Cholangitis vs cholecystitis

Cholangitis and cholecystitis are two conditions which share certain similarities but have different causes and symptoms. Cholangitis is basically an inflammatory process affecting the bile ducts, while cholecystitis affects the gallbladder, causing inflammation. The gallbladder is a small pear-shaped balloon that lies under the liver.

Many people who have slaughtered any domestic animal would have seen it as a dark green structure that feels like a bag. The colour is due to the bile which it stores, a compound without which digestion of various foods like fats and proteins cannot be complete. The contents are very bitter.

While cholangitis is mainly caused by bacterial infection, thereby causing an acute clinical condition or due to obstruction from gallstones, tumours or worms, it may also be caused by an autoimmune condition, leading to it becoming a chronic disease.

Such inflammation within the bile duct can lead to obstruction such that bile then backs up into the liver and a few other organs. This inevitably will cause inflammation to occur elsewhere in the body and, in severe cases, will lead to a blood-borne infection known as sepsis, which we have discussed some years ago on this page.

Cholecystitis, on the other hand, refers to an inflammatory condition that is limited to the gallbladder. Most cases are found among people who have gallstones, which are small stone-like deposits that form within the gallbladder.

Gallstones and other things which obstruct the gallbladder from emptying its contents properly, such that the bile can build up within it, lead to pressure build-up within the biliary system, the onset of inflammation and the development of a host of complications from chronicity of the condition, sepsis, rupture of the gallbladder and the development of an abscess around it.

This condition is technically known as cholelithiasis, and it usually means that in addition to the inflammatory process, there are stones in the gallbladder. Many of the people who have either cholangitis or cholecystitis also have cholelithiasis (gallstones), which are a common cause of both conditions.

We have also discussed gallstones on this page about six years ago and saw then that it was more common in women especially those ones with certain characteristics of being in their forties; fat; fertile; fair in complexion and well, female. These were discussed back then as the five “Fs” that are most prominently associated with the condition.

So today, we are discussing cholangitis and cholecystitis but not cholelithiasis, which, as we have seen above, can contribute to the development of both conditions. In accordance with the order in which the topic is laid out, we will discuss in the following paragraphs the features of cholangitis followed by those of cholecystitis. It is important to help you determine what the differences are.

The symptoms of cholangitis usually vary in different people simply because we are different. In some cases, a patient may not even be aware of these symptoms, or they may be off-and-on symptoms.

More commonly, however, the most common symptoms will be unusual and excessive shivering attacks; chills or fever; a general feeling of being unwell; swelling of the abdomen; abdominal pain; yellowing of the skin and the eyes, called jaundice; itching of the skin; passing of pale-coloured, smelly stools that float on water; unexplained weight loss and weakness.

These symptoms usually develop slowly and consequently appear slowly over a period before the patient becomes aware. By contrast, the symptoms of cholecystitis are sudden and severe in the acute form but are milder in the chronic form. These patients usually have abdominal pain at a very specific part of the abdomen, which is in the right upper aspect of it; there is associated bloating; formation of excess gas that is relieved through belching and farting.

There may also be pain in the middle of the back that can radiate to the shoulders or affect that part of the body from the onset. In addition, there may be intolerance of certain foods such as fatty or greasy foods and those containing a lot of spices. Nausea and vomiting are also prominent features, as well as an increase in the heart rate. These symptoms may be worse in the evenings and at night.

Due to these differences, a doctor who takes a careful history is usually able to reach a diagnosis after a proper physical examination and consequently request the relevant investigations that can help them confirm the diagnosis. These are mostly blood tests to determine what toll the illness has taken on the person’s physical status, their general level of physical well-being, and the deleterious effects, if any, the illness has had on the liver.

So, full blood tests, as they are called, and liver function tests will help to bring out these facts. Other system checks will depend on whether there are associated ailments such as hypertension, diabetes, and heart or kidney disease. An ultrasound scan is a vital tool to help in showing where blockages or inflammation are present within the liver or the gallbladder.

A patient who has cholangitis, for example, may have increased levels of bilirubin and obvious jaundice, as well as elevated liver enzymes, which will suggest that there is a blockage in the bile ducts. More specifically, an abdominal CT scan will show even more detail, especially after the administration of a contrast medium to bring out the various tissues in bolder relief.

Lastly, MRI will be even better or more specifically, magnetic resonance cholangiopancreatography. Where available, there is still one further investigation that uses endoscopic means to investigate the hepatobiliary system, called endoscopic retrograde cholangiopancreatography, or ERCP. These combine examinations of the liver and gallbladder.

