Definition of "Cholangitis"
[Acute ascending] cholangitis (from Greek "chol" meaning "bile", "ang" meaning "vessel", and "itis" meaning "inflammation") is inflammation of the biliary tree (i.e. duct system where bile flows).
Patient information
What is cholangitis? How's that different from cholecystitis?Cholangitis is inflammation of the biliary tree. The tree begins with many small branches, that ends in the common bile duct. You can remember that because the word "ang" means a "vessel". In contrast, cholecystitis involves a "cyst", or the bag that holds bile, the gallbladder.
"Common bile duct"... What on earth does this exactly mean 
?!! Do you mean infection of the gallbladder - where bile is stored?
Not really, inflammation of the gallbladder is called "cholecystitis". That happens when you have a blockage in the duct that comes immediately after the gallbladder - the cystic duct. Cholangitis is usually caused by a blockage in any part of the duct system where bile flows OTHER than the cystic duct. That way, it doesn't cause "backing up" into the gallbladder, and therefore inflammation of that. Rather, it causes infection of the duct system itself. We call that duct system the "biliary tree", by the way.
- Charcot's triad, indicates ascending cholangitis (infection of biliary tree, but not necessarily due to obstructive cause) which includes:
- RUQ abdominal pain: → inflammed biliary tree
- Pain may also be felt at upper mid part of abdomen. It may also be felt in the back, or below the RHS shoulder blade
- May come and go
- Feel sharp, cramp-like or dull
- Fever, usually with rigors (chills) → inflammatory
- Jaundice, which may come and go → blockage of the drainage of bile, causes a backlog of bile, and thus causes it to seep throughout to skin
- RUQ abdominal pain: → inflammed biliary tree
- Dark urine and clay-colored stools → posthepatic obstruction
- Nausea and vomiting → inflammatory
- Reynolds' pentad, indicates OBSTRUCTIVE ascending cholangitis. It is Charcot's triad+
- Shock (hypotension+tachycardia+poor end organ perfusion), especially hypotension. Examples of poor end organ perfusion include oligouria, confusion, LOC
- Altered mental state, especially confusion
Patient information
What happens when the tree where bile flows is inflammed?It's something we call Charcot's triad. There's tummy pain in the upper right side, where the biliary tree is. Fever, which you'd expect with any infection. And jaundice. This can be memorized with "CHArcot", which stands for colored yellow, hot, and ahhhh (as in abdominal pain).
Jaundice is where you become yellow, right? Why does that happen?
The yellow pigment of bile, is what makes you yellow. Remember the biliary tree is where bile flows. When bile can't drain, it seems out into skin, causing your skin to become yellow.
- Caused by bacterial infection, most common, ascending from the ampulla of Vater (i.e. the junction of the bile duct w/ the duodenum)
- This can occur if the bile duct is already partially obstructed (e.g. by gallstone or tumor)
- Infection causing this condition may also spread to the liver
Patient information
What causes the tree where bile flows to become inflammed?Bacteria infection is the most common. The likelihood of this happening is particularly increased when there's a stone or tumor, that's causing a blockage.
- Gallstones
- Sclerosing cholangitis
- HIV
- Narrowing of the common bile duct
- Travel to countries where you might catch a worm or parasite infection, rarely
- Abdominal U/S → look for blockage
- ERCP → look for blockage
- MRCP → look for blockage
- PTHC → look for blockage
- Blood tests, including:
- Bilirubin level
- Liver enzyme levels, LFT's
- WBC
Patient information
How can you check out inflammation of the tree where bile flows?Ultrasound, is always good for organs of the tummy. You can do blood test, and see if there's more bilirubin in blood, or whether the liver has been affected, or if there's an infectious picture with the white blood cells. And using a camera.
Wait... the liver? How is that related to the place where bile flows?
The liver makes bile. So it's the same tract.
How do you use a camera?
That's called ERCP. So you go down the throat as usual, down to the small intestine. You then go through the ampulla of Vater, into biliary tree.
Can you use x-rays?
Yeah you can, but usually you can't see the place where bile flows. But you can use contrast to outline it, that's called PTHC. Alternatively, you can use something that works well soft tissue, which is the MRI. That's called MRCP.
- Abx → cure infection
- ERCP or other surgical procedure, when Pt is stable, unless Pt is very ill or quickly getting worse
- Prevention, by:
- Tx gallstones, tumors, infestations of parasites
- If recurring, a metal/plastic stent placed in the bile system to prevent the infection from returning
Patient information
What can you do about inflammation of the place where bile flows?Because it's often caused by a bacterial infection, antibiotics can help. If the cause is a stone, you can use a camera and pull the stone out. If the cause is a tumor you can remove that. If it keeps happening again and again, you can use a stent to keep the biliary tree open, so it doesn't clot and cause problems again.
- Often very good with Tx, but poor without it
- Sepsis
- Extraintestinal features, as UC is autoimmune in origin, and frequencies of 27% have been mentioend, including:
- Apthous ulcer of the mouth
- Ophthalmic, including:
- Iritis/uveitis (inflammation of the eye's iris)
- Episcleritis
- Musculoskeletal, including:
- Seronegative arthritis
- Ankylosing spondylitis (arthritis of the spine)
- Sacroiliitis (arthritis of the lower spine)
- Cutaneous/skin, including:
- Erythema nodosum (inflammation of subcutaneous tissue involving the lower extremities)
- Pyroderma gangrenosum (painful ulcerating lesion involving the skin)
- DVT and PE
- Autoimmune hemolytic anemia
- Clubbing (deformity of the ends of the fingers)
- Primary sclerosing cholangitis (inflammation of the bile ducts)
[faq]What bad thing can happen due to inflammation of the place where bile flows?
Blood infection, that's called sepsis.
- Cholecystitis (inflammation of the gallbladder, cf the biliary tree)
- Pancreatitis (caused by blockage of the ampulla of Vater, the pre-duodenum portion of the biliary tree)
- Gallstone (cause)
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