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The term cholangitis refers to obstruction and inflammation of the bile ducts, which can happen due to autoimmune, genetic changes or be the result of gallstones or, more rarely, infection by the parasite Ascaris lumbricoides, for example. Thus, due to inflammation of the bile ducts, there is an alteration in the process of transporting bile to the gallbladder and to the intestine, resulting in the accumulation of this substance in the liver and which may result in decreased liver function.
Initially cholangitis does not lead to the appearance of symptoms, however as it progresses and there is liver involvement, it is possible to notice the more yellow skin and eyes, itching and excessive tiredness. It is important that the general practitioner or hepatologist is consulted as soon as the first symptoms appear, as it is possible to delay the development of the disease, prevent the destruction of the bile ducts and the development of other complications.
Main symptoms
In most cases, cholangitis does not cause any symptoms and, therefore, in many cases, the disease continues to develop until it is discovered in routine tests or until it seriously compromises the liver. At this stage, it can cause symptoms such as:
- Excessive tiredness;
- Itchy skin;
- Dry eyes and mouth;
- Muscle and joint pain;
- Swelling of the feet and ankles;
- Yellow skin and eyes;
- Diarrhea with fatty mucus.
It is also common for cholangitis to appear in association with other autoimmune diseases, such as dry keratoconjunctivitis, Sjogren's syndrome, rheumatoid arthritis, scleroderma or Hashimoto's thyroiditis, for example. In addition, cholangitis may be related to the presence of gallstones or due to the presence of large amounts of worms in the bile ducts.
As the disease is related to genetics, people who have cases of this disease in the family can have tests to identify whether they also have biliary cholangitis, because, although it is not an inherited disease, there are more chances of having several cases within the same family.
How to diagnose
Generally, cholangitis is suspected when changes are seen in a routine blood test done to assess liver function, such as increased liver enzymes or bilirubin. In these cases, to identify the disease, the doctor may order other, more specific tests, such as the measurement of anti-mitochondrial antibodies, anti-nuclear antibodies and markers of bile lesions such as alkaline phosphatase or GGT.
Imaging tests, such as ultrasound or cholangiography, may be indicated to assess the structures of the liver. In addition, a liver biopsy may also be necessary if there are doubts about the diagnosis or to assess the evolution of the disease. Learn more about the liver tests.
How the treatment is done
It is important that the treatment of biliary cholangitis be done according to the guidance of the general practitioner or hepatologist, as this way it is possible to avoid the destruction of the bile ducts, the formation of a scar tissue without function and the development of cirrhosis of the liver. Thus, the treatment of cholangitis aims to control symptoms and prevent disease progression, and can be recommended by the doctor:
- Ursodeoxycholic acid: is the main medication used in the treatment and helps bile to leave the liver, preventing the accumulation of toxins in the liver;
- Cholestyramine: it is a powder that must be mixed in food or drink and that helps to relieve the itchiness caused by the disease;
- Pilocarpine and moisturizing eye drops: helps to hydrate the mucous membranes of the eyes and mouth, preventing dryness.
In addition to these, the doctor may recommend other medications, according to the symptoms of each patient. In addition, in the most severe cases, it may still be necessary to have a liver transplant, especially when the damage is already very advanced. See how the liver transplant is done.
Created by: Tua Saúde Editorial Team
Bibliography>
- BRAZILIAN SOCIETY OF HEPATOLOGY. Primary biliary cholangitis (CBP) . 2018. Available at:. Accessed on 29 Oct 2020