Chronic cholangitis - causes, symptoms, diagnosis and treatment
Chronic cholangitis - An inflammatory disease of the biliary tract (both intra- and extrahepatic ducts), characterized by a long recurrent and lead to cholestasis. The main clinical signs - a combination of pain in the liver, high fever, chills and jaundice. The diagnosis is based on ultrasonography of the pancreas and biliary tract, retrograde cholangiopancreatography, CT biliary tract, biochemical and blood count. Combined Treatment: conservative antibiotic therapy, pain relief, detoxification, surgical decompression of the biliary tract.
Chronic cholangitis
cholangitis is much rarer than the other inflammatory diseases of the hepatobiliary system. This pathology develops mainly in the adult population (average age 50 years), with significant differences in disease have both men and women. The most common chronic cholangitis occurs against a background of other diseases of the liver and gall bladder, in 37% of cases is formed after cholecystectomy. There is a special form of the disease - primary sclerosing cholangitis, which develops on the background of relative health, and slowly progresses for about ten years leads to irreversible liver damage. The true incidence figures sclerosing cholangitis is unknown, as its diagnosis is difficult. Among patients dominated by young men (the disease manifests in the age of 20-25 years). In recent years, the tendency of growth of cases sclerosing cholangitis, which is due primarily to the improvement of its diagnosis. Depending on the timing of detection of disease and mortality in chronic cholangitis may range 15-90%.
blood cultures for sterility).
To promote the penetration of the intestinal flora in the bile duct are: disruption of duodenal papilla, and hematogenous dissemination lymphogenous bacterial agents. This mechanism of infection observed in the anomalies of the biliary tract (congenital cysts and others.); stenosis and deformities after surgery, endoscopic procedures; tumors of the pancreas and ZHVP; cholestasis on the background of cholelithiasis; parasite infestation. For the formation of chronic cholangitis usually requires a combination of translocation of intestinal flora in the biliary tract, cholelithiasis and increase intraductal pressure. Chronic cholangitis can be configured as a logical continuation of acute cholangitis, but perhaps his primary chronic course.
Thus, the risk factors of chronic cholangitis are any medical diagnostic and surgical interventions on the biliary tract, performed on the background of congenital malformations and infection.
biliary colic patient noted a mild fever, accompanied by chills unexpressed. Clinic chronic cholangitis usually worn, recurrent, so patients do not always attach importance to the first manifestations of the disease. In the later stages of the disease may occur ikterichnost skin, mucous membranes. Gradually developed a general weakness, fatigue, especially pronounced in the elderly. After 60 years of diagnosis of chronic cholangitis it is usually difficult because the clinical picture does not match the severity of the inflammatory process, erased symptoms, so diagnosis is late.
Chronic suppurative cholangitis can lead to infection penetration into the systemic circulation and the development of biliary septic shock, which in 30% of cases are fatal. No less severe complications are liver abscess, porto-caval thrombosis and other septic manifestations. Sclerosing cholangitis is often complicated by chronic liver cirrhosis, hepatocellular carcinoma.
gastroenterologist is required in all patients with suspected biliary tract pathology. The basis for the formulation of the correct diagnosis is to determine the patient's triad Charcot. Further examination begins with laboratory tests. In general, the analysis of the blood in chronic cholangitis identify high leukocytosis, neutrophilic leukocyte shift, increased ESR. Biochemical screening detects increased levels of bilirubin, alkaline phosphatase activity and D-GTR rarely - transaminases and alpha-amylase. Microbiological studies almost 100% of patients indicate the presence of bile in the intestinal flora, half of the patients - in the blood.
Widespread use in chronic cholangitis found and instrumental methods of diagnosis. Thus, ultrasonography of the pancreas and biliary tract indicates expansion and thickening of the walls of the bile ducts. CT biliary tract not only confirm data obtained during the ultrasound, but also help to identify complications of suppurative cholangitis (liver abscesses, pylephlebitis).
Consultation doctor-endoscopist need for retrograde cholangiopancreatography, which helps visualize calculi in the biliary tract, and point to their expansion. Magnetic resonance cholangiopancreatography in recent years comes to replace ERCP as a non-invasive technique that allows not only to identify signs of chronic cholangitis, but also to determine the reasons for its development. If the diagnostic search carried out before surgery, can be used percutaneous transhepatic cholangiography - through a needle inserted into the biliary tract, it is carried out not only by their contrasting but drainage.
Differentiate chronic cholangitis should be viral hepatitis, obstruction of the bile duct with gallstones, and acute calculous cholecystitis, tumors (liver, pancreas, bile ducts), strictures of the bile ducts of another etiology.
Gastroenterology.
Drug therapy with bile hypertension is regarded as a stage of preparation for the rapid discharge of the biliary tract. The department carried out detoxification, appointed analgesic and antibiotic therapy. Pending receipt of bacterial cultivation appointed broad-spectrum antibiotics - cephalosporins, penicillins (penetrating into the bile), aminoglycosides. During the verification of a parasitic infection assigned etiotropic antiparasitic treatment.
The goals of surgical intervention in chronic cholangitis is to remove stones from the biliary tract and improve bile outflow (drainage GVP). For this purpose, carried out external drainage of the bile duct (by Kerr, on Halstead), percutaneous transhepatic drainage of the biliary drainage with nazobiliarnoe RPHG, extraction of stones from the common bile duct, bile duct stone extraction with RPHG, endoscopic stenting of the common bile duct, endoscopic balloon dilatation of the sphincter of Oddi.
Postoperatively, it is recommended to continue antibacterial and choleretic therapy to diet, to include in the diet of foods rich in vitamins and vegetable oils.
Prediction and prevention of chronic cholangitis
Chronic cholangitis - this is a serious pathology, which has a fairly high mortality rate and the incidence of complications. Worsens the prognosis in chronic cholangitis old age, female sex, prolonged hyperthermia (over two weeks), consciousness disorders, anemia, signs of liver failure and kidney failure. Prevention of recurrent cholangitis and secondary aims at timely diagnosis and treatment of diseases that lead to this condition.