Do you need to have a fever to have cholangitis? I am in more pain than usual and very nauseated. I also feel very full after I eat a small amount. Just wondering how you can tell if it is cholangitis or regular pain.

You do not necessarily need fever/chills for a cholangitis attack. Fever/chills typically means the infection has been lingering for a bit and is getting worse. For me, I could tell I was having a cholangitis attack when I'd wake up belching and feeling very nauseous, followed by a lot of vomiting. This would be accompanied with absence of appetite, darker urine, and increased itching. If I didn't take antibiotics, then it would escalate to fever/chills over time. That said, I'm sure the signs are different for different people.

Just went for labs and now starting to get a fever. If it goes above 101 I will call and see what they want to do. Thank you.

My liver enzymes are ok except AlkPhos is elevated. I am new to this. Could this be why I am having pain? I have a call in to the doctor.

Sharp stabbing pain, especially after I eat but can come at any time, radiating to my back. Right side. Seems to stab, then let up, then stab again. The back pain is constant. Very nauseated and now have diarrhea. Low grade temp today but nothing over 100.5. Just had a stent removed last Wednesday and all tests were normal until today. I am new to all of this but it seems to have progressed very quickly. Completely occluded bile duct in December and they ballooned it open. In May more pain and was occluded again so they placed a stent, which was removed last week. Just tired of being in pain.

At the very least brief your doctor and see if he/she will prescribe some antibiotics.

Cholangitis attacks can also materialize without usual warning signs. Some of mine happen quite suddenly after weeks of feeling decent. Starts with chills, then fever often 102ish, nausea, headache within an hr or so, then urine very dark. With or without right upper abd pain. Gravol for the nausea (unless already vomiting) and sleep for the next several hours is best bet. Usually on the mend after that (starting Cipro when can keep it down) but if doesn't lift in the next day or 2, then to hospital for IV abx. Very important to go to Emerg if not getting better as you may be obstructing and need ERCP/stenting.

I will try fluids and rest. Waiting for doctor to call. If pain or fever get worse I will go to ER. Thanks everyone.

Hi Deborah,

I was wondering if your doctors had anything to say about the attack without the fevers.

I’ve started taking Urso and stopped eating meat three months ago and haven’t had any fever/chill flare ups since. I do however, often get strange joint pain in my knees, elbows and neck along with right quadrant pain, headaches and gas. I figure they’re mini flare ups and they usually resolve themselves but the one I’m experiencing now has been going on for a week or more. I have Cipro I’m supposed to take when my fever is > 100.4 but I don’t have a fever.

I was hoping you could share your experience in hopes of helping me decide how to proceed.



Joint pain unfortunately goes hand in hand with PSC. Several things that helped me that you might consider. Magnesium. I took 2 600 mg capsules every night at bedtime. This also helped with muscle cramping. Also 600 units of Vitamin E daily. Have you had your CMP labs done recently? If not you might want to have those checked. Your bilirubin may be climbing and if high enough indicating a possible stricture in your ducts which may require an ERCP. Especially if the pain continues to stay you may need to have that checked. You will not necessarily run fever when this occurs, but I always kept a full course of Cipro by my bed if I would have gotten an infection. One other thing you might have your calcium levels checked as well. I know after transplant you have to take mega doses of calcium each day but I didn’t take before transplant. I do wonder if that might help with the joint pain though. Just a thought. Best wishes in your management of your PSC.

PSC 2011 / Liver Transplant 7-2015