Cholangitis
Infection of the bile ducts, usually from a blockage
Quick Facts
- Type: Bile duct infection
- Common cause: Blocked bile duct, often a gallstone
- Classic signs: Fever, jaundice, right upper belly pain
- Action: Seek urgent medical care
Overview
Bile is a fluid made by the liver that helps digest fats. It travels through a system of tubes called bile ducts to reach the intestine. Cholangitis is an infection of these bile ducts. It usually develops when a duct becomes blocked, most often by a gallstone, so bile backs up and bacteria multiply in the stagnant fluid.
Acute cholangitis can become serious quickly because the infection can spread from the bile ducts into the bloodstream. The classic combination of fever, jaundice (yellowing of the skin and eyes), and right upper abdominal pain is an important warning sign. Cholangitis is treated as a medical urgency: it needs antibiotics and, crucially, relief of the blockage so bile can drain.
Symptoms
Doctors often describe a classic trio of symptoms, though not everyone has all three.
- Fever and chills
- Jaundice (yellowing of the skin and the whites of the eyes)
- Pain in the upper right side of the abdomen
- Nausea and vomiting
- Dark urine and pale stools
- Itching of the skin
Severe cholangitis can also cause confusion and low blood pressure on top of fever and jaundice. This combination signals that the infection may be entering the bloodstream and is a medical emergency requiring immediate care.
Causes
Cholangitis almost always results from something blocking the flow of bile, which lets bacteria grow. Common causes of blockage include:
- Gallstones: A stone that moves into and blocks the bile duct is the most common cause.
- Narrowing (strictures): Scarring or narrowing of the bile ducts.
- Tumors: Cancers of the bile duct, pancreas, or nearby structures that press on or block the duct.
- After procedures: Cholangitis can follow procedures on the bile ducts, such as ERCP or stent placement.
- Parasites: In some parts of the world, parasites can block the ducts.
Risk Factors
- Gallstones or a history of gallstone disease
- Previous bile duct procedures or stents
- Narrowing or scarring of the bile ducts
- Cancers of the bile duct, pancreas, or gallbladder
- Older age
- Certain chronic bile duct conditions
Diagnosis
Diagnosis combines the clinical picture with blood tests and imaging:
- Blood tests: Show signs of infection and abnormal liver and bile (raised bilirubin and liver enzymes).
- Ultrasound: A first-line scan to look for gallstones and dilated bile ducts.
- CT or MRI (MRCP): Provide detailed views of the bile ducts and the cause of blockage.
- ERCP: A specialized procedure that both shows the blockage and can relieve it during the same session.
Treatment
Treatment has two essential parts: controlling the infection and relieving the blockage so bile can drain.
- Antibiotics and fluids: Started promptly to fight the infection and support the circulation.
- Draining the bile duct: The key treatment. This is most often done with ERCP, in which an endoscope is used to remove a stone or place a stent to open the duct. Other drainage methods are used if ERCP is not possible.
- Treating the cause: Once the acute infection settles, the underlying problem is addressed, such as removing the gallbladder if gallstones were responsible.
- Intensive care: Needed for severe infection causing low blood pressure or organ stress.
Prevention
- Seek treatment for symptomatic gallstones before complications arise
- Attend follow-up if you have bile duct stents or narrowing
- Report fever, jaundice, or right upper abdominal pain promptly
- Follow your care team's advice after any bile duct procedure
When to See a Doctor
Seek urgent medical care if you have fever and chills together with yellowing of the skin or eyes and pain in the upper right abdomen, especially if you have a history of gallstones. Go to the emergency department immediately if you also become confused, faint, develop a racing heart, or feel very unwell, as these suggest the infection may be spreading into the bloodstream and becoming life-threatening.
Frequently Asked Questions
What is the most common cause of cholangitis?
The most common cause is a gallstone that moves into and blocks the bile duct. When bile cannot drain, it stagnates and bacteria multiply, causing infection. Narrowing of the ducts, tumors, and bile duct procedures are other causes.
What are the classic symptoms of cholangitis?
Doctors describe a classic trio of fever with chills, jaundice (yellowing of the skin and eyes), and pain in the upper right abdomen. Not everyone has all three. When confusion and low blood pressure are added, it signals severe, life-threatening infection.
Why is cholangitis treated as an emergency?
Because the infection can spread quickly from the blocked bile ducts into the bloodstream, leading to sepsis. Treatment usually requires both antibiotics and a procedure to drain the bile duct, often by ERCP, and delays can be dangerous.
How is the blockage relieved?
Most often by ERCP, a procedure in which an endoscope is passed to the bile duct to remove a stone or place a stent that opens the duct and lets bile drain. If ERCP is not possible, other drainage methods are used. The underlying cause is treated afterward.
References
- MedlinePlus, U.S. National Library of Medicine. Cholangitis.
- Mayo Clinic. Gallstones - Symptoms and causes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones.
- Centers for Disease Control and Prevention (CDC). Sepsis.