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What is cholangitis?

Cholangitis is a redness and swelling (inflammation) of the bile duct system.

The bile duct system carries bile from your liver and gallbladder into the first part of your small intestine (the duodenum).

In most cases cholangitis is caused by a bacterial infection. The infection often happens suddenly. But in some cases it may be long-term (chronic).

What causes cholangitis?

There are several health problems that may cause an infection in your bile duct system.

In most cases cholangitis is caused by a blocked duct somewhere in your bile duct system. The blockage may be from:

  • Lumps of solid material (gallstones)
  • A tumor
  • Blood clots
  • A narrowing of a duct that may happen after surgery
  • Swollen pancreas
  • A parasite infection

Cholangitis may also be caused when you have:

  • A backflow of bacteria from your small intestine
  • A blood infection (bacteriemia)
  • A test done to check your liver or gallbladder (such as a test where a thin tube or endoscope is put into your body)

The infection causes pressure to build up in your bile duct system. It may spread to your liver if it’s not treated.

Who is at risk for cholangitis?

If you have had gallstones you are at greater risk for cholangitis. Other risk factors include:

  • Having HIV
  • Traveling to countries where you might be exposed to worms or parasites
  • Having any recent medical procedures to your bile duct area

What are the symptoms of cholangitis?

Symptoms may be medium to severe. Each person’s symptoms may vary.

Symptoms may include:

  • Pain in the upper right part of your belly or abdomen
  • Fever
  • Chills
  • Yellowing of the skin and eyes (jaundice)
  • Nausea and vomiting
  • Clay-colored stools
  • Dark urine
  • Low blood pressure
  • Lethargy
  • Not as alert

The symptoms of cholangitis may look like other health problems. Always see your health care provider to be sure.

How is cholangitis diagnosed?

The pain from cholangitis can feel a lot like the pain from gallstones.

To be sure you have cholangitis, your health care provider will look at your past health and give you a physical exam. He or she may also use other tests.

You may have blood tests including:

  • Complete blood count (CBC). This test measures your white blood cell count. You may have a high white blood cell count if you have an infection.
  • Liver function tests. A group of special blood tests that can tell if your liver is working properly.
  • Blood cultures. Tests to see if you have a blood infection.

You may also have imaging tests including:

  • Percutaneous transhepatic cholangiography (PTC). A needle is put through your skin and into your liver. Dye is put into your bile duct so that it can be seen clearly on X-rays.
  • ERCP (endoscopic retrograde cholangiopancreatography). This is used to find and treat problems in your liver, gallbladder, bile ducts, and pancreas. It uses X-ray and a long flexible tube with a light and camera at one end (an endoscope). The tube is put into your mouth and throat. It goes down your food pipe (esophagus), through your stomach, and into the first part of your small intestine (the duodenum). A dye is put your bile ducts through the tube. The dye lets the bile ducts be seen clearly on X-rays.
  • Magnetic resonance cholangiopancreatography (MRCP). This test is used to look for any problems in your belly. It can show if there are gallstones in your bile duct. The test  is done from outside your body. It does not involve putting a tube (endoscope) into your body. It uses a magnetic field and radio frequency to make detailed pictures.
  • Ultrasound (also called sonography). This test creates images of your internal organs on a computer screen using high-frequency sound waves. It is used to see organs in your abdomen such as the liver, spleen, and gallbladder. It also checks blood flow through different vessels.

How is cholangitis treated?

It is important to get a diagnosis right away. Most people with cholangitis feel very sick. They see their health care provider or go to the emergency room.

If you have cholangitis, you will likely be in the hospital for a few days. You will be given fluids by IV (through a vein or intravenously). You will also have pain medicine and bacteria-fighting medicine (antibiotics).

You may also need to drain the fluid in your bile duct and find the cause of any blockage. In most cases this is done by a method called ERCP (endoscopic retrograde cholangiopancreatography).

To drain your bile duct using ERCP, a long thin flexible tube (endoscope) is put in your mouth. The scope goes down your food pipe (esophagus) and into your stomach. It passes into the first part of your small intestine (the duodenum) and into the bile ducts. The doctor can see the inside of these organs and ducts on a video screen. The video screen is connected to a camera in the scope. A small tube (called a T-tube) is passed into the ducts to drain fluid. This tube is brought out through the skin. This lets fluid drain out until the infection and inflammation clear up.

You may also have firm tubes (stents) put into the bile ducts to keep them open. Gallstones can also be removed. In most cases these things can be done using the ERCP scope.

You may need surgery if treatment doesn’t work or if you are getting worse. Surgery will open your ducts to drain the bile and fluid that’s building up.

Key points about cholangitis

  • Cholangitis is redness and swelling (inflammation) of the bile duct system.
  • The bile duct system carries bile from the liver and gallbladder to the first part of your small intestine (the duodenum).
  • In most cases cholangitis is caused by a bacterial infection.
  • People who have had gallstones are at greater risk for cholangitis.
  • Surgery may be needed.

Next steps

Tips to help you get the most from a visit to your health care provider:
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: Sohrabi, Farrokh, MD
Date Last Reviewed: 10/22/2013
© 2000-2015 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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