Bacterial cholangitis (acute cholangitis)
What to do if you think you have it
IMPORTANT: Acute cholangitis or COVID-19?
People with PSC sometimes experience infections in the bile ducts called 'acute cholangitis'.
One of the signs of acute cholangitis can include a higher temperature than normal. There is more information about acute cholangitis below. A high temperature is also one of the main symptoms of COVID-19.
Because of the rising number of COVID-19 cases across the UK, it is important that you seek medical advice if you think you have acute cholangitis and you have a high temperature in case it is COVID-19. This is especially important if you keep a supply of antibiotics at home and intend to start them.
If you think you have cholangitis and have a high temperature, consider COVID-19 as well.
Call your GP or contact NHS111 for advice call 111 (or out of hours numbers if you are in Northern Ireland) and let them know your symptoms and that you suspect acute cholangitis because you have PSC.
Call 999 if it is an emergency.
Reviewed by: Dr Andrew Yeoman and Dr Doug Thorburn 3 February 2021
Order or download our Alert Card to keep in your wallet or purse to help understand your symptoms and make treatment decisions with your GP or emergency medical team if acute cholangitis (also called bacterial cholangitis) is suspected.
Did you know that the Alert Card is also available as a digital version in the PSC Support App?
'Fantastic, my husband has used it many times in hospital. Its helped all members of staff. A medical student even asked to take notes from it. I would highly recommend.' Hannah
'Excellent, used on my last admission to hospital,a doctor in A & E who did not know about PSC and a doctor on the ward, both said it helped them know what they were dealing with.' Russell
'Helped me to realise I had a cholangitis attack. Haven’t had to use it in hospital yet (touch wood) but always carry it with me. My husband also has one, just in case…' Elsbeth
'A true lifesaver! I had cause to use my card recently during an acute Cholangitis attack which had progressed to Sepsis. It gave me clarity and helped me to explain my concerns to the triage nurse to speed up admission through A&E.' Matthew
Cholangitis attacks: top tips
- Keep a note of all your signs and symptoms and how long you have had them.
- Get an urgent appointment with a medical professional. If in doubt, seek medical advice early.
- Expect to have an urgent blood test.
- Expect to be given antibiotics.
- Contact contact your PSC doctor if you think you have cholangitis for advice about whether you should start antibiotics if you have a prescription at home.
- Contact your usual PSC doctor immediately if you are at all unsure of your treatment or care.
- Always let your PSC doctor know that you have had a cholangitis attack.
What is a cholangitis attack?
Cholangitis attacks (or flares) may occur in people with PSC, even in those with otherwise good liver function. The exact cause is not known but is thought to be the result of an infection of the bile ducts within the liver.
Am I having a cholangitis attack?
Cholangitis attacks can be difficult to recognise. Signs and symptoms can vary from person to person and should not be ignored. They can include:
- feeling run down
- new or worsening pain in the right upper part of your abdomen
- reduced appetite/ nausea
- new or worsening itch (particularly on your palms or soles of your feet)
- jaundice (yellowing of the skin and/or the whites of the eyes)*
- fever, shivers, chills*
- a high temperature*
- darkening of your urine*
- pale stools*
- sudden change in liver blood test results*
*any of these signs or symptoms may indicate a severe cholangitis attack
Do I need medical attention?
Yes. If you think you are having a cholangitis attack, urgent medical care is required. Contact your GP or out of hours medical provider for an urgent appointment about your suspected cholangitis attack (bile duct infection). Treatment may be required even if you don’t have the severe signs and symptoms.
IF IN DOUBT, SEEK MEDICAL ATTENTION
If any of the following signs or symptoms of severe cholangitis are present, then it is advised to attend your local accident and emergency department immediately:
- sudden onset of jaundice
- severe pain in the right upper part of your abdomen
- unmanageable fever (for instance, not controlled with paracetamol)
- chest pain
- loss of consciousness
If you have severe cholangitis, you may need to be treated and monitored in hospital.
Please give this person immediate medical attention
Left untreated, bacterial cholangitis in primary sclerosing cholangitis can cause serious complications such as sepsis, jaundice and liver decompensation.
- Acute cholangitis attacks can present with a broad range of symptoms
- The classic features of infection can be absent
- Blood markers of infection (white blood cell count, CRP and bilirubin) may also be normal
- Acute cholangitis attacks in PSC are not always associated with the presence of stones (calculi)
Presentation of acute cholangitis attacks
Often, symptoms are non-specific, including (but not limited to):
- a feeling of being run down
- new or worsening pain in the right upper quadrant
- reduced appetite
- new or worsening itch (particularly on the palms or soles)
In more severe cases, the patient may look jaundiced, have a fever, notice darkening of their urine +/- pale stools, or simply manifest sudden deterioration in their liver biochemistry.
Treatment of bacterial cholangitis
The UK-PSC consortium advises that antibiotics targeting the most common bacterial culprits be used in the first instance. Common first-line agents include:
Unfortunately, there is currently no good evidence to indicate how long antibiotics should be continued for, but approximately 2-3 weeks is the standard duration.
Severe cholangitis may require hospital admission for intravenous antibiotics, intravenous fluids, and continuous medical monitoring.
- We recommend that you ensure that your PSC doctor knows about the cholangitis attack as soon as possible. They will consider your individual circumstances, and in some cases, may also consider an MRI scan or endoscopy to investigate and/or help clear your bile ducts.
- Talk to your PSC doctor about having a course of antibiotics prescribed and available for you in case you experience a bout of cholangitis. This should particularly be considered if you have had a previous attack*.
*Not everyone gets repeated cholangitis attacks, nor is a cholangitis attack a sign that your PSC is progressing.