Cholangitis - causes, symptoms, diagnosis and treatment

Cholangitis - Non-specific inflammation of the bile ducts acute or chronic course. When cholangitis noted in the right upper quadrant pain, fever with chills, dyspepsia, jaundice. Cholangitis diagnosis involves analysis of biochemical parameters of blood, holding a fractional duodenal intubation with bakissledovaniem bile, ultrasonography, percutaneous transhepatic cholangiography, ERCP. In the treatment of cholangitis used antibiotic therapy, detoxification therapy, the purpose of enzymes, FTL (mud baths, sodium chloride baths, paraffin and ozokeritoterapiya, UHF, diathermy), sometimes - surgical decompression of the biliary tract.

  • Classification cholangitis
  • Reasons cholangitis
  • The symptoms of cholangitis
  • Diagnosis cholangitis
  • Treatment cholangitis
  • Prediction and prevention of cholangitis
  • Cholangitis - treatment

  • Cholangitis


    Gastroenterology cholangitis, usually diagnosed in conjunction with gastroduodenitis, cholecystitis, hepatitis, cholelithiasis, pancreatitis.

    suppurative cholangitis occurs melting of the walls of the bile ducts and the formation of multiple abscesses. Severe observed during the formation of fibrinous films on the walls of the bile ducts (cholangitis diphtheritic) and the emergence of foci of necrosis (necrotizing cholangitis).

    The most common chronic cholangitis, which can develop as a result of acute inflammation or acquire a protracted course from the beginning. There are latent, recurrent, long-term current septic, abscess, and chronic sclerosing cholangitis form. When sclerosing cholangitis in biliary ducts walls grows connective tissue that causes the bile duct stricture and even more of their deformation.

    According to the localization of inflammation distinguish choledochitis (inflammation of the common bile duct - common bile duct), angiocholitis (inflammation of the intrahepatic and extrahepatic bile ducts), papillitis (inflammation of the papilla of Vater). By etiological factors distinguish bacterial cholangitis, aseptic and parasitic nature.

    anaerobic infections, at least - Mycobacterium tuberculosis, typhoid bacillus, Treponema pallidum). The microorganisms penetrate into the bile ducts mainly by rising from the lumen of 12 duodenal ulcer, hematogenous - via the portal vein, lymphogenous - cholecystitis, pancreatitis, enteritis. The small intrahepatic bile ducts are usually inflamed in viral hepatitis. Parasitic cholangitis often develop during concomitant opistorhoze, ascariasis, giardiasis, strongyloidiasis, clonorchiasis, fascioliasis.

    Aseptic enzymatic cholangitis may develop as a result of irritation of the walls of the bile ducts activated pancreatic juice, which takes place in pancreatobiliary reflux. In this case, there is a first aseptic inflammation and infection accession takes place again, at a later period.

    In aseptic type and sclerosing cholangitis occurs due to an autoimmune inflammation of the bile ducts. At the same time, along with sclerosing cholangitis, often marked ulcerative colitis, Crohn's disease, vasculitis, rheumatoid arthritis, thyroiditis, and so on. D.

    The prerequisites for the development of cholangitis is cholestasis, which occurs when dyskinesia biliary tract anomalies of the bile ducts, choledochal cysts, cancer, biliary tract, choledocholithiasis, stenosis of the papilla of Vater, and so on. D. Precede the onset of cholangitis may be iatrogenic damage to the duct wall during endoscopic manipulation (retrograde cholangiopancreatography, installing stents, sphincterotomy), surgical interventions on the biliary tract.

    biliary colic, radiating to the right shoulder blade and neck. In acute cholangitis rapidly growing intoxication, progressing weakness, deteriorating appetite, worried headache, nausea, vomiting, diarrhea. Later in acute cholangitis appears jaundice - yellowing of the skin and visible sclera. Against the background of jaundice develops itching, usually worse at night and disrupts normal sleep. As a result, pronounced itching in the body of the patient with cholangitis are determined by scratching the skin.

    In severe cases, the triad of Charcot can join impairment of consciousness and shock phenomenon - in this case develops syndrome known as Reynolds' pentad.

    Clinical manifestations of chronic cholangitis are erased, but the progressive nature. The disease is characterized by a dull pain in his right side weak intensity, discomfort, and epigastric fullness. Jaundice with chronic cholangitis develops late and indicates far come changes. Common disorders in chronic cholangitis include low-grade fever, fatigue, weakness.

    Complications cholangitis may be holetsistopankreatit, hepatitis, biliary cirrhosis, multiple liver abscesses, peritonitis, sepsis, toxic shock, liver failure.

    Biochemical tests indirectly indicate cholestasis; with cholangitis noted an increase in bilirubin, alkaline phosphatase, transaminases, alfa-amylase. To detect pathogens carried cholangitis fractional duodenal intubation with bacteriological sowing bile. In 60% of cases with cholangitis occurs mixed bacterial flora. In order to avoid parasitic infestation study shows feces on eggs of helminths and protozoa.

    By visualizing diagnostic methods cholangitis otnosyatsya abdominal ultrasound and liver, biliary tract, ultrasonography, CT. With their help it is possible to obtain an image of the bile ducts, to reveal their expansion, to determine the presence and focal structural changes in the liver.

    Among the instrumental methods of diagnosis of cholangitis leading role for endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography (MRPHG) chrespechёnochnoy percutaneous cholangiography. On the obtained radiographs and tomograms well visualized biliary tract structure that allows you to identify the cause of obstruction.

    Differential diagnosis of cholangitis is needed with cholelithiasis, cholecystitis non-calculosis, viral hepatitis, primary biliary cirrhosis, pleural empyema, right-sided pneumonia.

    plasmapheresis.

    In remission cholangitis widely used physiotherapy: inductothermy, UHF, microwave therapy, elektoroforez, diathermy, mud applications, ozokeritoterapiya, paraffin, sodium chloride baths.

    Since the treatment of cholangitis is impossible without normalization zhelcheotvedeniya functions often have to resort to various surgical procedures. In order to decompress the bile duct may be held zndoskopicheskaya papilosfinkterotomiya, extraction of bile duct stones, endoscopic stenting of the common bile duct, percutaneous transhepatic bile duct drainage, external drainage of the bile ducts, and others. Intervention.

    The most effective treatment for sclerosing cholangitis is a liver transplant.

    cirrhosis, renal failure, generalized septic process, forecast unsatisfactory. Timely treatment of catarrhal cholangitis allows for healing; with purulent, diphtheritic and necrotic form - a more serious prognosis. Prolonged course of chronic cholangitis can lead to permanent disability.

    Prevention cholangitis necessitates timely treatment gastroduodenitis, acalculous cholecystitis, cholelithiasis, pancreatitis, helminth and protozoan infestations; observation by a gastroenterologist after previous surgery on the biliary tract.