Is cholangitis dangerous what to do. Cholangitis - inflammation of the bile ducts

Cholangitis is an inflammation of the bile ducts that occurs as a result of infection through the blood or lymph coming from the gallbladder or intestines. The syndrome rarely develops on its own, most often occurring as a complication of hepatitis, pancreatitis, gallstone formation, gastroduodenitis, if the patient ignored their symptoms and was not treated.

Classification

Determining the type of disease plays an important role in the preparation of a treatment regimen. Cholangitis is classified into several groups of signs. According to the nature of the course, acute and chronic forms are distinguished. According to pathomorphological changes, the acute form is divided into subtypes:

• purulent - characterized by the melting of the walls of the bile ducts and the formation of many internal abscesses;
• catarrhal - it is characterized by swelling of the mucous membranes lining the inner surface of the biliary tract, excessive blood flow to them and a glut of leukocytes with further exfoliation epithelial cells;
• diphtheritic - begins with the appearance of ulcers on the mucous membranes, desquamation of the epithelium and leukocyte infiltration of the walls, followed by tissue death;
• necrotic - passes with the formation of dead areas that occur under the influence of aggressive enzymatic activity of the pancreas.

Chronic cholangitis is divided into the following forms:

• sclerosing (with proliferation of connective tissue);
• latent;
• recurrent;
• septic for a long time;
• abscessing.

According to the location of the inflammatory process, there are:

• choledochitis (inflamed common duct);
• angiocholitis (affected intra- and extrahepatic bile ducts);
• papillitis (inflamed large duodenal papilla).

By origin, cholangitis happens:

The chronic form of the disease is more common than the acute form and develops after an exacerbation of the disease and as an independent disease, initially taking a protracted course.

Sclerosing type cholangitis is a special form of the disease. Initially having a chronic form of the course, inflammation in the bile ducts occurs without prior infection. The inflammatory process leads to tissue sclerosis - hardening, they completely block the lumen of the ducts, thereby causing cirrhosis of the liver. This disease is not treatable, slow progress (about 10 years) ends with the formation severe violations followed by death.

Main reasons

In most cases, cholangitis occurs as a result of an infection in the bile ducts. The most common infectious agents are:

• coli;
• staphylococcus;
• enterococcus;
• non-clostridial anaerobic infection;
• pale spirochete;
• typhoid stick.

The infection can spread upward. In this case, pathogenic bacteria enter the bile ducts:

• from duodenum;
• through the blood through the portal vein;
• through the lymph (as a complication of pancreatitis, enteritis, cholecystitis).

The main prerequisite for the formation of the pathological condition of the bile ducts is considered to be their impaired patency, which contributes to the stagnation of bile and is an unfavorable factor in the penetration of infection. The patency of the biliary tract is impaired in such diseases:

• choledocholithiasis - stone formation in the biliary system;
• chronic cholecystitis, accompanied by narrowing of the lumen of the ducts as a result of tissue scarring;
• postcholecystectomy syndrome - pathological condition coming after excision of the gallbladder;
• cystosis or tumor process of another etiology with localization in the bile duct;
• stenosis of the duodenal papilla;
• cholestasis - obstructed bile secretion, occurring with biliary dyskinesia.

With the development of infection in a descending type, microorganisms affect the extra- and intrahepatic bile ducts, penetrating from the affected organs abdominal cavity above the gallbladder.

Cholangitis can also be provoked by endoscopic manipulations for the treatment or examination of the bile ducts, as a result of which the integrity of the walls was violated: choledochal stenting, retrograde cholangiopancreatography, sphincterotomy. Damaged mucous membranes become especially vulnerable to bacteriological infections, therefore, after any invasive examination or operation, you should regularly visit a doctor in order to control the healing process.

Symptoms

In adults and children early age cholangitis develops in different ways. Adult patients rarely complain of pain in the acute stage. Their primary symptoms are mild, but if left untreated, the disease progresses rapidly, turning into a purulent complicated form, with extensive internal inflammation, fraught with general sepsis.

In children, the acute form of cholangitis practically does not occur. Most often, it begins after the addition of a secondary streptococcal infection. The signs of the disease are nonspecific, the symptoms largely coincide with other diseases of the gastrointestinal tract, so if they occur, you should consult a doctor who will differential diagnosis on the basis of which an effective treatment regimen will be drawn up.

