10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

What Is Cholangitis?
Medically reviewed by Youssef (Joe) Soliman, MD — By Noreen Iftikhar, MD —
Updated on November 4, 2021

Symptoms Causes Diagnosis Treatment Complications

Outlook Takeaway

Cholangitis is inflammation (swelling) in the bile duct. The American Liver

Foundation notes that cholangitis is a type of liver disease. It can also be
broken down more specifically as the following:

primary biliary cholangitis (PBC)

primary sclerosing cholangitis (PSC)

secondary cholangitis

immune cholangitis

The bile ducts carry bile from the liver and gallbladder to the small
intestine. Bile is a green to yellow-brown fluid that helps your body digest
and absorb fats. It also helps to clear waste from the liver.

When the bile ducts get inflamed or blocked, bile can back up into the
liver. This can lead to liver damage and other problems. Some types of
cholangitis are mild. Other kinds can be serious and life threatening.

There are two main types of cholangitis:

Chronic cholangitis happens slowly over time. It can cause

symptoms for years.

Acute cholangitis happens suddenly. It can cause symptoms over a

short time period.
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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

What are the symptoms?

Symptoms depend on what kind of cholangitis you have and for how long.
Every person with cholangitis may have slightly different signs and
symptoms. Many people with cholangitis may not notice any symptoms.

Some early symptoms of chronic cholangitis may include:

fatigue
itchy skin

dry eyes
dry mouth

If you have chronic cholangitis for a long time, you may have:

pain in the upper right side

night sweats

swollen feet and ankles

darkening of the skin (hyperpigmentation)

muscle pain
bone or joint pain
bloating (fluid in the stomach area)

fat deposits (xanthomas) in the skin around the eyes and eyelids
fat deposits in the elbows, knees, palms, and soles of the feet

diarrhea or greasy bowel movements

clay-colored bowel movements

weight loss
mood changes and memory problems
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If you have acute cholangitis, you may also have other symptoms. These
include sudden symptoms like:

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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

high fever for more than 24 hours 

pain or cramps in the upper right side of your abdomen

chills
nausea

vomiting
back pain

yellowing of the skin and eyes (jaundice)

dark urine

low blood pressure

confusion

Your doctor may find signs of cholangitis in other parts of the body. These
include:

swollen or enlarged liver

swollen or enlarged spleen

high cholesterol
underactive thyroid gland (hypothyroidism)

weak and brittle bones (osteoporosis)

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What causes cholangitis?

There is a range of causes for cholangitis, but sometimes the cause isn’t
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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

Chronic (long-term) cholangitis may be an autoimmune disease. This

means that your body’s own immune system mistakenly attacks the bile
ducts. This causes inflammation.

Over time, inflammation can trigger scars or the growth of hard tissue
inside the bile ducts. The scarring makes the ducts hard and narrow. They
can also block smaller ducts.

Causes of acute (sudden onset) cholangitis may be due to:

a bacterial infection
gallstones

blockages

tumor

Environmental causes of both acute and chronic cholangitis may be due

to:

infections (bacteria, virus, fungi, or parasites)

smoking

chemicals

Risk factors that might increase your chance of getting cholangitis

include:

Sex. PSC is more common in men, while PBC is more common in

women.

Age. It usually occurs in adults between the ages of 30 and 50  .

Genetics. Cholangitis may run in your family.

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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

How is cholangitis diagnosed?

Your doctor can diagnose cholangitis with various types of tests and
scans. They may order one or more of the following blood tests:

Complete blood count (CBC). A CBC blood test is used to measure

your white blood cell count. If you have an infection, your white
blood cell count will likely be elevated.
Liver function tests. Liver function tests can help determine whether
your liver is functioning properly and if your liver enzymes are within
a normal range.

Anti-mitochondrial antibody test. The presence of anti-

mitochondrial antibodies (AMAs), along with the results from other
blood work, may be an indication of cholangitis.

Cholesterol test. A cholesterol test can be helpful in determining

your risk factor for gallstones, which can lead to cholangitis.

Blood culture. A blood culture test can tell your doctor if you have a
blood infection.

Several types of imaging tests can help your doctor see how your liver
and bile duct are working. Although imaging tests aren’t always needed,
they can help your doctor confirm a diagnosis or rule out other conditions
that may have similar symptoms.

These imaging tests may include:

Ultrasound. An ultrasound uses high-frequency sound waves to

capture live images from the inside of your body. It allows your
doctor to see any potential issues with your organs and blood
vessels without needing to make an incision. For diagnosing
cholangitis, an ultrasound will focus on your liver, gallbladder, and
bile ducts.
CT scan. A CT scan is a form of X-ray that creates detailed images
of your internal organs and body structures. For diagnosing
cholangitis, a dye may be injected intravenously, which helps to
show if there is a blockage in the bile ducts. 
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Magnetic resonance cholangiopancreatography (MRCP). This is a

special type of magnetic resonance imaging (MRI) exam that
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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

produces detailed pictures of your liver, gallbladder, and bile ducts.

It can also show if there are gallstones in your bile duct or any type
of blockage.

Endoscopic retrograde cholangiopancreatography (ERCP). This

procedure combines an X-ray and the use of a long, flexible tube
with a light and camera on the end, called an endoscope. Your
doctor will guide the scope down your throat into your stomach and
then into the first part of your intestine. This will allow them to view
your organs for any problems. They will then inject a dye into your
bile ducts and take an X-ray to see if there is a blockage. SUBSCRIBE

Percutaneous transhepatic cholangiography (PTC). With this

procedure, a contrasting agent (dye) is injected through your skin
into your liver or bile duct. Then, you’ll get an X-ray of the ducts to
determine if there’s an obstruction. Because of the invasive nature
of this procedure, it’s used a lot less frequently than the procedures
listed above.