The identification of where these blockages are helps to distinguish between cholangitis and cholecystitis and, even more so, with other problems within the biliary system. In the kind of country we currently live in, many of these investigations are beyond the reach of most of the people who need to do them.

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Some are not even able to afford more than the initial blood tests and an abdominal ultrasound scan. The difference in the nature of these disease conditions also demands different treatments. The therapy prescribed in cholangitis will depend on whether it is acute or chronic.

Primarily, antibiotics are prescribed to deal with the infection and may continue in most cases for 7 to 10 days. Sometimes, treatment could go on for up to 21 days. On the other hand, cholecystitis will usually be treated at the onset with antibiotics followed by an operation to remove the gallbladder. This may be an open operation or by minimally invasive means.

The latter method is often three or more times more expensive than the open surgery, and is not an available option for most Nigerians for obvious reasons. In other situations, like a poor overall health status of a patient or advanced age, certain changes in diet may be recommended and any collection from the organ will be drained through the skin.

Generally, the prognosis in either condition is a good one if prompt and adequate treatment is given. However, it is important to understand that either disease condition can be severe enough to cause death.

Questions and answers

Sunday Doctor, I am 42 years old and trying to get pregnant. For the past three months, I have been seeing bloody egg-white mucus around days 10 to 15 of my menstrual cycle. What does this mean for my fertility and overall health? Thanks. May God continue to bless you .                             081*******

Amen to your prayer. This is a fairly common occurrence that can occur in early pregnancy, when implantation bleeding occurs and may last from a few hours to about two or three days. If there is obvious loss of bright red blood, you should see a doctor for a proper examination. Otherwise, the first thing you should do is a pregnancy test to know if you may be pregnant already.

Sunday Doctor, good afternoon. Please, what can you say about chromosome deletion? Is any of the parents to blame, or the hospital?      0803*******

Let us call it a genetic mistake. It carries huge consequences. They mostly occur from physical damage caused by viruses, heat, ultraviolet rays, excessive irradiation and certain chemicals found in pesticides. Such abnormal irradiation may occur in patients undergoing radiotherapy and those exposed to nuclear contamination, as the world has seen after disasters at Chornobyl in today’s Ukraine and Fukushima in Japan. This is neither the fault of the parents nor the hospital.

Sunday Doctor, good afternoon. I have an eight-year-old son whose penis is just like that of his two-year-old brother. What are the possible implications for his future development?                     0802*******

The size of a penis depends on various factors. There are petite men with large penises and huge men with small penises. This happens at every age bracket without discrimination. There are several other sizes in between. If you are worried, take him to see a paediatrician for a proper examination. If something is found to be wrong, he can be treated.

Sunday Doctor, good day, sir. I am a 53-year-old woman. I just finished taking omeprazole, clarithromycin, and amoxicillin. I feel better and can take yoghurt and even spicy foods. Can I take smoothie even if I add milk into it? Then what about the treatment I took; do I need to take more of the medicine? Thank you.                             0803*******

You can take milk. Since you tolerate yoghurt, milk will not be a problem, because it is good for tackling stomach acid. The continuation of your medicines is a decision for your doctor to make.

Sunday Doctor, good day. Early last week, I forced myself to pass stool, and it came with some blood. Ever since then, going to the toilet has been hell. The pain is always terrible, and I am now afraid to even go there. What could be wrong, please?                   0701*******

Basically, you must have sustained a tear in your anus. That is why you bled. You should see a doctor for the proper examination to be performed so that you can get the appropriate treatment. Your doctor may refer you to a general surgeon if they feel the need to do so.

Sunday Doctor, good evening. My mum has been with me here in Chicago for two years. It is four weeks now since she stopped eating well. She says she thinks she has malaria. Her mouth is bitter, her stomach is foamy, and she has a headache. I took her to see my family physician, who happens to be a Nigerian, and he said there is no malaria in Chicago. What should I do?                                  +(1)7********

Your family physician is correct. However, they should investigate her for other possible causes of these symptoms, including worms which she may have carried along with her. Malaria is unlikely because even if she travelled with the parasites in her blood, they would have all died after about 120 days.

Sunday Doctor, whenever I look down, I feel aches inside my eyes. If I shake my head from side to side, it is very painful. I went to do some blood tests today, but the lab man said I was okay, but that I should take typhoid treatment. So, he prescribed Ciprofloxacin for me to buy. Should I use it?                                                                           081********

You should not use it. The fact that they didn’t see any malaria parasites in your blood does not mean you don’t have malaria. It so much depends on how careful they were in looking for the parasites. Your complaints closely resemble what one would experience when there is malaria. You have two options here: you either take the treatment for malaria using any convenient medication you have used in the past, or you repeat these blood tests in another lab for comparison.