The following signs indicate the development of acute cholangitis:

• pain in the right hypochondrium of a aching nature, radiating to shoulder joint or in the region of the scapula;
• fever, accompanied by chills and intense sweating;
• bouts of nausea leading to vomiting;
• jaundice with the addition of severe skin itching.

In the absence of adequate measures for the treatment of acute cholangitis, the pathology becomes chronic, which is characterized by the following manifestations:

• decreased performance, constant weakness;
• hyperemic and itchy skin (most often on the palms);
• an increase in body temperature outside of colds;
• thickening of the distal (nail) phalanges of the fingers.

AT childhood cholangitis leads to weight loss because the child is constantly sick and refuses to eat. Intoxication caused by the activity of microorganisms and decay products formed during extensive purulent inflammation leads to the development of an anemic state. The patient's skin is pale, the sclera are colored in yellow. The child may complain of constant headaches. If at this stage of cholangitis is not treated, the progress of the disease can lead to a slowdown in physical development.

Diagnosis of the disease

Since this disease is recognized by outward signs is not possible, on the basis of a physical examination only a presumptive diagnosis is made. Its clarification is carried out on the basis of a comprehensive examination of the patient, including the following laboratory and hardware examinations:

1. Liver tests will allow you to determine the biochemical composition of the blood (to draw up a treatment plan, the doctor will need information about the level of bilirubin, transaminases, alkaline phosphatase, alpha-amylase).
2. Examination of the contents of the duodenum by duodenal sounding and bacteriological culture of bile will help to identify the type of microorganisms that caused cholangitis.
3. Analysis for helminthic invasions (ascaris, lamblia, etc.).
4. On ultrasound, CT, ultrasonography, the nature of pathological changes in the biliary tract, their narrowing or expansion, localization of inflamed areas and the nature of local blood circulation. A hardware examination will make it possible to assess the condition of the bile ducts and liver themselves.
5. In combination with hardware methods, endoscopic research methods are used in the diagnosis: transhepatic cholangiography, retrograde pancreatocholangiography.

Diagnosis begins with the delivery of laboratory tests, according to the results of which the doctor will determine the necessary additional studies that he needs to draw up a treatment plan.

Complications

If you ignore the first signs of cholangitis and do not diagnose and treat this disease in time, the inflammatory process in the biliary tract can lead to the following serious conditions:

• Crohn's disease;
• cirrhosis of the liver;
• the development of hepatic coma;
• acute liver or kidney failure;
• hepatitis;
• blood poisoning;
• peritonitis;
• infectious-toxic shock.

Treatment

When the diagnosis of cholangitis is confirmed, the main vector of treatment is the removal of the internal inflammatory process. At the same time, intoxication of the body is eliminated and measures are taken to stop the processes that cause compression of the bile ducts. In the presence of concomitant diseases of the biliary system, gastrointestinal tract, liver or kidneys, a medication course is required to correct them.

To suppress pathogenic microflora, combinatorial drug treatment broad-spectrum antibiotics (cephalosporins, metronidazole, aminoglycazides). In order to remove intoxication as soon as possible, blood plasma is purified (plasmapheresis). To consolidate the result of treatment outside the acute stage of cholangitis, stabilization of the patient's condition is facilitated by physiotherapeutic procedures.

The general well-being of the patient during this period is well affected by the use of therapeutic mud, treatment paraffin applications, sodium chloride baths with a high concentration, physiotherapy with the use of high-frequency magnetic fields, drug electrophoresis, deep heating with currents.

Launched cholangitis in a chronic form is not amenable to conservative treatment. At this stage, the ducts are often so deformed that it is no longer possible to restore their patency with a course of antibiotics.

Surgical treatment is recommended when all methods of conservative therapy have already been applied, and it was not possible to normalize the outflow of bile. by the most effective method surgical treatment advanced forms of cholangitis are considered endoscopic procedures - minimally invasive and having a brief rehabilitation period. Endoscopic techniques are contraindicated in necrotic and purulent processes, and are also excluded in the presence of multiple abscesses in the lumen of the biliary tract.

Surgical interventions are carried out in order to eliminate the decompression of the affected pathways. Their format is determined by the prevalence of the inflammatory process and the nature of pathological changes. So, as part of the surgical treatment of sclerosing type cholangitis, doctors recommend a liver transplant.

Diet

Diet therapy is an integral part of the treatment of all diseases associated with impaired functionality of the organs responsible for digestion. Nutrition during inflammatory processes in the bile ducts should be organized in such a way as to normalize the functioning of the biliary system and reduce the load on the liver.

