Cholangitis Symptoms, Risk Factors & Treatment

Cholangitis Meaning

Cholangitis is an infection that occurs in the bile duct (the channel through which bile fluid passes from the liver to the gallbladder and intestines). Under normal circumstances, bile fluid is sterile. However, when there is a blockage in the bile duct, the accumulation of bile fluid will be at risk of causing infection. Meanwhile, the digestive process in the body requires bile fluid produced by the liver.

Some types of cholangitis are generally mild. Others can be serious and life-threatening. The two main types of cholangitis are:

• Chronic cholangitis occurs slowly over time and can cause symptoms for years.
• Acute cholangitis occurs suddenly, causing symptoms over a short period of time.

In most cases, cholangitis is caused by a bacterial infection, and often occurs suddenly. However, in some chronic cases, some sufferers may experience inflammation and cholangitis as part of an autoimmune condition.

Symptoms of Cholangitis

Symptoms of cholangitis will vary depending on the type a person has and how long they have had the disease. Many people with cholangitis may not experience any symptoms. However, there are some early symptoms of cholangitis to watch out for, such as:

• Fatigue.
• Itchy skin.
• Dry eyes.
• Dry mouth.

Meanwhile, if someone suffers from cholangitis for a long time, then here are some symptoms that may occur, namely:

• Pain in the upper right side of the body.
• The appearance of sweat at night.
• Swollen feet and ankles.
• Darkening of the skin (hyperpigmentation) occurs.
• Muscle pain.
• Bone or joint pain.
• Bloating (fluid in the abdominal area).
• The appearance of fat deposits (xanthomas) on the skin around the eyes and eyelids.
• Fat deposits on the elbows, knees, palms, and soles of the feet.
• Diarrhea or oily bowel movements.
• Clay-colored stools.
• There is weight loss.
• Mood swings and memory problems

If someone has acute cholangitis, they may also experience several other sudden symptoms, such as:

• High fever for more than 24 hours.
• Pain or cramping in the upper right side of the abdomen.
• Feeling nauseous and vomiting.
• Back pain.
• Experiencing jaundice or yellowing of the skin and eyes.
• Dark-colored urine.
• Low blood pressure.
• Feeling confused or disoriented.

Generally, cholangitis sufferers occur at the age of 50-60 years. If ignored or not treated properly, severe cholangitis is at risk of causing death. The death rate caused by cholangitis ranges from 13-88 percent.

Causes of Cholangitis

Cholangitis is generally caused by bacterial infection. Bacteria can multiply in the bile duct and attack it if the bile duct is blocked. In addition to bacterial infection, several other factors can also cause cholangitis, including:

• Blood clotting.
• Tumor.
• Parasitic infection.
• Swelling of the pancreas.
• Side effects of medical procedures, such as endoscopy.
• Infection of the blood (bacteremia).
• Have a history of gallstone disease.

Cholangitis Risk Factors

Someone who has a history or has had gallstones will be at a higher risk of experiencing cholangitis. In addition, there are several other risk factors for cholangitis that need to be watched out for, namely:

• Having an autoimmune disease such as inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
• Suffering from narrowing of the bile duct.
• People who have recently undergone a recent medical procedure involving the bile duct area.
• Suffering from human immunodeficiency virus (HIV).
• Traveling to countries where the risk of infection with worms or other parasites is high.
• Having sclerosing cholangitis.
• Aged between 30-50 years.
• Having a family history of cholangitis.

Diagnosis 

Initial diagnosis will begin with identifying the symptoms suffered, as well as personal and family medical history. Then, further blood and physical tests will be performed to see signs of abnormalities, such as jaundice (a yellowish color on the skin and whites of the eyes) and a tender upper abdomen.

