Recurrent pyogenic cholangitis

Recurrent Pyogenic Cholangitis (RPC), also known as Oriental Cholangiohepatitis, is a chronic liver disease characterized by repeated episodes of bacterial infection in the bile ducts (cholangitis) and liver. This condition is more prevalent in Southeast Asia and is associated with the formation of bile duct stones and biliary strictures, leading to recurrent bouts of fever, jaundice, and right upper quadrant abdominal pain.

Etiology

The exact cause of RPC is not well understood, but several factors have been implicated in its development. These include parasitic infections, particularly by Clonorchis sinensis (a liver fluke), nutritional deficiencies, and genetic predisposition. The condition is also associated with poor sanitation and hygiene practices.

Pathophysiology

RPC is characterized by the formation of pigmented stones within the bile ducts, which leads to obstruction and secondary bacterial infection. The recurrent infections and obstructions cause chronic inflammation, leading to the development of multiple strictures along the bile ducts. Over time, this can result in secondary biliary cirrhosis and an increased risk of cholangiocarcinoma (bile duct cancer).

Clinical Features

Patients with RPC typically present with recurrent episodes of:

• Fever
• Jaundice
• Right upper quadrant abdominal pain
• Chills
• Dark urine
• Clay-colored stools

Diagnosis

The diagnosis of RPC is based on a combination of clinical history, imaging studies, and laboratory tests. Imaging modalities such as Ultrasound, CT scan, and Magnetic Resonance Cholangiopancreatography (MRCP) are crucial for visualizing the bile ducts, detecting stones, and identifying strictures and dilatations. Laboratory tests may show elevated liver enzymes and signs of infection.

Treatment

Treatment of RPC focuses on relieving biliary obstruction and treating bacterial infections. This may involve:

• Antibiotics to control the infection
• Endoscopic removal of bile duct stones
• Endoscopic Retrograde Cholangiopancreatography (ERCP) with sphincterotomy and stent placement to relieve obstruction
• Surgical intervention in cases where endoscopic treatment is not feasible or successful

Prevention

Preventive measures for RPC include improving sanitation and hygiene practices to reduce the risk of parasitic infections and ensuring adequate nutrition.

Prognosis

The prognosis for patients with RPC varies. While the condition can be managed with appropriate treatment, recurrent infections and complications such as biliary cirrhosis and cholangiocarcinoma can significantly affect the quality of life and life expectancy.

See Also

• Cholangitis
• Biliary cirrhosis
• Cholangiocarcinoma
• Liver fluke