For this, fasting is prescribed in the first 2 days of treatment of acute cholangitis. After that, easily digestible foods are gradually introduced into the diet. At the time of treatment, foods high in fat, smoked meats, salted, spicy and fried foods are completely excluded.

• wholemeal bread;
• dairy products with a minimum fat content;
• vegetables - it is allowed to take it raw, but preference is given to stewed or boiled, as well as steamed vegetable dishes;
• eggs;
• pasta;
• porridge.

If the patient feels well, boiled or baked meat of low-fat diet varieties (rabbit, turkey, veal) can be added to the diet.

To avoid intense bile formation, throughout the course of treatment, you need to eat fractionally, in small portions, taking breaks between meals at 2-3 hours.

Of particular importance in the treatment of cholangitis is the drinking regimen. Drinking up to 1.5 liters per day pure water without gas, the patient will provide favorable conditions to remove toxins. Instead of water, you can drink a decoction of wild rose or dried fruits, ginger or green tea - they relieve nausea well and help detoxify the body.

Eating food from the list of prohibited foods will reduce the effectiveness of treatment and may cause a recurrence of cholangitis even during a period of long-term remission.

Prevention and prognosis

With timely treatment of the acute form of the disease, not complicated by sepsis, abscess formation or functional insufficiency of the liver or kidneys, the pathology is cured by conservative methods. Factors that worsen the prognosis are elderly age, chronic course of the disease, fever persisting for 14 days or longer, anemia, female gender.

Chronic forms of cholangitis often occur with complications requiring surgical intervention. An inflammatory process that lasts for years can lead to disability, and in this case there is a high probability of death. The cause of death is septic shock, which occurs as a result of systemic blood poisoning and occurs when the patient refuses treatment.

Among diseases of the digestive tract, cholangitis is one of the most difficult pathologies in terms of diagnosis and treatment. There are several different forms of this disease, which differ in symptoms and causes. Some of them are hidden and do not have a specific cause. All these factors make it difficult to determine the disease and “postpone” the time to start therapy.

What can this lead to? Here is a far from complete list of complications: sepsis (blood poisoning), cirrhosis of the liver, cancer of the bile duct or bladder, infectious toxic shock, etc. Each of these conditions arises either due to the lightning-fast course of the pathology, or due to its untimely diagnosis. About how to suspect the disease in the initial stages and start proper treatment you can find out from this article.

What is cholangitis and the basics of anatomy

The literal translation of the word "cholangio" from Latin- gallbladder. Accordingly, cholangitis is an inflammatory process in any of these vessels. A person has a complex network of ducts of various sizes through which bile flows. This network begins with the liver and ends in the intestines, where fats are digested and harmful microbes are destroyed.

Simplistically, the path of this biological fluid can be described by the following steps:

1. During meals or special medications, bile begins to form in the liver lobules. Then it enters the intrahepatic bile capillaries;
2. From the entire liver, the capillaries are collected in two large ducts - one for each lobe of the organ (right and left);
3. From these formations, the common hepatic duct is formed, to which it joins gallbladder through the cystic duct. Together, these two structures form a large "collector" of bile - Choledochus (synonymous with the common bile duct);
4. Choledoch opens into the duodenum and secretes the required amount of bile. Unused balances are returned to the bubble along the same path.

Symptoms of cholangitis occur when intrahepatic or extrahepatic structures that are involved in the release of bile components are affected.

Types of disease

As we have already said, the signs of cholangitis can differ significantly in various forms of the disease. For convenience, doctors divide this pathology according to two main criteria - the duration of the course and the type of inflammation. These nuances are of fundamental importance, since they determine optimal time care (emergency / planned), doctor's tactics and the need for surgery.

Depending on the duration of the course, the following pathology options are distinguished:

• Fulminant or fulminant. The most severe and dangerous form, in which all signs of the disease and blood poisoning appear suddenly and progress rapidly (within a few hours). Fulminant ends in death in 90-100% of cases, even despite timely and qualified medical care;
• Spicy. The most common variant, in which typical symptoms appear, developing within 1-2 days;
• Chronic. The most difficult option for diagnosis. It can occur on its own or as a result of an acute form. Clinical picture at the same time, it is often erased - often the only complaint of patients is liquid stool or intermittent abdominal pain.

