Cholangitis

Cholangitis is an inflammation of the gallbladder. The gallbladder serves as a temporary storage site for bile. Bile is produced by the liver. The bile flows into the gallbladder through small bile ducts, where it is stored. When you eat fatty foods, the gallbladder receives a signal to contract. These contractions release bile into the bile ducts. The bile travels through the bile ducts into the small intestine, where it is needed for the digestion of fats. A sudden, one-time episode of inflammation is called acute cholecystitis. When the inflammation recurs regularly or persists for a long time, it is referred to as chronic cholecystitis.

Initially, the main symptom is severe, persistent pain in the upper right abdomen. The pain often worsens with deep breathing and may radiate to the right shoulder blade. Another characteristic symptom is the sharp pain the patient feels when the doctor presses on the upper right abdomen.

In addition to pain, symptoms such as nausea and vomiting are common. Some patients have a fever or elevated temperature. Pale stools and dark urine are signs that the bile ducts are blocked. 

Inflammation of the gallbladder is almost always caused by a gallstone that blocks the flow of bile into and out of the gallbladder. In only 5% of people with gallbladder inflammation is there another cause. This can be an infection resulting from surgery, a severe injury, or a burn.

The diagnosis is often made based on the pattern of symptoms in combination with blood tests. Blood tests can be performed to determine whether an infection or inflammation is present. In addition, liver function tests can indicate reduced bile flow. For example, elevated bilirubin levels may be observed in the blood.

Ultrasound (echo)

Gallstones located in the gallbladder or bile ducts can be detected with an ultrasound. Thickening of the gallbladder wall, caused by inflammation, can also be seen on an ultrasound. An ultrasound is an imaging test that uses sound waves. Sometimes an ultrasound does not provide sufficient clarity. In that case, a CT scan or MRI scan may be performed. These are imaging tests that produce detailed images (in cross-sections or “slices”) of the gallbladder and liver.

Surgery

Treatment generally involves the surgical removal of the gallbladder and the gallstones. Surgery is sometimes not possible in cases of acute inflammation. In that case, you will be admitted to the hospital and will usually be given antibiotics and pain relievers. Once the attack subsides, the surgery can still be performed if necessary. Removal of the gallbladder (cholecystectomy) can be done via keyhole surgery (laparoscopy) or through open abdominal surgery (with a slightly larger incision).

ERCP (Endoscopic Retrograde Cholangiopancreatography)

Gallstones located in the bile ducts can sometimes be removed using an ERCP (an endoscopic examination of the bile ducts). This is an endoscopic procedure of the bile ducts, during which the doctor can perform minor procedures. The doctor can access the bile ducts through the mouth, esophagus, stomach, and duodenum using a flexible tube (endoscope). Using a small grasper attached to the endoscope that can be advanced through the scope, the doctor can remove gallstones.