Get Treatment For Cholangitis

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Why Choose Cedars-Sinai Marina del Rey Hospital for Cholangitis Treatment?

Cedars Sinai Marina del Rey Hospital's dedicated team of specialists delivers cutting-edge, compassionate care for all kinds of liver disorders, including cholangitis. Our physicians are actively involved in both clinical and translational research projects as well as educational programs in our community and across the nation. This top ranking is a credit and a tribute to our integrated, multidisciplinary team of experts who dedicate every day to provide an unparalleled level of seamless, patient-focused care. What we offer for your liver care is:

  • Special expertise
  • Advanced prevention and treatment strategies
  • Complete support services
  • Easy access to a broad range of support services at one convenient location

Cholangitis is an inflammation of the bile duct system, caused by a combination of biliary outflow obstruction and biliary infection. During an obstruction, the flow of bile is reduced (biliary stasis) and infection can occur. Infection can also flow in a retrograde direction up the bile duct as a result of acute cholecystitis or instrumentation such as endoscopic retrograde cholangiopancreatography (ERCP).

When left untreated, cholangitis has significant potential for mortality and morbidity, therefore, is an important condition to recognize and manage.

Key Points

  • Less than 200,000 cases of cholangitis occur annually in the U.S.;
  • About 9% of patients admitted to hospital with gallstone disease have cholangitis;
  • Approximately 1% of patients develop cholangitis after ERCP;
  • Malignant disease (bile duct tumors, gallbladder tumors, ampullary tumors, pancreatic tumors, and duodenal tumors) accounts for 10-30% of cases with acute cholangitis.

It is vital that people with this type of infection get diagnosed and treated promptly as complications can result which only exacerbate the condition.

Cholangitis can quickly become an acute, septic, life-threatening infection that requires rapid evaluation and treatment involving:

  • Antibiotics - frequently used to arrest the infection that occurs in the biliary tree;
  • An ERCP - done to remove stones or open strictures that may have caused cholangitis;
  • Surgery -  for patients that do not respond to antibiotics or non-invasive procedures;
  • Correction of electrolyte abnormalities and coagulopathies if present;
  • Biliary tract decompression - percutaneous drainage via interventional radiology
  • Broad-spectrum antibiotics- antibiotics should cover gram-positive, anaerobic gram-negative aerobic enteric organisms.
    • Piperacillin/tazobactam (Zosyn)
    • Imipenem/Meropenem
    • Ampicillin/sulbactam (Unasyn) + metronidazole

Recovery depends on how quickly treatment is begun, therefore, it is vital that a medical professional be consulted as soon as possible.

There are four recognized types of cholangitis:

  • Acute cholangitis or ascending cholangitis - defined as a bacterial infection superimposed on an obstruction in the bile duct system. It is often caused by a gallstone, but it can also be related to a stricture or an abnormal growth of tissue;
  • Primary sclerosing cholangitis (PSC) - is a chronic cholestatic liver disease of intra and/or extrahepatic bile ducts associated with other immunological diseases such as autoimmune pancreatitis and inflammatory bowel disease;
  • Secondary sclerosing cholangitis (SSC) - is a rare cholestatic disease with immunopathogenic mechanisms.
  • Recurrent pyogenic cholangitis (RPC) - also called cholangiohepatitis, is related to recurrent bacterial infections and obstructions in the bile duct.

Symptoms of Cholangitis

The common presenting symptoms of cholangitis are fever, jaundice, and abdominal pain, although only 50 to 75 percent of patients with acute cholangitis have all three. Often, geriatric and immunocompromised patients do not display clear and defined clinical symptoms and signs to guide the diagnosis.

