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Cholangitis

Introduction

This condition is due to an inflammatory process of the bile ducts in the liver and outside of the liver. There could be an underlying infection, some bile duct tumor or underlying AIDS infection. In that latter case there are chronic infections that cause scarring and the development of cirrhosis of the liver. There is another form of an autoimmune type cholangitis, called primary sclerosing cholangitis (PSC) where there is a chronic inflammation of the bile ducts.

This causes blocking of the bile ducts, which will also cause cirrhosis of the liver. This is associated with certain cell surface antigens (the histocompatibility antigens HLA-B8, -DR3, -DR2, and -DR6) and is found in young men who often also have ulcerative colitis.

Symptoms

The clinical presentation can vary depending what the underlying cause of the cholangitis is. However, it may take a long time to diagnose this as the onset is usually slow with symptoms of fatigue, itchy skin (=pruritus) and the development of jaundice. There can be right upper abdominal pain with a fever. If hepatitis is present, then symptoms of liver and spleen enlargement, ascites and portal hypertension with bleeding from esophageal varices can be present.

Treatment

As this is a chronic illness and very complex clinically, a specialist such as a gastroenterologist should be involved in the management of the disease. If there are bouts of recurrent bacterial cholangitis, samples of bile via a procedure called endoscopic retrograde cholangio-pancreatoscopy (ERCP study, thanks to www.medgadget.com for image) for culture and sensitivity testing will guide the gastroenterologist as to what antibiotic to use to eradicate the infection. If strictures develop these can be dilated under ERCP guidance or a stent can be placed to overcome strictures. In end stage disease associated with PSC a liver transplant might be the only cure.

 

References:

1. DM Thompson: The 46th Annual St. Paul’s Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

7. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

9. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

Last modified: August 27, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.