cholangitisInflammation of the com-
mon bile duct (see biliary system). There
are 2 types: acute ascending cholangitis
and sclerosing cholangitis. Acute
ascending cholangitis is usually due to
bacterial infection of the duct and its
bile, generally as a result of blockage of
the duct by, for example, a gallstone
(see bile duct obstruction). The infection
spreads up the duct and may affect the
liver. The main symptoms are recurrent
bouts of jaundice, abdominal pain,
chills, and fever. Mild attacks are treated
with antibioticsand a high intake of flu-
ids. In severe, life-threatening attacks,
which may be accompanied by septi-
caemiaand kidney failure, the infected
material may be drained from the bile
duct by surgery or endoscopy.
Sclerosing cholangitis is a rare condi-
tion in which all the bile ducts within
and outside the liver become narrowed.
The condition causes cholestasis, chron-
ic jaundice, and itching of the skin. The
liver is progressively damaged. Colestyra-
minemay relieve itching. The only other
treatmentavailable is a liver transplant.
chole-A prefix that means relating to
thebileor the biliary system.
cholecalciferolAn alternative name
for colecalciferol, also known as vitamin
D 3 (see vitamin D).
cholecystectomySurgery to remove the
gallbladder, usually to deal with gall-
stones. Cholecystectomy is also used in
acute cholecystitisand as an emergency
treatment for perforation of the gall-
bladder or empyema. The procedure is
carried out using conventional surgery
or, more commonly, by minimally inva-
sive surgeryusing a laparoscope.
cholecystitisAcute or chronic inflam-
mation of the gallbladder, causing severe
abdominal pain. Acute cholecystitis is
usually caused by a gallstoneobstruct-
ing the outlet from the gallbladder. The
trapped bile causes irritation of the
gallbladder walls and may become in-
fected by bacteria. The main symptom
is severe constant pain in the right side
of the abdomen under the ribs, accom-
panied by fever and, occasionally,
jaundice. Treatment is usually with anal-
gesic drugs, antibiotic drugs, and an
intravenous infusion of nutrients andfluids. In some cases, complications
develop, which may include peritonitis,
if the gallbladder bursts, and empyema.
Both require urgent surgical treatment.
Repeated mild attacks of acute chole-
cystitis can lead to a chronic form, in
which the gallbladder shrinks, its walls
thicken, and it ceases to store bile.
Symptoms (indigestion, pains in the
upper abdomen, nausea, and belching)
may be aggravated by eating fatty food.
Cholecystectomyis the usual treatment.
cholecystographyAn X-ray procedure
that uses a contrast mediumto examine
the gallbladderand common bile duct,
usually to detect gallstones. Cholecys-
tography has largely been replaced by
ultrasound scanning of the gallbladder.
cholecystokininA gastrointestinal hor-
moneproduced in the duodenumin
response to the ingestion of fats and
other food substances. It stimulates the
release of bile from the gallbladderand
digestive enzymes from the pancreas,
thus facilitating the digestive process.
choleraAn infection of the small intes-
tine by the bacterium VIBRIO CHOLERAE
causing profuse watery diarrhoea, which
can lead to dehydration and death.
Infection is acquired by ingesting con-
taminated food or water. Outbreaks of
cholera occur regularly in northeast India,
but worldwide the disease is controlled
by sanitation. Treatment is with water
containing salts and sugar (see oral
rehydration therapy) and, in severe cases,
intravenous infusion. Antibiotic drugs
can shorten the period of diarrhoea and
infectiousness. With adequate rehydra-
tion, affected people usually make a full
recovery from the infection.
cholestasisStagnation of bilein the
small bile ductswithin the liver, leading
to jaundice and liver disease. The
obstruction to the flow of bile may be
intrahepatic (within the liver) or extra-
hepatic (in the bile ducts outside the
liver). Intrahepatic cholestasis may occur
as a result of viral hepatitis (see hepati-
tis, viral) or as a side effect of a number
of drugs. The flow of bile improves grad-
ually as the inflammation from the
hepatitis resolves or the drug is discon-
tinued. The bile ducts outside the liver
can become obstructed by, for example,CHOLANGITIS CHOLESTASISC