Cholangitis or bile duct inflammation is an infection of the bile duct. Typically, sufferers suffer from fever, upper abdominal pain and jaundice. Treatment is usually by the administration of antibiotics.

What is cholangitis?

Schematic representation of the anatomy and structure of the gallbladder with gallstones. Click to enlarge.

Cholangitis is an inflammation of the biliary tract. These canal-like structures are needed to transport the bile from the liver to the duodenum via the gallbladder. In the bile, among other things, toxins are removed. Their main task, however, lies in the digestion of fat.

Characteristically, sufferers suffer from severe pain in the upper abdomen, fever and jaundice, ie a yellowing of the skin. Cholangitis is often accompanied by vomiting and discoloration of the stool.

Basically, a distinction is made between acute purulent cholangitis, non-purulent cholangitis and sclerosing cholangitis. The different forms of cholangitis have different causes, but usually lead to the same symptoms.

causes

Acute cholangitis is mainly caused by bacteria. The pathogenic bacteria are often derived from the small intestine, from which they penetrate into the bile duct in an unexplained manner. In exceptional cases, viruses are responsible for the inflammatory reaction in the bile ducts.

The most common cause of bile duct inflammation is the formation of gallstones. These block the bile ducts beyond a certain size and thus prevent the transport of the bile. In bile congestion, pathogens can easily colonize, causing bile duct infection. To date, it is unknown what causes chronic cholangitis.

Part of an autoimmune disease is assumed, in which the immune system recognizes and damages its own cells as a foreign body. Rare causes of inflammation of the bile duct are tumors in the bile ducts, parasite infestation and diverticula. After operations on the liver, the duodenum or the bile ducts themselves, it can sometimes come to constrictions, which facilitate the development of bile duct inflammation. Very rarely are genetically caused malformations of the bile ducts triggers a cholangitis.

Symptoms, complaints & signs

  • colicky upper abdominal pain
  • fatigue
  • fever
  • Yellowing of the skin
  • Yellowing of the eyes
  • rarely blood poisoning

Diagnosis & History

To diagnose acute cholangitis, the history is usually sufficient. In the context of the patient discussion, the attending physician investigates, among other things, since when the symptoms exist and whether risk factors such as obesity or gall disease are present.

This is followed by the physical examination. If a bile duct infection actually occurs, the doctor can detect the so-called Charcot triad. It is a complex of three symptoms, fever, right upper abdominal pain and jaundice. If these three symptoms occur together, the likelihood of cholangitis is very high.

To confirm the suspected diagnosis, a blood test is usually performed. In bile duct inflammation, the number of leukocytes is usually increased, indicating an infection. Gallstones are diagnosed by ultrasound. Sclerosing cholangitis can often be detected by antibodies in the blood.

The course of infection of the bile duct depends on the severity of the disease. If an acute bile duct infection is diagnosed and treated quickly, a complete cure is to be expected.

complications

In most cases, complications will not occur until the bile duct infection is diagnosed too late or when the treatment begins too late. The patient mainly suffers from pain in the upper abdomen and a general malaise. The eyes and the skin turn yellow and the person concerned is no longer able to perform any physical activity.

Likewise it can come to very high fever. If the bile duct infection remains untreated, it can also lead to a blood poisoning, which leads in the worst case to the death of the patient. In many cases there is also a strong itching on the skin due to bile duct inflammation. Treatment is usually with the help of antibiotics and painkillers.

If it starts early, there are no further complications for the patient, and the disease will stop after a few days. If it has come through the bile duct inflammation to the formation of gallstones, these must also be removed. Life expectancy will not be reduced on successful bile duct inflammation treatment. However, it can not be ruled out that the disease will occur again during the course of life.

When should you go to the doctor?

Acute cholangitis requires a timely visit to the doctor. This is also quickly realized by those affected by the strong symptoms, since the sometimes severe pain without medical treatment are difficult to bear.

The other signs of inflammation of the bile ducts make the visit to the doctor necessary, as neither jaundice nor fever or chills are compatible with work ability and significantly limit the quality of life of those affected. For a quick visit to the doctor, there are two other reasons: First, the Choalangits with all their unpleasant symptoms without therapy almost never spontaneously back. On the other hand, the visit to the physician can protect against serious complications such as shock or massive impact on the patient's central nervous system or kidneys.

The fact that the cholangitis is often associated with severe gradients, the visit of a doctor or even a hospital is justified even on mere suspicion of this disease. The sooner the treatment starts, the quicker and more pleasant is the medical help. Therefore, even for patients with chronic bile problems or concomitant disease, for example in the intestine, the doctor's visit makes sense. The first treatment for cholangitis does not have to be done by the attending physician, but is possible in every emergency room.