The second fundamental point in determining the form of pathology is the type of inflammatory process. In any diagnosis, this nuance is necessarily indicated, since further treatment tactics depend on it. Currently, doctors distinguish the following options:

Causes

The greatest role in the occurrence of cholangitis (all but sclerosing) is played by the presence of two factors - a harmful microorganism and stagnation of bile. What causes them to occur? The bacterium that causes the inflammatory process can enter the ducts from the gallbladder or from the intestinal cavity. That is why cholangitis often occurs after acute cholecystitis, in the presence of intestinal (small intestinal) insufficiency or biliodigistive reflux - the reflux of intestinal contents into the duct system.

Stagnation of bile appears when its outflow is disturbed. This situation can occur under the following conditions:

• Blockage of the duct with a stone on the background cholelithiasis;
• The development of acute pancreatitis and swelling of the head of the pancreas;
• The presence of a tumor that compresses the choledochus or prevents the outflow of bile;
• Strictures (pronounced narrowing) of the biliary tract;
• The defeat of the Futter's nipple is the place where the lumen of the common bile duct and the pancreatic duct opens.

Separately, it is necessary to say about the causes of sclerosed cholangitis. This form is different from all the others. It is not possible to unequivocally determine the cause of its development, even at the modern level of medicine. Most doctors believe that the disease occurs during the development of an autoimmune process.

Due to the “mistake” of immunity, in which the defending cells begin to produce antibodies against healthy tissues, the tissue of the ductal system is affected. Prolonged sluggish inflammation leads to proliferation of connective tissue, narrowing of the lumen and impaired bile outflow. A frequent "target" of this disease is the intrahepatic bile capillaries, which often leads to the formation of cirrhosis of the liver.

Symptoms

As already mentioned, this disease is quite difficult in terms of diagnosis. One form can manifest itself differently in two identical patients, disguise itself as another pathology, or even proceed hidden. However, there are certain signs that suggest a correct diagnosis.

It must be remembered that the symptoms that disturb a person can differ significantly in acute and chronic course. Sclerosing primary cholangitis also has its characteristic features, which will be described below.

spicy variant

Treatment of cholangitis, in this case, is carried out only in a surgical hospital. it life threatening a condition that, if untimely seeking medical help or inadequate therapy, can lead to blood poisoning and even death. That is why, in the presence of typical signs, it is strongly recommended to consult a doctor, and not try to get rid of the manifestations of the disease on your own.

Unlike most other pathologies, with inflammation of the biliary tract, doctors are not looking for individual symptoms, but for a certain combination of them. For this condition, the appearance in a person of the following set of symptoms is most characteristic:

1. Increased body temperature. As a rule, fever rises within a few hours and remains at a fairly high level (38-40 o C). Patients feel severe weakness, chills and headache. Often, a person has severe sweating, because of which he can lose a large amount of fluid per day. In some patients, the fever may have a “jump-like” course and change by 1-2 ° C throughout the day. Such fluctuations in temperature exhaust a person, his health deteriorates so much that it is difficult for him to get out of bed. Consciousness is clouded, there is no appetite, fainting may occur;
2. Jaundice / obsessive itching of the skin. These two symptoms have the same origin and are associated with the retention of bilirubin in the body. Bilirubin is a toxic substance formed after the breakdown blood cells and excreted in the urine and bile. Since inflammation of the biliary system leads to disruption of this process, bilirubin compounds begin to be deposited in various tissues. Their deposition in the skin leads first to severe obsessive itching, and then to a change in its color. The entry of bilirubin into the sclera explains the yellow tint of the eyes (around the iris). An attempt by the body to excrete a toxic substance in the urine is manifested by its darkening - up to the color of "dark beer";
3. Pain in the right side of the abdomen(directly under the ribs). This place corresponds to the approximate location of the bladder and common bile duct. If a person finds it difficult to determine the area where they are discomfort, you can conduct a simple test - with the edge of your palm, tap on the lower edge of the costal arches on the right and left. With cholangitis / cholecystitis, the pain intensifies with tapping on the right.

The listed complaints can be supplemented by a number of other pathological signs: blood pressure less than 90/60 mm Hg; the appearance of a feeling of heartbeat; increased heart rate more than 90 beats / min, etc. However, specific to this disease is a combination of the above three manifestations of the disease.

Chronic form

It is much more difficult to suspect and confirm the presence of this form than to diagnose acute cholangitis in a person. The fact is that in a chronic course, pathology can slightly impair a person’s well-being, and he does not seek medical help. An additional difficulty is the variety of manifestations of pathology - for this form, a characteristic combination of symptoms has not been found. In each patient, the disease proceeds individually.

