What is cholangite?
Cholangitis is an inflammatory process in the bile ducts. In most cases, inflammation depends on benign or malignant obstructive processes complicated by the presence of bacterial infections - favored by the underlying mechanical obstruction of the biliary tract by calculi - or more rarely parasitic.
Infectious cholangitis: acute and chronic
Acute infectious cholangitis is the result of obstructive processes in extrahepatic bile ducts, complicated by bacterial invasion in bile. It is therefore a pathology secondary to other morbid processes of the extrahepatic bile ducts, accumulated by biliary stasis and mostly attributable to calculosis or to intrinsic or extrinsic stenoses of the common bile duct or malignant (bile duct neoplasms, gall bladder tumors). ampulla of Vater, pancreas or duodenum).
More rare are cases in which infective cholangitis results from diseases of the digestive tract (intestinal fistulas, duodenal ulcers or diverticula, acute appendicitis, typhoid), pancreas (pancreatic tumors, cystic fibrosis, pancreatitis) or lymph nodes of the hepatic hilum (neoplasms, tuberculosis). Infectious cholangitis can be caused by lesions associated with surgical operations performed on the stomach, duodenum or appendix.
The obstructive process can also be caused by the presence of parasitic infestations, such as that of Ascaris lumbricoides or Clonorchis sinensis . This is a very rare occurrence in industrialized countries, where the germs most commonly responsible for the infection are bacteria : Escherichia coli in the first place, followed by pneumobacilli, salmonella, streptococci ( Streptococcus faecalis ), Enterobacter, Clostridia, Klebsiella and Pseudomonas . In general, the infection - favored as often mentioned by the biliary stasis - is carried out ascendingly (hence the term ascending cholangitis ), more rarely through the descending blood, lymphatic or canalicular pathway. Bacterial infections can be simple or complicated by the presence of pus ( acute suppurative cholangitis ), an event that increases the risk of ulceration, necrosis and hemorrhage.
The symptoms of infective cholangitis vary depending on the origin of the disorder and the general condition of the patient; in principle, they include intermittent fever, often preceded by chills and accompanied by abdominal pain and jaundice, which is also intermittent and accompanied by dark urine and pale stools. To this triad (fever, pain in the right hypochondrium, jaundice), called Charcot, is added the typical symptomatology of the underlying condition, of which the cholangitis is a consequence. Common procession of symptoms characteristic of liver disorders: nausea, vomiting, sense of general malaise, poor digestion.
The diagnosis makes use of cholangiographic techniques to study the irregularities and stenoses of the bile ducts, highlighting any obstacles to the outflow, while the ultrasound, CT and magnetic resonance allow to identify the circumferential thickening of the bile duct wall and any calculations . As regards the blood chemistry parameters, in the presence of infectious cholangitis the elevation of bilirubin (hyperbilirubinemia, especially of the conjugate quota), of the ESR, of the number of white blood cells (neutrophil leukocytosis) and of serum related to biliary stasis (such as the alkaline phosphatase). Generally contained the increase of aspartate-aminotransferase transaminases and alanine aminotransferase.
Cholangitis therapy involves the use of broad-spectrum antibiotics to resolve the infectious process; in any case, it cannot disregard the removal of any obstructive process responsible for biliary stasis, which can be performed by traditional, laparoscopic or endoscopic surgery ..
In the absence of treatment, complications of the disease include hepatic abscess, secondary biliary cirrhosis, hepatic failure, renal failure and septic (potentially lethal) shock.
To learn more: Medicines for the treatment of cholangitis
Sclerosing cholangitis
Primitive sclerosing cholangitis is an inflammation of the bile ducts on an autoimmune basis, presumably caused by the development of exaggerated immune reactions against the bile ducts, which lead to their abnormal narrowing. Sclerosing cholangitis is often associated with inflammatory bowel disease (mostly Crohn's disease and ulcerative colitis).