You might need other tests such as urine, bile, or stool samples.

How is it treated?
Treatment for chronic and acute cholangitis may be different, based on
the cause. Treatment also depends on how early you receive a diagnosis.
Both chronic and acute cholangitis can lead to serious complications if
they go untreated.

Early treatment is especially important for acute cholangitis. Your doctor

may recommend antibiotics, such as penicillin, ceftriaxone, metronidazole,
or ciprofloxacin, for up to 10 days  .

They may also recommend procedures in the hospital, such as:

intravenous (IV) fluids

bile duct drainage

Unlike acute cholangitis, no medications are available to treat chronic

cholangitis. A drug called ursodeoxycholic acid may help protect the liver.
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It works by improving bile flow, but it doesn’t treat cholangitis itself.

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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

Treatment and care for chronic cholangitis includes:

managing symptoms

monitoring liver function

procedures to open blocked bile ducts

Procedures for both chronic and acute cholangitis are:

Endoscopic therapy. Balloon dilation may be used to open up the

ducts and increase bile flow. This helps to improve and prevent
symptoms. You may need this therapy several times to treat
cholangitis. Endoscopic therapy may also be used for
sphincterotomy (a procedure that cuts the muscle between the
common bile duct and pancreatic duct) or stent placement. With
endoscopic therapy, you may need full anesthesia or a degree of
sedation that sometimes requires intubation to protect the airway.

Percutaneous therapy. This is similar to endoscopic therapy, but it’s

through the skin. Your doctor will numb the area or put you to sleep
before the procedure.

Surgery. Your doctor may remove the blocked part of the bile duct.
Or, you may have stents put in to open or drain the bile ducts. You’ll
be under full anesthesia (asleep) for surgery.

Liver transplant. In serious cases, you may need a liver transplant.

Your doctor will replace your damaged liver with a new one. You’ll
need to take antirejection drugs for the rest of your life after the
surgery. This helps your body keep the new liver healthy.

You may also need treatment for some serious side effects of cholangitis:

Nutrition. Cholangitis can affect digestion and how your body

absorbs some vitamins. You may need to take vitamin A, D, E, and K
supplements.

Bone weakness. Your doctor may prescribe medications for

osteoporosis. Calcium and vitamin D supplements can help improve
bone density and strength.

High blood pressure. Your doctor may monitor and treat high blood
pressure inA Dthe liver, which is called portal hypertension.
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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

Complications of cholangitis
Cholangitis can lead to serious health problems if it isn’t treated.
Complications include:

Liver problems. Cholangitis can cause liver scarring (cirrhosis). This

can slow liver function or lead to liver failure. It also increases the
risk of liver cancer. It can cause liver swelling and high blood
pressure.

Gallstones. Blocked bile can harden into stones. This may cause
pain and infections.
Enlarged spleen. If the liver isn’t working properly and can’t filter out
wastes and toxins, old blood cells can collect in the spleen, causing
it to swell.
Enlarged veins. High blood pressure in the liver may put too much
pressure on veins in the stomach. This can lead to swollen and
broken veins. It may also cause bleeding.

Blood infection. Acute cholangitis can lead to sepsis (a blood

infection). This can damage several parts of the body and may be
life threatening if not treated.

Chronic cholangitis is also linked to other conditions, including thyroid

problems, scleroderma, and rheumatoid arthritis.
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What’s the outlook?


Your signs and symptoms will vary from other people with cholangitis. In
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some cases, the cause may not be known. You can’t always prevent

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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

cholangitis.

Early treatment can help you have a better outcome. It also helps to
prevent symptoms and complications. Get medical attention as soon as
possible if you have any symptoms, such as:

fever

abdominal pain

yellowing of the eyes and skin

changes in digestion and bowel movements

You may not have any symptoms at all. Regular checkups can help you
learn about your liver health with a simple blood test.

Some types of cholangitis may be easier to clear up with treatment. Take

all medications as prescribed and see your doctor for all follow-up
appointments.

You can prevent complications with daily lifestyle measures, such as not
smoking. A balanced diet with plenty of fiber may ease cholangitis
symptoms and prevent complications. Talk with your doctor or nutritionist
about the best diet plan for you.

The bottom line

Cholangitis is a condition that involves the inflammation of the bile duct
system. Some types of cholangitis are mild. Other kinds can be serious
and life threatening.

Chronic cholangitis happens slowly over time. Acute cholangitis, on the

other hand, happens suddenly and usually causes symptoms over a short
period of time. These symptoms can include a high fever, nausea, chills,
pain in the abdomen, and dark urine.

Cholangitis can lead to serious health problems if it goes untreated.

That’s why it’s important to get medical attention if you have any
symptoms and to have regular checkups with your doctor to ensure your
liver and bile ducts are working properly.
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10/06/2023, 22:47 Cholangitis: Symptoms, Treatment, Causes, Diagnosis, and More

Last medically reviewed on November 4, 2021

How we reviewed this article:

SOURCES HISTORY

Our experts continually monitor the health and wellness space, and we
update our articles when new information becomes available.
Current Version

Nov 4, 2021

Written By
Noreen Iftikhar, MD

Edited By
Claire Brocato

Medically Reviewed By
Youssef (Joe) Soliman, MD

Copy Edited By
Siobhan DeRemer

Feb 21, 2019

Written By
Noreen Iftikhar, MD

Edited By
Jessica Jondle

Medically Reviewed By
Saurabh Sethi, MD, MPH
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