CHOLANGITIS

GROUP MEMBERS

1. ENERST KAPYA 20182516

2. HELLEN NAKANYIKA 20182533
3. KAYOBA CHITAMBEYA 20182556
4. EPIDIUS SIWAWA 20182571
5. CAREN SISHUMBA 20182511
6. NCHIMUNYA KALAULA 20182541
7. MAPESHO KHONDOWE 20182563
8. NANCY HABEENZU 20182562
CHOLANGITIS

 Cholangitis is an inflammation of the bile duct system. The bile duct system carries bile
from the liver and gallbladder into the first part of your small intestine (the duodenum).
AETIOLOGY

COMMON
 Bacterial infection
 Autoimmune
 Gall stones –
 Tumour eg cholangiocarcinoma
RARE
 Pancreatitis
 Ischemic cholangiopathy and Parasitic infestation.
 Blockage
 Chemicals
 Infection(viral, fungal, bacterial and parasites)
RISK FACTORS

 Having autoimmune diseases such as inflammatory bowel disease

 (ulcerative colitis or Crohn's disease)
 Recent medical procedures involving the bile duct area
 human immunodeficiency virus (HIV)
 Traveling to countries where you might be exposed to worms or parasites
 Being female. Chronic cholangitis is more common in women.
 Age. It usually occurs in adults between the ages of 30 and 60.
 Genetics. Cholangitis may run in the family.
 Location. The disease is more common in North America and northern Europe.
 
TYPES

 There are two main types of cholangitis:

 Chronic cholangitis happens slowly over time. It can cause symptoms over 5 to 20 years.
 Acute cholangitis happens suddenly. It can cause symptoms over a short time period.

 It can also be broken down more specifically and known as the following:
 primary sclerosing cholangitis (PSC)
 secondary cholangitis
 Recurent pyogenic cholalngitis
 Ascending cholangitis
 Primary sclerosing cholangitis(PSC) is an idiopathic condition likely of autoimmune
origin that causes progressive inflammation and scarring of intrahepatic and extrahepatic
biliary ducts resulting in progressive liver disease, which can lead to liver cirrhosis and be
complicated by cholangiocarcinoma.
 Most patients are asymptomatic at diagnosis. It is associated with inflammatory bowel
disease (mostly ulcerative colitis) and other autoimmune conditions. Elevated alkaline
phosphatase is typical. Transaminases are only mildly elevated.
 Ascending cholangitis occurs when bacterial infection is superimposed on bile stasis from
impeded bile drainage. Bacteria ascend from the duodenum into the common bile duct
(CBD) causing infection. Gram-negative bacteria (e.g. Escherichia coli, Klebsiella,
Enterobacter), gram-positive bacteria (e.g.Enterococcus, Streptococcus) and mixed
anaerobes (Bacteroides, Clostridia) are the usual culprit organisms.
 Recurrent pyogenic cholangitis which may be seen in the literature as Oriental
cholangiohepatitis or hepatolithiasis is characterized by intrahepatic and extrahepatic
biliary strictures with intrahepatic, pigmented soft stones in the biliary tree. Patients
present with recurrent bouts of pyogenic cholangitis
 SECONDARY cholangitis it is caused by specific conditions like stones, trauma,
congenital lessions, AIDS,transplantation, collagen diseases, sarcoidosis, histiocytosis.
others causes
 Following recurrent pyogenic cholangitis
 Toxic damage following intra-arterial chemotherapy
 Following ischemic damage
 Chronic pancreatitis
CLINICAL FEATURES

 Pain in the upper right part of the abdomen

 Fever
 Chills
 Yellowing of the skin and eyes (jaundice)
 Nausea and vomiting
 Clay-colored stools
 Dark urine
 Low blood pressure
 Lethargy
 Changes in alertness
 Hyperpigmentation (darkening of the skin)
 High cholesterol
 Oedema(feet & ankles)
 Xamthomas(fat deposit around the eyes and eyelids)
 Dry mouth and eyes
 Steotorrhia
 Itchy skin
INVESTIGATIONS

 Complete blood count (CBC).

 Liver function tests.
 Blood cultures.
 
 IMAGING
 Ultrasound (also called sonography) If internal, it is called an endoscopic ultrasound (EUS ).
 CT scan
 Magnetic resonance cholangiopancreatography (MRCP)
 ERCP (endoscopic retrograde cholangiopancreatography)
 Percutaneous transhepatic cholangiography (PTC)
 X-ray (a cholangiogram uses dye to look at the bile ducts)
 Physical Examination Findings.
 Icterus and RUQ abdominal tenderness can be noted. Icterus is often more pronounced in
cases of neoplastic obstruction. Courvoisier’s sign is present when an enlarged gallbladder
is palpable in the presence of jaundice. It is suggestive of malignant obstruction of the
CBD.
TREATMENT

 Intravenous fluids (IVF).

 Intravenous (IV) broad-spectrum antibiotics.
 Close monitoring of vital signs.
 Correction of coagulopathy with vitamin K or fresh frozen plasma (FFP)
 Antibiotic therapy is guided by blood culture results.
 A drug called ursodeoxycholic acid may help protect the liver. It works by improving bile
flow. It doesn’t treat cholangitis itself.
MGT CONT’

 percutaneous (transhepatic) biliary drainage.

Treatment of bile duct blockages
 Endoscopic biliary decompression(to remove the cause of the blocked biliary tree).
 Balloon dilation may be used to open up the ducts and increase bile flow.
 plastic biliary stent placement.

SURGERY
 ERCP plus sphincterotomy with stone extraction
 Liver transplant
 
 
COMPLICATION

 Gallstones.
 Enlarged sleen
 Portal hypertension.
 Blood infection (sepsis)
 hepatic abscesses,
 acute renal failure,
 disseminated intravascular coagulopathy (DIC), and multiorgan failure.
 Osteoporosis
 Hyperlipidemia
 Cholangiolitic abscess
DIFERENTIAL DIAGNOSIS

 Choledocholithiasis
 Acute cholecystisis
 Right Sided Diverticulitis
 Liver cirrhosis
 Right Sided Pyelonephritis
 Cholangiocarcinoma
 REFERENCE

 1. Bewes and King, Primary Surgery, Vol 1 Non Trauma and Vol 2 Trauma, Blackwell,
London 2. Clain Alan(1996),
 Hamiltons Bailey’s Demostration of physical signs in clinical surgery, 17th edition,
ButterWorth-Heinemann, Oxford
 https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medic
ine/cholangitis
/
 SRB_S Manual of surgery 3rd Edition
 https://www.hopkinsmedicine.org/health/conditions-and-diseases/cholangitis
 https://www.healthline.com/health/cholangitis