The only significant clue can be the patient's past, or rather, the surgeries and concomitant diseases:

1. After removal of the gallbladder (an operation called "cholecysectomy"), every third patient develops chronic cholangitis;
2. The presence of gallstone disease significantly increases the risk of this disease;
3. An acute process transferred in the past can lead to the emergence of a chronic variant of the disease.

People with the listed risk factors are most susceptible to this pathology. They can be suspected of a protracted inflammatory process in the ducts if they have the following complaints:

• Chair disorder. Characterized by the appearance of a liquid / mushy stool with a light color, having a shiny surface, difficult to wash off the walls of the toilet bowl;
• Jaundice or skin itching, which appear mainly in the evening and at night;
• Pain in the upper abdomen. In most cases, discomfort is located in the right hypochondrium, but they can be on the left or in the middle between the ribs (in the epigastric region);
• The development of asthenovegetative syndrome - constant weakness, decreased performance, weight loss;
• The appearance of fever for an unknown reason;
• Feeling "broken", chills in the afternoon;
• Taste of bitterness in the mouth, especially after eating.

Sclerosing primary cholangitis (PSC)

A few statistical facts about this form:

• In 55% of people this disease proceeds without symptoms or with minimal manifestations;
• In 20-60% of cases, the disease is detected only at the stage of appearance of cirrhosis of the liver;
• Up to 20% of patients with PSC suffer from cholangiocarcinoma (malignant tumor), which developed at the end of the pathology.

These moments clearly indicate how difficult the diagnosis is. On the one hand, patients often do not pay attention to "minor" symptoms, which leads to late seeking medical help. On the other hand, not every city has a specialist who will suspect this rare but dangerous pathology.

What is the way out in this case? First of all, you need to be vigilant about your health. The table below will provide the necessary information to suspect PSC. The main thing is not to neglect it and objectively analyze the state of your body. This will prevent the progression of PSC and avoid dangerous complications.

Diagnostics

To confirm the diagnosis, a whole complex of laboratory and instrumental studies is needed. Most of them can be carried out in any multidisciplinary polyclinic with standard laboratory equipment.

But, unfortunately, in most provincial cities medical institutions not equipped even by the standard minimum. In this case, the doctor cannot prescribe necessary examinations therefore, patients often have to go to private clinics/laboratories.

Laboratory diagnostics

Instrumental examinations

MRCP

At the moment, the "gold standard" among the hardware research methods is MRCP - magnetic resonance cholangiopancreatography. Despite the complex name, the principle of this survey is quite simple. A special substance is injected into the human blood, which stains the ducts of the bile-excreting system and the gallbladder, they are studied on an MRI machine.

It should be noted that this method safe for humans, does not irradiate his body with x-rays and requires the use of special surgical instruments. It does not require hospitalization - the procedure itself takes 15-30 minutes and can be performed on an outpatient basis. There are not so many contraindications to MRCP, these include:

• Allergy to a contrast agent;
• The presence of certain implants in the body: pacemakers, cochlear implants, intravascular stents and metal clips in the brain. If there are other artificial devices in the body, you must first consult with the doctor performing the examination. He will analyze the situation and determine the possibility of diagnostics.

Preparation for the examination includes not eating or drinking for several hours before the procedure. Also, immediately before the examination, you must remove all metal accessories and clothing. If needed additional training, the attending physician consults the patient individually before the examination.

Other research methods

Despite the fact that MRCP is recommended as the main diagnostic method, not every hospital has an MRI machine and trained specialists in its staff. As alternative methods identifying the disease, doctors may recommend the following instrumental examinations:

Treatment

In the treatment of this disease, there are several fundamental points that every patient should know:

1. If an acute process is suspected, hospitalization in a surgical hospital is necessary. This tactical nuance is explained by the unpredictable course of the disease - at any time, inflammation of the ductal system can cause blood poisoning (sepsis) or disruption of other organs;
2. Every patient with an acute process potentially requires surgery to restore the outflow from the biliary tract. Doctors try to choose the most gentle technique for the body and try to avoid a large amount of intervention and incisions on the skin. If possible, surgeons perform all interventions with the help of an endoscope, passing it through the mouth to the final section of the common choledochus. This allows you not to injure excess tissue and reduce the risk of complications.
   The patient should be aware of the possibility of surgical intervention and not be afraid of this method of treatment;
3. Almost always, chronic forms of the disease are treated on an outpatient basis - hospitalization, like surgery, with protracted course is not mandatory, since the pathology is relatively predictable in its development.

