Cholangitis

Overview

Cholangitis means inflammation (swelling) of the bile ducts. Bile ducts are thin tubes that carry bile — a yellowish fluid made by the liver — out of the liver, through the gallbladder, and into the small intestine, where it helps digest fats. Most of the time, cholangitis happens when something blocks a bile duct, usually a gallstone. Bile then builds up, and bacteria (germs) that get into the blocked duct can cause an infection. This is called acute cholangitis, and it is a serious condition that needs treating in hospital straight away. With quick care, most people recover well.

Acute cholangitis is uncommon in the general population, but it is a well-known complication of gallstones and other bile duct problems. It is one of the more serious tummy-related infections doctors see, which is why hospitals treat it quickly.

It can affect anyone, but it is most often seen in adults. It is more likely in people who have had gallstones, have had surgery or procedures on the bile ducts, have a narrowed bile duct, or have a growth blocking the duct. Older adults are affected more often and can become unwell faster. In children it is rare and usually linked to other conditions, such as cysts of the bile ducts or a weakened immune system.

Symptoms

Common symptoms

• Pain in the upper right side of the tummy, which may spread to the back or right shoulder
• Fever, often with shivering or shaking chills
• Yellowing of the skin and the whites of the eyes (jaundice)
• Feeling or being sick
• Dark urine and pale, putty-coloured stools
• Itchy skin
• Feeling generally very unwell, tired or 'fluey'
• Pain or tenderness when the upper tummy is pressed

Symptoms in children

• Cholangitis is rare in children, and the signs can be vague
• Fever and feeling generally unwell may be the main clues
• Tummy pain, vomiting, or refusing feeds
• A yellowish tinge to the skin or eyes
• Irritability or unusual sleepiness — trust your instincts and get medical help

Symptoms in older adults

• Older adults may not get the 'classic' pattern of pain, fever and yellow skin
• Confusion, drowsiness, or sudden changes in behaviour can be the first sign
• Falls or new weakness
• Low blood pressure or feeling faint
• A sudden drop in appetite or general 'off' feeling with a mild temperature

Causes

Main causes

• A gallstone stuck in the main bile duct — by far the most common cause
• A narrowed or scarred bile duct (called a stricture), which slows the flow of bile
• A growth or tumour blocking the bile duct, such as in the bile duct itself or the pancreas
• Cysts in the bile ducts (usually present from birth)
• Bacteria travelling up from the gut into a duct whose flow is already poor
• Rarely, parasites in the bile ducts (more common in some parts of the world)
• After certain procedures on the bile ducts, such as ERCP (a camera test and treatment of the bile ducts)

Risk factors

• Having gallstones, now or in the past
• Being older, especially over 70
• Previous surgery or procedures on the gallbladder or bile ducts
• A known narrowing or scarring of the bile duct
• Conditions such as primary sclerosing cholangitis (long-term inflammation and scarring of the bile ducts)
• A weakened immune system
• Fast weight loss, which can make gallstones more likely
• Certain cancers affecting the bile duct or pancreas

When to see a doctor

See a doctor urgently if:

• Yellow skin or eyes, especially with fever or tummy pain
• Fever with pain in the upper right tummy
• Shaking chills
• Confusion or drowsiness in an older adult with tummy pain or fever
• Dark urine and pale stools
• Severe or worsening tummy pain

Book a routine appointment if:

• You have had gallstones and get repeated bouts of pain after fatty meals
• You have been told you have a narrowed bile duct and want to know what to watch for
• You have ongoing itching, tiredness, or digestive changes after a bile duct problem
• You want to discuss whether your gallbladder should be removed

Diagnosis

A doctor will ask about your symptoms and examine your tummy, checking for tenderness and looking for yellowing of the skin and eyes. Blood tests and a scan usually follow quickly. In hospital, you may be seen by a team that includes doctors who specialise in the liver and bile ducts (gastroenterologists) and surgeons. The aim is to confirm what is blocked, whether there is infection, and how urgent treatment is.

Tests that may be done

• Blood tests to check the liver, bile ducts and infection markers (such as white cell count and CRP)
• Blood cultures to look for bacteria in the blood
• Ultrasound scan of the tummy — often the first scan, as it is quick and shows gallstones well
• CT scan or MRI scan, including a special MRI of the bile ducts (MRCP) that shows the ducts in detail
• ERCP — a camera passed down the throat and into the bile duct, which can both confirm the problem and treat it
• A urine test and, if needed, a pregnancy test before scans or procedures

What to expect at your appointment

In hospital you will usually be given fluids through a drip and antibiotics through a vein while tests are done. You may be asked not to eat or drink for a while. Things can move quite fast — you may have a scan and a procedure on the same day. Expect to be monitored closely with regular observations of your blood pressure, pulse, temperature and oxygen level.

