Ascending cholangitis awareness

Overview

Ascending cholangitis is a serious infection of the bile ducts – the tubes that carry bile from your liver to your gallbladder and small intestine. It happens when bacteria travel up from the intestine into the bile ducts, often because a gallstone or other blockage is stuck there.

Ascending cholangitis is not common in the general population, but it occurs more often in people with gallstones or other bile duct problems. It is the most common serious infection of the bile ducts.

It can affect anyone, but it is more common in adults over 60 and in people who have had gallstones, bile duct surgery, or conditions that narrow the bile ducts.

Symptoms

Common symptoms

• Fever and chills
• Yellowing of the skin and eyes (jaundice)
• Pain in the upper right part of the abdomen
• Dark urine and pale stools
• Nausea and vomiting

Symptoms in children

• Fever, irritability
• Yellow skin and eyes
• Abdominal pain, poor feeding
• Vomiting

Symptoms in older adults

• Confusion or low blood pressure may be more noticeable
• Less obvious abdominal pain
• Fever may be lower
• Rapid heart rate and dehydration

Causes

Main causes

• Blockage in the bile duct, most often from a gallstone
• Narrowing of the bile duct from scarring or a tumor
• Infection from bacteria that travel up from the small intestine

Risk factors

• Gallstones
• Previous bile duct surgery or stent placement
• Liver disease or cirrhosis
• Pancreatitis (inflammation of the pancreas)
• Older age (over 60)
• Weakened immune system

When to see a doctor

See a doctor urgently if:

• If you have fever with yellow skin or eyes, call your emergency services immediately
• If you have severe abdominal pain that does not go away
• If you feel confused or extremely weak

Book a routine appointment if:

• If you have mild, repeated episodes of jaundice or abdominal discomfort, make an appointment with your doctor

Diagnosis

Your doctor will ask about your symptoms and examine you. They will likely order blood tests to check for signs of infection and liver problems. Imaging tests look at your bile ducts.

Tests that may be done

• Blood tests (complete blood count, liver function tests, bilirubin, and infection markers)
• Ultrasound of the abdomen to see the gallbladder and bile ducts
• Magnetic resonance cholangiopancreatography (MRCP) - a special MRI to view bile ducts
• Endoscopic retrograde cholangiopancreatography (ERCP) - a procedure that can both diagnose and treat blockages

What to expect at your appointment

If you are very ill, you will be admitted to hospital. The medical team will start antibiotics quickly and may do an urgent ERCP to unblock the bile duct. Most people recover well with prompt care.

Treatment

Treatment for ascending cholangitis aims to fight the infection and remove the blockage. It usually requires hospital care.

Self-care at home

• Do not wait at home if you have symptoms — seek emergency care
• Follow all instructions from your healthcare team

Medical treatments

You will be given antibiotics through a vein (intravenous) to fight the infection. Fluids and pain relief are also given. If a gallstone or other blockage is found, a procedure called ERCP (endoscopic retrograde cholangiopancreatography) is done to open the bile duct. Sometimes a small tube called a stent is placed to keep the duct open.

When is surgery considered?

If gallstones keep coming back or there is a tumor, surgery may be needed after the infection is under control. For example, removal of the gallbladder (cholecystectomy) is often recommended to prevent future blockages.

Living with this condition

After recovery from cholangitis, you will need to manage the underlying cause. If you had gallstones, you may have surgery to remove your gallbladder. Without a gallbladder, bile flows directly from the liver to the intestine, which is fine for digestion.

Lifestyle tips

• Maintain a healthy weight
• Eat a balanced diet low in saturated fats
• Stay active as tolerated
• Attend all follow-up appointments

Diet and exercise

Your doctor may recommend a low-fat diet initially. After recovery, a heart-healthy diet is best. Regular exercise helps maintain a healthy weight and reduces gallstone risk.

Mental health and emotional wellbeing

A serious infection like this can be frightening. It is normal to feel anxious or worried during recovery. Talk to your healthcare team if you have mood changes or stress. You are not alone.

Prevention

You cannot always prevent cholangitis, but treating gallstones early and managing risk factors like diabetes or high cholesterol can lower your risk.

Vaccines

There are no vaccines against cholangitis, but getting the flu and pneumonia vaccines can help prevent infections that could complicate your health.

Screening programmes

Routine screening is not needed for most people. If you have known gallstones or bile duct problems, your doctor may recommend regular check-ups.

Complications

If left untreated

• Sepsis (a severe, life-threatening response to infection)
• Liver abscess (pus collection in the liver)
• Liver failure
• Kidney failure
• Death

Long-term outlook

With prompt medical treatment, most people with ascending cholangitis recover fully. The key is to get to the hospital quickly. Your healthcare team will work to treat the infection and address the blockage, and most people can expect a good outcome.

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