Treatment of acute cholangitis

As mentioned above, almost every patient with this form is a potential candidate for surgery. The time of its implementation is determined by the patient's condition. With a relatively mild course of the disease and preserved functions of all organs, it is possible to perform surgical intervention on the first day after hospitalization.

A severe variant of the disease or the development of sepsis requires preliminary preparation of the body with the help of medications. In order to improve the human condition, the surgeon may prescribe the following therapy:

• Intravenous infusions of solutions that improve tissue metabolism and reduce the concentration of blood toxins: glucose or sodium chloride solutions, Ringer's solution, Disol or Trisol preparations, etc .;
• Combination of antimicrobials;
• Hepatoprotectors to maintain the functioning of liver cells: Essentiale, ademethionine, ursodeoxycholic acid and others;
• If necessary, drugs are used for pain relief and to eliminate spasms in the digestive tract (antispasmodics).

After the operation to restore the outflow from the choledochus, drug treatment continues. The time of taking the drugs is determined in each case individually and depends only on the state of the body and the characteristics of the course of the pathology.

Therapy of the chronic form

When identifying this type of disease, the doctor first of all tries to identify the cause chronic inflammation. It is this nuance that determines the further tactics of treatment. There may be several options:

In addition to specific treatment, all patients with chronic forms of the disease are recommended:

• Stick to a diet (table number 5 according to Pevzner), which implies frequent fractional nutrition 5-6 times a day, in a small amount, with the exception of fatty foods;
• If possible, exclude physical and psychological stress;
• Stop smoking, drinking alcoholic and caffeinated drinks;
• Take multivitamin complexes with the presence of vitamins K, D, E and A. The absorption of these substances is impaired during prolonged inflammation of the biliary system.

Disability time

Since the vast majority of patients with cholangitis are students or able-bodied people, this issue needs to be given attention. At acute variant, the length of stay in the hospital is 10-30 days, depending on the condition of the person and the activity of the disease. After discharge, the sick leave/certificate is extended for 20-30 days to continue treatment at home and restore the body.

As for chronic cholangitis, at the moment, there are no unambiguous recommendations. In each case, the doctor himself determines the duration of the patient's disability, depending on his well-being and the possibility of therapy.

FAQ

Question:
How life-threatening is this disease?

Inflammation of the ductal system is a life-threatening condition in which there is always the possibility of developing sepsis, irreversible damage to the liver and other organs.

Question:
What diseases can occur under the "mask" of cholangitis?

In some cases, similar symptoms can be found in acute pancreatitis, against the background of acute / exacerbation of chronic cholecystitis. To correctly diagnose, it is enough to use the laboratory and instrumental methods of research described above.

Question:
Is it possible to make a diagnosis of "acute cholangitis" only on the basis of symptoms and ultrasound data?

With a combination of typical signs of pathology (fever, jaundice, pain) and an expansion of the choledochus more than 6 mm according to the results of ultrasound, the diagnosis is considered justified.

Question:
What operation can a doctor perform in case of an acute course of the disease?

The main goal of surgical intervention is to restore normal outflow from the common bile duct and reduce pressure in the biliary system. There are several basic options for performing this operation:

• Endoscopic method. With the help of an endoscope, which is inserted into oral cavity and moves along the digestive tract, the doctor penetrates into the choledoch, through its mouth in the duodenum 12;
• Percutaneous transhepatic drainage. Under the control of the ultrasound machine, the surgeon penetrates the choledoch with a needle through the skin and liver tissue and installs drainage - a thin tube to create an outflow of bile;
• open way. It is used extremely rarely. The doctor dissects the tissues in layers, starting from the skin in the upper abdomen, after which he highlights the large bile duct and installs a drain. There is a variant of this operation, in which instead of a large incision, the surgeon makes only 2-3 small wounds for endoscopic instruments. It is with the help of them that drainage is carried out.

is a nonspecific inflammation of the intrahepatic or extrahepatic bile ducts. It is characterized by a triad of symptoms - a rapid increase in temperature to febrile numbers, severe pain under the right hypochondrium, jaundice. In order to diagnose acute cholangitis, ultrasound of the liver and gallbladder is performed, computed tomography biliary tract, biochemical tests of the liver. Also, the diagnosis is clarified with the help of ERCP, percutaneous transhepatic cholangiography. Treatment is conservative, only in severe cases resort to surgical intervention to decompress the biliary tract.