Treatment

Cholangitis is treated in hospital, and treatment has two main goals: treating the infection and getting bile flowing again. Doctors give fluids and antibiotics through a drip and keep a close eye on you. The blocked duct usually needs to be opened, most often with a procedure called ERCP. Most people start to feel better within a day or two of the duct being cleared, though some need a longer stay.

Self-care at home

• Once home, rest and build up your activity slowly over a week or two
• Drink regularly and eat light meals if your appetite is slow to return
• Take any prescribed course of antibiotics exactly as directed, and finish it
• Keep the wound or throat comfortable after a procedure and follow the discharge advice you are given
• Note the date of any follow-up appointments and keep them
• Go straight back to medical care if fever, pain, or yellowing returns

Medical treatments

Treatment is supportive and procedural rather than a single 'cure' medicine. In hospital, fluids are given into a vein to keep you hydrated and to support your blood pressure, and antibiotics are given into a vein to fight the infection — the choice is made by your medical team based on your tests and local guidance. Pain relief and medicine to stop you feeling sick may also be used. To unblock the duct, doctors usually pass a thin, flexible camera through the mouth, down the food pipe and stomach, and into the bile duct (ERCP). They can then widen the opening, remove stones, or place a small tube (stent) to keep bile flowing. Occasionally a different procedure through the skin, or surgery, is needed. In serious cases, care in a high-dependency or intensive care unit may be required.

When is surgery considered?

Surgery is not usually the first step. However, many people later have their gallbladder removed (cholecystectomy), usually as keyhole surgery, to prevent another stone causing the same problem. This is often planned a few weeks after you have recovered from the infection. Surgery may also be needed if the blockage is caused by scarring or a growth that cannot be managed with a camera procedure.

Living with this condition

Most people recover fully after treatment and get back to normal life within a few weeks. If you are waiting for gallbladder surgery, you may need to eat a little more carefully for a while — some people find fatty or greasy meals trigger discomfort. Keep a note of any symptoms that come back so you can describe them clearly to your doctor.

Lifestyle tips

• Eat regular meals rather than long gaps, which helps bile flow
• Choose a balanced diet with plenty of vegetables, fruit and fibre
• Keep alcohol within recommended limits, or avoid it if your liver is being monitored
• Stay active — gentle walking is fine once you feel ready
• Avoid very rapid weight-loss diets; slow, steady weight loss is kinder to the gallbladder
• Attend follow-up appointments and tell your doctor about any new symptoms

Diet and exercise

There is no special 'cholangitis diet', but a balanced, lower-fat way of eating suits many people with gallbladder or bile duct problems. Aim for regular meals, healthy fats in moderation, and plenty of fluids. Build exercise back up gradually after illness — start with short walks and increase as your energy returns. If you have had surgery, ask your team when it is safe to lift or exercise more strenuously.

Mental health and emotional wellbeing

Being suddenly unwell and needing hospital treatment can be frightening, and it is very normal to feel anxious afterwards, especially while waiting for surgery. Some people feel shaken for weeks. Talk to your doctor if low mood, worry or poor sleep is affecting your daily life — support is available, and you do not have to cope alone. If you ever feel you are in crisis or having thoughts of harming yourself, contact your local emergency number or a local crisis support service straight away.

Prevention

You cannot always prevent cholangitis, but you can lower the risk. The most important step is to get gallstone problems and bile duct narrowing checked rather than ignored, and to have recommended surgery or follow-up when it is offered. If you have a known bile duct condition, ask your doctor what warning signs to watch for so you can act fast. Keeping to a healthy weight, losing weight steadily rather than very quickly, and eating regular balanced meals may reduce the chance of forming gallstones.

Vaccines

There is no vaccine against cholangitis itself. However, some people with long-term liver or bile duct conditions are advised to have routine vaccinations, such as hepatitis A and hepatitis B, to protect the liver. Ask your doctor or pharmacist which vaccinations are recommended for you.

Screening programmes

There is no general screening programme for cholangitis. People with known bile duct narrowing, primary sclerosing cholangitis, or previous bile duct procedures are usually monitored with regular check-ups and blood tests, and sometimes scans, so problems are picked up early.

Complications

If left untreated

• The infection can spread into the bloodstream (sepsis), which is life-threatening
• Pockets of pus can form in the liver (abscesses)
• Kidney injury and low blood pressure
• Failure of more than one organ in severe cases
• Scarring and long-term narrowing of the bile ducts, which can cause repeated problems
• Repeated episodes if the underlying cause, such as gallstones, is not dealt with

Long-term outlook

The outlook is good for most people who are treated promptly. Many feel much better within a couple of days of the blockage being cleared, and most make a full recovery. Some people need longer in hospital or a second procedure, and a small number become seriously unwell — which is exactly why doctors treat cholangitis as urgent. Once you have recovered, dealing with the underlying cause (often by removing the gallbladder) greatly reduces the chance of it happening again. Having a clear follow-up plan with your medical team is the best way to feel confident going forward.

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