Cholangitis Disease

BASICS

DESCRIPTION

Bacterial inflammation of the bile duct system that is associated with obstructive biliary duct pathology. May be acute or chronic.

System(s) affected: Gastrointestinal
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: 55-70 years, rare in children, more common in adults
Predominant sex: Female > Male

SIGNS AND SYMPTOMS

May have only one or two symptoms, and the abdominal exam may be unrevealing

Right upper quadrant pain (RUQ), not severe
Jaundice
Chills and fever
Shock
CNS depression

CAUSES

Biliary tract obstruction from:
- Stones
- Tumor (pancreatic, CBD, ampulla, metastatic)
- Benign strictures (postsurgical, PSC)
- Parasites (Ascaris)
- Pancreatitis
- Blood clots
Reflux of small bowel bacteria
- Choledochoenterostomy
- "Sump syndrome"
Other
- Cholecystitis
- Bacteriemia
- Surgical, radiographic, endoscopic manipulation

RISK FACTORS

Cholelithiasis
Endoscopic or surgical manipulation
Foreign bodies, such as parasites

DIAGNOSIS

LABORATORY

Increasing WBC with left shift
Hyperbilirubinemia - in 90%
Alkaline phosphatase - increasing in 90%
Positive blood culture - in 50% (gram negative aerobes, and some anaerobes)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

In acute toxic disease, pus under pressure in the common bile duct

SPECIAL TESTS

Need to delineate underlying biliary tract abnormality
Cholangiography is definitive test
Percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic ultrasound
Magnetic resonance cholangiopancreatography (MRCP)

IMAGING

Ultrasound will diagnose gallbladder stones and common bile duct size, but will demonstrate common bile duct calculi in less than 15%

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Inpatient

GENERAL MEASURES

Control sepsis, then evaluate with cholangiography and treat underlying biliary tract pathology

SURGICAL MEASURES

Patients who do not respond to antibiotics and supportive care require emergency decompression of the biliary duct system. This may be accomplished by surgery, endoscopy, or transhepatic cholangiography.
In case of obstruction secondary to stones, endoscopic papillotomy and stone extraction will drain the duct and may be definitive treatment of the underlying cause and is shown to reduce mortality

ACTIVITY

As tolerated

DIET

Nothing by mouth until acute phase is terminated

PATIENT EDUCATION

For patient education materials favorably reviewed on this topic, contact: National Digestive Diseases Information Clearinghouse, Box NDDIC, Bethesda, MD 20892, (301)468-6344

FOLLOW UP

PREVENTION/AVOIDANCE

Cholangiography when indicated at time of cholecystectomy with endoscopic, radiographic, or surgical clearance of retained CBD stones

POSSIBLE COMPLICATIONS

Most serious is hepatic abscess
Sepsis
Secondary sclerosing cholangitis

EXPECTED COURSE AND PROGNOSIS

Acute cholangitis - good
Acute toxic cholangitis - mortality high

MISCELLANEOUS

ASSOCIATED CONDITIONS

Choledocholithiasis
Malignant tumors
Benign strictures
Biliary-enteric anastomosis
Invasive procedures
Foreign bodies
Parasites
Secondary sclerosing cholangitis

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.