Treatment & Therapy

To prevent severe complications such as sepsis, cholangitis must be treated as soon as possible. Since acute bile duct inflammation is usually caused by bacteria, therapy is given by the administration of antibiotics. Which antibiotic is prescribed by the doctor, depends on the bacterial species. Often cephalosporin is used.

An effective treatment of the infection is usually only possible if the person taking two different antibiotics at the same time. In most cases, the patient's state of health improves within a few days after the administration of antibiotics. Since inflammation of the bile ducts is often very painful, in addition to the antibiotics, painkillers can be used. Particularly suitable are agents that also have an antispasmodic effect, since many sufferers suffer from colicky pain. In case of very high fever, antipyretic drugs must be taken to maintain body function.

If gallstones are the cause of the infection, they usually have to be removed. The inflammation of the bile duct then goes back by itself in many cases. In a general disturbance of the flow of bile, a stent can be used which has a support function for the bile duct. The goal of the therapy is to restore the bile flow. In sclerosing cholangitis, this is hardly possible because the causes are unknown and therefore can not be treated. In these cases the treatment consists of a purely symptomatic therapy, which increases the general well-being.

Outlook & Forecast

Cholangitis has a favorable prognosis in adults with a stable immune system and no other diseases. The cure and permanent freedom from symptoms is bound to an early treatment and treatment of the complaints. In most cases, recovery of cholangitis is achieved within a few weeks by using medication. A recurrence of the disease is possible in principle, but is rarely observed.

A condition for a cure of the bile duct inflammation is the removal of possibly existing gallstones. These prevent the recovery of the patient until their complete disappearance. Without medical care, the health of the patient can deteriorate significantly. In addition, there is a risk that the inflammation will change from a recurrent to a chronic course.

The longer the cholangitis remains untreated, the higher the risk of secondary diseases. Frequently it comes thereby to changes of the bile ducts. It is expected in these patients with scarring and narrowing of the biliary tract. These complications worsen the prognosis and can lead to further illnesses. In severe cases there is a risk of biliary congestion, liver cirrhosis and the development of bile duct cancer. This increases the patient's risk of shortening normal life expectancy. The cure is generally delayed in patients with a weakened immune system.

prevention

It is not possible to specifically prevent cholangitis. Nonetheless, there are several measures that significantly reduce the risk of acute bile duct inflammation. Since gallstones are the most common cause of infection of the bile duct, they should be prevented. The best prophylactic measure is a healthy diet. Best is a low-fat diet that is rich in fiber. In addition, it is important to absorb enough fluid. The chronic form of cholangitis can not be prevented.

aftercare

In the case of bile duct inflammation, in most cases the person concerned has only a few measures of aftercare available. The person concerned must primarily consult a doctor for this disease, so that it does not lead to a further worsening of the symptoms or other complications. The sooner a doctor is visited, the better is usually the further course, so that the affected person should contact a doctor at the first signs and symptoms of bile duct inflammation.

A self-healing can not occur. The disease itself is usually treated by taking antibiotics. It is always important to ensure a correct dosage and also on a regular intake, so that the symptoms are alleviated. It should also be noted that the antibiotics should not be taken together with alcohol, as their effect is otherwise attenuated.

In children, parents need to monitor and control the intake. Even after the treatment, further regular examinations by a doctor are very important in order to detect damage to the internal organs at an early stage. As a rule, the life expectancy of the patient does not decrease if the bile duct inflammation is recognized and treated in good time.

You can do that yourself

In cases of bile duct inflammation, those affected feel very ill. Treatment should be fast in order to minimize the risk of consequential damage. In case of non-treatment or pure self-treatment, a life-threatening condition can occur. A strict bed rest is usually kept by itself.

Depending on the cause of the disease, it is advisable to combine a prescribed antibiotic therapy with a probiotic treatment of the intestine. In the acute stage, food should be completely eliminated in order to relieve the bile ducts. Later, the diet should be switched to light diet - also to relieve the mostly involved liver - changed.

Likewise, the adequate intake of fluid is conducive to the recovery process. Here, preference should be given to still mineral waters and unsweetened herbal teas. Even after a successful treatment, the liver is usually heavily stressed, so alcohol and fats should be avoided in the future.

When an autoimmune disease is the cause of the inflammation, it is important to constantly strengthen the immune system by avoiding stress, providing for compensatory relaxation, a balanced diet and regular exercise. Also, a micronutrient therapy (selenium, minerals) has proved to be beneficial in inflammatory processes.

Homeopathically treated Colocynth (C6), Magnesium Phosphoricum (C6), Bryonia album (C6) or Chamomilla vulgaris (C6) can be taken every hour in the acute stage of the disease to help against the pain.

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