Kolangiitti

Kolangiitti, or cholangitis in English, is an inflammation of the bile ducts. Acute cholangitis is typically caused by a bacterial infection that ascends from the duodenum in the setting of biliary obstruction; chronic forms are less common and often linked to ongoing biliary disease.

Causes and pathophysiology: Obstruction from gallstones, benign or malignant strictures, or external compression can predispose to cholangitis. Bacteria commonly involved include Escherichia coli, Klebsiella, Enterococcus, and occasionally anaerobes. The condition arises when bacteria multiply within the bile ducts and trigger inflammation, sometimes accompanied by systemic infection.

Signs and symptoms: The classic triad is fever, jaundice, and right upper quadrant pain (Charcot triad). In more severe cases, patients may develop hypotension or altered mental status (Reynolds pentad), indicating sepsis or organ dysfunction.

Diagnosis: Laboratory findings often show leukocytosis and cholestatic liver tests (elevated bilirubin, alkaline phosphatase, transaminases). Blood cultures may be positive. Imaging is essential: ultrasound can detect biliary dilation and stones; magnetic resonance cholangiopancreatography (MRCP) or CT can define obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) is both diagnostic and therapeutic when feasible.

Treatment: Immediate broad-spectrum antibiotics targeting enteric bacteria are started. Definitive management requires biliary decompression, typically by ERCP with sphincterotomy and stone extraction or drainage. If ERCP is not possible, percutaneous drainage or surgical intervention may be needed.

Prognosis and epidemiology: Prompt treatment reduces mortality and complications. Delays increase the risk of sepsis, liver failure, and death. Cholangiitis is more common in individuals with biliary obstruction and can recur if the underlying cause is not addressed.