Cholangitis - inflammation of the bile ducts. It's hard proceeding disease, which can be independent, but often combined with inflammation of the gallbladder or liver.
The primary cause of cholangitis is a violation of the bile ducts and the accession of infection. Violation of the bile ducts often occurs when choledocholithiasis - gallstones in the biliary tract. Other causes of impaired bile flow may be narrowing of bile ducts scarring due to chronic cholecystitis, gallbladder removal (postcholecystectomical syndrome), cysts or tumors of the common bile duct.
Often the flow of bile is impaired by helminthic invasion. Bile ducts may be blocked by Ascaris. These parasitic diseases as opistorhoz, hydatid disease, shistostomoz, giardiasis can also give rise to cholangitis.
Infection in the biliary tract mainly falls from the intestine as bile stasis in broken mechanism prevents the penetration of the intestinal contents in an upper part of the gastrointestinal tract. In addition to the rising (intestinal) path of infection exists and downward path when the infection penetrates into the biliary tract to the blood or lymph from the other inflammatory focus in the abdomen.
Types of cholangitis
By the nature of the flow are acute and chronic cholangitis.
Acute cholangitis, depending on the type of inflammation may take the following forms:
- Catarrhal cholangitis, in which there is swelling of the mucous membrane of the bile ducts. This form of treatment in the absence of the inflammation becomes chronic, and results in further narrowing of cicatricial ducts;
- Suppurative cholangitis. Bile ducts are filled with purulent discharge, mixed with gall. This form often spreads to the gallbladder and liver, involving these authorities in purulent inflammation;
- Diphtheritic cholangitis. The mucosa of the biliary tract ulcerate and then necrotic, leading to the destruction of the bile ducts and the walls of purulent fusion of the surrounding tissues, including the liver;
- Necrotizing cholangitis. It occurs when ingested bile ducts aggressive pancreatic enzymes, resulting in the development of areas of necrosis mucosa of the biliary tract.
Chronic cholangitis on the nature of the flow can be latent (hidden), recurrent, and septic abscess.
A special form of chronic cholangitis - sclerosing cholangitis. This primary chronic inflammation that occurs without an infectious agent, presumably autoimmune nature. When this occurs in the biliary tract inflammation, resulting in sclerosis - tough overgrowing ductal lumen, which in turn leads to cirrhosis. Sclerosing cholangitis is not treatable, has slowly-progressive course, and for an average of 10 years leads to serious violations of which can be fatal.
The symptoms of cholangitis
Symptoms of acute cholangitis in manifest rapidly, there is fever with chills and drenching sweat, the pain of the type of biliary colic - a rather intense, aching, localized in the right upper quadrant, sometimes extending to the shoulder blade and upper arm. It is accompanied by nausea, vomiting. Skin and sclera take yellow, appears itching.
Symptoms of acute cholangitis in older patients and children have some differences. In elderly people, the pain may be absent, and scant inflammation symptoms cholangitis, however, takes a heavy, usually purulent form.
Cholangitis in children in the acute form is rare, mainly as a secondary infection (usually strep) in other diseases. Acute cholangitis in children occurs very rapidly, symptoms of cholangitis in this case, non-specific and peculiar to any acute inflammation of the gastrointestinal tract, and therefore acute cholangitis in children may be mistaken for other gastrointestinal diseases.
The symptoms of cholangitis in chronic less severe, intense pain inherent only in the presence of stones in the bile ducts. The main symptoms of cholangitis in this case is the general weakness and fatigue, unexplained periodic temperature rises, itchy skin. The signs of cholangitis is clubbing and redness of the palms.
Chronic cholangitis in children causes a decrease in body weight due to a lack of appetite and nausea, constant intoxication leads to anemia, jaundice or pallor of the skin, slows down the physical development of the child can be left behind and in the overall development, there are chronic headaches.
Diagnosis is based on characteristic symptoms of cholangitis, a thorough examination of the data and hardware and laboratory studies:
- Ultrasound of the gallbladder, liver and bile ducts;
- Radioisotope study of the biliary tract;
- Intravenous cholangiography (X-ray of the biliary tract with intravenous contrast agent, allowing to see the intra- and extrahepatic ducts);
- Retrograde cholangiopancreatography (X-ray of the biliary tract and pancreas with endoscopic injection of contrast agent);
- Holangiomanometriya (measuring the pressure inside the bile duct);
- Holedohoskopiya (endoscopic examination of the bile ducts);
- General and biochemical analysis of blood;
- Laboratory examination of the bile.
Treatment of cholangitis
Treatment cholangitis may be conservative or surgical, depending on the form of the disease. Treatment of cholangitis is only in the hospital, because of the risk of serious complications - purulent abscesses of the liver and gall bladder, peritonitis, and cholangitis in chronic liver cirrhosis.
Conservative treatment of cholangitis used when there is no mechanical obstruction of the outflow of bile biliary ways. In this case, the prescribed antimicrobials (broad spectrum antibiotics and sulfonamides), drugs that reduce toxicity (gemodeza intravenous, etc.) that improve the flow of bile, spasmolytics (e.g. Duspatalin).
In cases where conservative treatment does not give results, as well as in all cases where it is impossible to establish the normal flow of bile medication, resorting to surgical treatment of cholangitis. The method of choice at the moment, in the absence of contraindications (purulent, necrotic processes, abscesses) is an endoscopic procedure.
This method allows for drainage of bile duct stone removal, elimination of stenosis (narrowing), without resorting to extensive abdominal surgery, thus reducing operative trauma, prevent bleeding and improve recovery. If you have more severe cholangitis spend abdominal operation to remove portions subjected to purulent fusion or necrotic decay. In the postoperative period prescribed antibiotic therapy.