas orcommon bile duct , parasites ( Ascaris lumbricoides or Fasciola hepatica ) obstruction in a drainage tube, or extrinsic compression. The obstruction is usually complete, and consequently the infected material cannot drain properly.
It can also be caused by iatrogenic contamination of a biliary tree obstructed by Endoscopic Retrograde Cholangiopancreatography or percutaneous transhepatic cholangiography . Less common causes include primary sclerosing cholangitis and HIV- associated sclerosing cholangitis (related to infections with Cytomegalovirus , Cryptosporidium , Microsporidia , and the Mycobacterium avium complex )
Causes
An obstruction, due to the presence of something like a stone , tumor, or blood clot within the bile duct system is generally the main cause of the disease. Other possible causes include a blood infection or bacteremia , bacteria from the small intestine, or a diagnostic test such as endoscopy .
Diagnostic tests
Exams may include:
- Abdominal ultrasound
- Endoscopic retrograde cholangiopancreatography(ERCP)
- Magnetic resonance cholangiopancreatography(CPRM)
- Percutaneous transhepatic cholangiography(CTP)
Blood tests can be:
- Bilirubinlevel
- Liver enzymelevels
- Liver function tests
- White blood cell count
Risk factor’s
Generally, a 50-year-old is at risk for cholangitis. A person who has had gallstones, on the other hand, is at higher risk of having the disease. It is recommended that a person who is considered at risk visit a medical professional regularly for a checkup.
Types of cholangitis
Cholangiohepatitis, primary sclerosing cholangitis and ascending cholangitis are some of the types of this infection.
- A person experiences repeated attacks of cholangitis. This is combined with intrahepatic biliary obstruction and intrahepatic pigment stones. “Intrahepatic” means that it affects the internal structures of the liver.
- Primary sclerosing cholangitis. The inflammation of the bile ducts is progressive. This can lead to obstruction and damage to the bile ducts inside as well as outside the liver.
- Ascending cholangitis. A person suffering from infection experiences ascending cholangitis of the bile duct due to bacteria rising from the point where it intersects with the duodenum. You will probably have jaundice, abdominal pain, or fever.
Diagnosis
A person with symptoms of cholangitis will likely have to undergo some diagnostic tests. You may need blood tests, including a blood culture to check for infection, a test to determine any liver dysfunction , and a complete blood count.
You may also request that you undergo diagnostic imaging tests, such as endoscopic retrograde cholangiopancreatography (ERCP), cholangiography, or percutaneous transhepatic cholangiography (CTP).
The results of these tests can help a medical professional recognize the obstruction in the bile duct system and determine the course of treatment.
Treatment
Treatment of disease typically involves the administration of antibiotics by intravenous (IV), restoring blood pressure to a normal level if low, and possibly surgery for a blockage in the bile duct system.