The most common signs and symptoms of cholangitis include:

  • Right upper quadrant pain
  • Jaundice
  • Clay-colored stools
  • Darkened urine
  • Fever 
  • Chills and/or shaking
  • Lethargy

Patients with prior biliary surgery, the elderly, and those with severe disease are more likely to have the following signs and symptoms:

  • Low blood pressure and altered mental status may be seen in severe cases
  • Pyogenic liver abscess
  • Sepsis
  • Multi-organ system dysfunction
  • Rigors
  • Tachycardia
  • Shock

Diagnosis of Cholangitis

Generally, diagnosis of acute cholangitis involves:

  • A history of biliary disease
  • Evidence of cholestasis, a condition that slows down the normal flow of bile into the gallbladder
  • Imaging with biliary dilatation or evidence of the underlying etiology (eg, a stricture, stone, or stent)

Routine testing of patients with suspected cholangitis should include:

  • ERCP (endoscopic retrograde cholangiopancreatography)
  • MRCP (magnetic resonance cholangiopancreatography)
  • A cholangiogram or percutaneous transhepatic cholangiogram
  • Full blood count (FBC)
  • Liver function tests (LFTs)
  • Serum creatinine
  • A c-reactive protein test
  • Serum amylase
  • Urine dipstick

Imaging tests:

  • Ultrasound imaging of the abdomen, which can be used to detect the presence of stones
  • Abdominal CT (if unclear diagnosis)
  • MRCP (if unclear diagnosis)

Differential diagnosis - As gallstones - formation of stones in the gallbladder – are highly prevalent, their presence does not necessarily mean that a patient’s abdominal pain is due to cholelithiasis. Acute cholecystitis, acute biliary pancreatitis, liver abscess, acute viral hepatitis, peptic ulcer disease, bowel obstruction, intestinal perforation, are among the many conditions that may cause upper abdominal pain.

Risk Factors for Cholangitis

An individual is more likely to develop an inflammation of the bile duct system if any of these risk factors are present:

  • A history of gallstones or health conditions that make you more likely to get gallstones
  • HIV (human immunodeficiency virus)
  • Congenital anomalies of the biliary tract (abnormally narrow, blocked, or absent)

Gallstone disease is the most common cause of biliary obstruction, which is an important factor in the pathogenesis of cholangitis.

Ethnicity. The prevalence of gallstones is highest in persons of Hispanic origin and Northern Europeans compared to people from Asia and Africa.

Sex and age. According to the American College of Gastroenterology, women are much more likely to develop gallstones than men. Elderly patients are more prone to gallstones and, therefore, cholangitis.

Causes of Cholangitis

Any condition which causes biliary obstruction has the potential to cause cholangitis. The blockage may be from:

  • Gallstones, common bile duct stones
  • Tumors (pancreatic, cholangiocarcinoma, hepatic)
  • Blood clots
  • Swollen pancreas
  • Gallbladder and bile duct disorders
  • Parasitic infections (roundworm, liver fluke)
  • Endoscopic manipulation or ERCP, cholangiogram
  • HIV (human immunodeficiency virus)

Natural ways to cope with cholangitis:

  • Quit smoking and stop drinking alcohol - Alcohol is hard on the liver, and it can cause liver disease, and smoking yields chemicals with cytotoxic potential which increases necroinflammation and fibrosis.
  • Physical exercise - Regular exercise and an active lifestyle can help your body expel all the toxins. When your liver and bile duct system does not work properly, any sort of physical exercise like walking, running, jogging, aerobics or swimming can be helpful.
  • Manage stress - Every chronic illness causes stress and impacts your overall quality of life. There are many types of meditation and relaxation techniques including meditation, relaxation exercises, and yoga.
  • Take milk thistle - One of the most effective and popular natural supplements for liver health, milk thistle helps to draw toxins out of the body. It is beneficial in preventing gallstones and may protect against certain types of cancer.
  • Include probiotics in your diet - Antibiotics disrupt the natural balance of the gut microbiota. This may result in digestive discomfort such as diarrhea, nausea, indigestion, and low energy. Probiotics counteract all the potential alterations brought on by antibiotic treatment. You can usually get more than enough probiotics from active cultures of bacteria in fermented foods like low-fat kefir or yogurts.

Inflammation of the bile duct system can be helped by following some general health advice:

  • stop smoking
  • maintain a healthy weight
  • stop drinking alcohol

Following this advice could help prevent cholangitis from getting worse. However, you can’t always prevent getting cholangitis. For example, the etiology of the inflammatory and fibrotic bile duct lesions characteristic of primary sclerosing cholangitis (PSC) is still unknown, and therefore it seems not to be preventable. Early treatment can help you have a better outcome, and to prevent symptoms and complications. Working together, you and your doctor can help prevent specific complications.

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