To confirm the suspicion, the doctor will recommend further examinations. Some examples of these further examinations:

• Magnetic resonance cholangiopancreatography (MRCP). This is a special type of magnetic resonance imaging (MRI) test that produces detailed images of the liver, gallbladder, and bile ducts. It can also show whether there are gallstones in the bile ducts or any other type of blockage.
• CT scan. To diagnose cholangitis, a dye may be injected intravenously, which helps show whether there is a blockage in the bile duct.
• Abdominal (belly) ultrasound. To diagnose cholangitis, the ultrasound will focus on the liver, gallbladder, and bile ducts.
• X-ray examination combined with endoscopy or ERCP (endoscopic retrograde cholangiopancreatography).
• X-ray examination combined with the injection of a special dye directly into the bile duct or PTC ( percutaneous transhepatic cholangiography ).

Complications 

If not treated properly and immediately, cholangitis can cause various serious complications for sufferers as a side effect of its symptoms. The following are complications that may occur if not treated immediately:

• Hematological system dysfunction. If not treated immediately, cholangitis can cause hematological system dysfunction or disorders in the blood flow system and tissues in the body. Various symptoms and diseases such as anemia, blood cancer, blood dyscrasia, thalassemia, thrombocytopenia, and hemophilia are various complications that can occur. This is caused by the bile duct infected with bacteria spreading to the blood vessels.
• Septic shock. Cholangitis can cause septic shock as one of its complications if not treated immediately. Septic shock is a condition when blood pressure drops beyond the normal blood pressure limit. This of course endangers the life of the sufferer if it occurs. Septic shock is caused by one of the effects of sepsis, namely a bacterial infection that occurs in the blood. As a result of this infection, the body must release antibodies to ward it off. The onset of septic shock is characterized by high fever accompanied by chills, rapidly fluctuating blood pressure, and a weak pulse.
• Kidney dysfunction . Kidney dysfunction occurs when the kidneys are unable to do their job of filtering blood and waste products from the body. Kidney dysfunction can occur due to various factors such as lack of blood flow to the kidneys and dehydration, in addition to complications that can arise from cholangitis.
• Nervous system dysfunction. If there is dysfunction or disturbance in the body’s nervous system, the brain will not work optimally, causing an imbalance in the body. This is because the main task of the nervous system is to help convey messages from the brain to the entire body. Nerves are divided into three, namely sensory, motor, and autonomic. Several symptoms will appear when one of these nerve groups is disturbed, such as pain in the body, weakness, twitching, numbness, excessive sweating, and difficulty defecating.

Treatment 

Treatment for chronic and acute cholangitis may also vary, depending on the cause. Treatment for cholangitis depends on the cause. In patients with acute cholangitis, treatment is generally done by administering IV fluids in the hospital along with antibiotics. For example, such as penicillin, ceftriaxone, metronidazole, to ciprofloxacin.

Meanwhile, chronic cholangitis patients are usually given ursodeoxycholic acid. However, it is important to remember that the drug is only intended to relieve symptoms and prevent complications, not to cure the disease.

If these treatments do not produce results, the doctor may also recommend that people with chronic or acute cholangitis undergo procedures such as:

• Surgery is performed to remove the blocked part of the bile duct.
• Endoscopic retrograde cholangiopancreatography (ECRP). Aims to address blockages in the bile duct, as well as placing a stent in the bile duct to keep it open.

Prevention of Cholangitis

Regular health checks are very important to prevent this disease. Especially if you have a history of gallstones, sclerosing cholangitis, bile duct stenosis, HIV/AIDS, and a history of visiting areas prone to parasitic infections.

In addition, several healthy lifestyle practices also need to be implemented to reduce the risk of cholangitis, namely:

• Exercise regularly.
• Do not smoke.
• Consume healthy, highly nutritious foods and increase your fiber intake from vegetables and fruits.
• Avoid consuming raw meat, as it can be a source of bacteria.
• Limit consumption of alcoholic beverages.

When to See a Doctor?

Immediately see a doctor if you experience one or several early symptoms of cholangitis. Especially if you experience swollen feet and ankles or darkening of the skin (hyperpigmentation). Because early diagnosis and treatment are very important in the treatment of cholangitis.