Cholangitis symptoms: Overview
Cholangitis symptoms can be very serious. Most patients with cholangitis symptoms are very sick. Cholangitis symptoms develop when there is an infection and obstruction in the common bile duct and the biliary tract. In patients with cholangitis symptoms, bile can not flow down into duodenum from the liver and back flow of bile into the liver and ultimately into blood occurs. This is how patients with cholangitis symptoms develop jaundice. Jaundice is yellowish greenish discoloration of the skin and the eyes which happens as a result of bile back flowing into the blood. Jaundice is an important feature of cholangitis symptoms. Cholangitis symptoms in an individual patient depend upon the age, gender and history of other medical problems. I will be presenting several cases of patients with cholangitis symptoms that I took care of. All the patient stories I present here are from real patients but I have changed all the personal information to protect the identity of the patients.
Cholangitis symptoms: 52 year old female with high fevers
Mrs J is a previously healthy 52 year old female who works at the the local bank. She was at work when her symptoms started. About an hour after she had her lunch, she started get somewhat nauseated. She did not actually throw up but was feeling very feverish and weak. She felt so sick she had to excuse herself from work. She dove back home and remained in bed for the rest of the day. Her appetite was gone and she did not eat or drink anything that day after she went home. She was too tired and just fell asleep early. She woke up in the morning feeling sicker. She had a bad pain on the right side of her stomach. She was sweating profusely and her skin was itching everywhere. She had severe nausea and vomited a few times. As she looked in the mirror, she was surprised to find herself looking so sick. He color was off and her eyes looked ugly. She felt like she was going to faint. At that point, she called for help and she was rushed to the local ER.
In the ER, the doctor noticed she was jaundiced and had high fevers. She also had severe tenderness on the right side of her abdomen. The ER doctor was immediately concerned about cholangitis symptoms. He ordered some blood work and an ultrasound of the abdomen. The ultrasound showed a dilated common bile duct with signs of inflammation confirming the diagnosis of cholangitis symptoms. Her blood pressure was on the lower side and I was called to admit the patient to ICU. As the on-call doctor, I transferred her to ICU from ER and started her on iv fluids and antibiotics.
Her blood work showed an elevated white blood cell count. It is an indicator of inflammation and is found in most patients with acute cholangitis symptoms. She also had a high bilirubin level. Bilirubin level measures the amount of bile in the blood and is a result of the back flow of bile into the blood in patients with cholangitis symptoms. Her blood pressure remained low and I infused several more liters of iv fluids into her veins. When the blood pressure starts to get low in patients with cholangitis symptoms, it is an indication of severe sepsis and septic shock. When that happens, patients with cholangitis symptoms can get worse quickly and can die within a few hours if not treated properly.
With the antibiotics and iv fluids, her blood pressure improved and became more stable. I consulted one of our gastroenterologist and he gave orders to get the procedure room ready for her. A gastroenterologist is a specialist trained in special procedures and specialized treatment of diseases related to the digestive tract, liver and gall bladder. A consultation with gastroenterologist is critical in treating patients with cholangitis symptoms. When I called the gastroenterologist and described the cholangitis symptoms, he knew the patient would need a procedure called ERCP or endoscopic retrograde cholangiopancreatography.
The gastroenterologist inserts a tube with camera and equipment from the patient’s mouth and go all the way to the stomach and then to the duodenum which is the upper part of the intestine just below the stomach. From the duodenum, the gastroenterologist explores the bile ducts with the use of special equipment, special dyes and x-ray machines. The details of how a gastroenterologist does that in patients with cholangitis symptoms is very complex and is outside the scope of this website. But the goal of the procedure is to clear the obstruction in the bile ducts and allow the normal flow of bile. In many patients with acute cholangitis symptoms, ERCP alone can relieve the obstruction. Other patients with acute cholangitis symptoms may require additional surgery to get that done.
The cholangitis symptoms of Mrs. J improved with ERCP. Her jaundice slowly resolved and she became more stable. She then had an endoscopic cholecystectomy to remove her gall bladder. You can read more about cholecystectomy in the patient story of Miss B who had acute cholecystitis. In many patients admitted to the hospital with symptoms of acute cholangitis, the gall bladder is ultimately taken out to prevent recurrence of symptoms. Mrs. J recovered from the surgery and was discharged home after 4 more days in the hospital.
Not all patients with acute cholangitis symptoms have this kind of happy ending. Some patients with acute cholangitis symptoms develop complications requiring prolonged hospitalization and even severe long term consequences. I hope the story of Mrs. J helped you understand more about acute cholangitis symptoms. Please check back soon as I will be uploading more stories about different aspects of patients with acute cholangitis symptoms.