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Chronic cholangitis
Last reviewed: 06.07.2025
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Chronic cholangitis is a chronic bacterial inflammation of the bile ducts (extrahepatic and intrahepatic).
Symptoms of chronic cholangitis
Latent form: pain and tenderness in the right hypochondrium are mild or absent, weakness, chills, subfebrile body temperature, occasionally skin itching, icterus of the skin and visible mucous membranes, gradual enlargement of the liver.
Recurrent form:pain in the right side and tenderness in the right hypochondrium upon palpation, nausea, bitterness in the mouth, itchy skin; during an exacerbation - jaundice, fever, prolonged subfebrile condition is possible; with a long course - thickening of the terminal phalanges in the form of drumsticks and nails in the form of watch glasses, the liver and spleen are enlarged, dense.
Protracted septic form: severe course with fever, chills, pain in the right hypochondrium, enlarged liver, spleen, severe intoxication, kidney damage, jaundice. Resembles septic endocarditis.
Sclerosing (stenosing) form: general weakness, malaise, increased body temperature, chills, itchy skin, jaundice, enlarged liver and spleen.
In the late stages of chronic cholangitis, biliary cirrhosis of the liver may develop.
Laboratory data
The same as in acute cholangitis, but for chronic cholangitis anemia is more common.
Instrumental data
The same as in acute cholangitis. Intravenous cholangiography or endoscopic retrograde cholangiopancreatography reveals dilated bile ducts (extra- and intrahepatic), in sclerosing cholangitis - intrahepatic ducts in the form of beads, often sharply narrowed with reduced branching, narrowing in some sections or along the entire length of the common bile duct.
Survey program
The same as in acute cholangitis. In addition, in difficult differential diagnostic cases, laparoscopy with cholangiography and targeted liver biopsy is necessary.
Diagnosis of chronic cholangitis
The diagnosis is formulated based on the etiological and pathogenetic features of cholangitis and its role in a number of other manifestations of the pathological process.
Primary cholangitis develops as an independent disease. Among them, primary sclerosing cholangitis should be singled out - a disease of presumably autoimmune origin. "Oriental cholangitis" is also described as primary - an insufficiently studied form, endemic for some regions of Asia and possibly associated with clonorchiasis. In secondary symptomatic cholangitis, the disease that served as a prerequisite for its development or associated with it comes first. True, in cholestatic hepatitis and primary biliary cirrhosis of the liver, it is not customary to stipulate the participation of cholangitis in the formation of the pathological process, but it is appropriate to imply this. If cholangitis acts as an independent disease, its primacy should be reflected in the diagnosis. This emphasizes the isolation of such rare forms from the absolutely predominant cases of secondary cholangitis.
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