PSC Alert Sheet Acute Cholangitis – Canadian Version
Left untreated, acute cholangitis in PSC can cause serious complications, such as sepsis, jaundice and liver decompensation. This PSC Alert Sheet is a useful reference to help understand your symptoms and make treatment decisions with your medical team if acute cholangitis (also called bacterial cholangitis) is suspected.
Download this PDF version of the PSC Alert Sheet to print at home.
Many thanks to UK-PSC and PSC Support (UK) for sharing their PSC Alert Card for adaptation for people with PSC in Canada. And to the Canadian PSC specialists who reviewed the accuracy of the information.
What is a cholangitis attack?
Cholangitis attacks (or PSC 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 recognize. 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.
Keep track of signs and symptoms.
Do I need medical attention?
Yes. If you think you are having a cholangitis attack, urgent medical care is required. Go to an ER or walk-in clinic or contact your PSC 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 then go to your local emergency room immediately:
- sudden onset of jaundice
- severe pain in the right upper part of your abdomen
- unmanageable fever (for instance, not controlled with acetaminophen (e.g. Tylenol)
- light-headedness/dizziness
- chest pain
- confusion and/or lethargy
- loss of consciousness
If you have severe cholangitis, you may need to be treated and monitored in hospital.
Next steps
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 ERCP 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.
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 provider. If in doubt, seek medical advice early.
- Usual care often includes an urgent blood test.
- Usual care often includes antibiotics.
- If you have an antibiotic prescription at home from your PSC doctor, contact your PSC doctor if you think you have cholangitis for advice about whether you should start the antibiotics.
- Contact your 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.
Prepared January, 2025. With appreciation to PSC Support (UK) and UK-PSC for the development and sharing of the original Cholangitis Alert Card. And to the Canadian PSC medical specialists who reviewed this modified Canadian version.