General information

Diagnostics

To establish the diagnosis of acute cholangitis, the first step is to laboratory research. Biochemical tests of the liver reveal an increase in the levels of bilirubin, alkaline phosphatase, triglycerides, ALT and AST. The total amount of blood protein decreases due to albumins and γ-globulins increase. Often in acute cholangitis, there is an increase in the level of amylase, lipase, as well as trypsin and its specific inhibitors, which indicates the involvement of the pancreas in the process. With the development of signs kidney failure increased levels of creatinine and urea. In the general blood test, you can see a significant increase in the number of leukocytes with a shift in the formula to the left, increase in ESR. Bacteremia is often found in the blood.

Duodenal sounding in bile reveals a significant number of epithelial cells, an increase in the level of lipids, sialic acids, different types transaminases, fibrin. When sowing, a huge number of bacteria are revealed, often not one, but two or even three different pathogens. On ultrasound of the liver and gallbladder, you can see dilated intrahepatic and extrahepatic ducts, an increase in the gallbladder, liver, and structural changes in its parenchyma. If the picture is not informative enough, an additional CT of the biliary tract, magnetic resonance imaging of the liver and biliary tract is performed.

From instrumental methods for diagnosis, endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography are used. The first technique also has a medicinal value, it helps to eliminate blockage in the common bile duct, if it is caused by a stone of small and medium size. These studies make it possible to visualize the bile ducts well, to determine the location of the obstruction.

Treatment of acute cholangitis

Therapy for acute cholangitis is aimed at removing the blockage of the biliary tract and fighting infection. From the very beginning, the patient is prescribed antibiotics. The choice of drug depends on the sensitivity of the flora. If a sensitivity test fails, antibiotics that act on the intestinal and anaerobic flora are used. These are synthetic penicillins, aminoglycosides, cephalosporins (mainly III and IV generations), fluoroquinolones. Reserve antibiotics are carbapenems. When choosing drugs, it is desirable to give preference to those that are excreted through the liver along with bile, for example, ceftriaxone or cefoperazone. If the drug was chosen correctly, then the patient's condition improves within 12-24 hours. The course of antibiotic therapy is 14-21 days.

In addition to antibiotics, the patient must be prescribed detoxification therapy. For manifestations of severe liver failure, steroid hormones can be used. They also correct the activity of the kidneys and heart. In acute cholangitis caused by helminthic invasion, anthelmintic drugs are prescribed. If acute cholangitis is accompanied by blockage of the biliary tract, they are decompressed by endoscopic RPCG. Open surgery is rarely performed and only after stabilization of the patient's condition.

Forecast and prevention

The prognosis for acute cholangitis largely depends on its stage and the degree of blockage of the bile ducts. If the blockage is minor and it was eliminated in time, the course of cholangitis is favorable. With prolonged cholangitis, late diagnosis, after the development of infectious-toxic shock, the prognosis worsens significantly. The type of pathogen also affects the prospects for treatment. Poorly treatable acute cholangitis caused by pneumococcus and multiresistant flora. The prognosis worsens in cancer patients, patients older than 50 years.

Prevention of acute cholangitis is the treatment of the underlying disease (cholelithiasis, biliary dyskinesia, etc.). Gastroenterologists advise patients who are at risk to eat right, monitor body weight, and undergo scheduled medical examinations on time.

Disorder of digestion. Such dyspeptic disorders may indicate a wide variety of gastrointestinal disorders.

However, most often they develop against the background of cholangitis. The diagnosis is quite serious, so the course of the disease should not be started.

With absence timely treatment dangerous complications may arise that will threaten the life and health of the patient.

What is this pathology

Acute brings severe discomfort, pain. The attack can be so severe that the patient loses consciousness. Chronic form occurs with mild symptoms, however, slowly affects most of the bile ducts in the liver and beyond.

Cholangitis was discovered in the 19th century. The study of this disease was carried out mainly by physicians in Europe.

Swift technical progress in the 20th century made it possible for scientists to study this pathology in more detail, to identify the causes of the inflammatory process.

By the end of the 20th century, there were many effective ways to treat cholangitis in medicine.

All people are at risk. A similar violation of the gastrointestinal tract occurs in men and women of different age categories. However, most often the disease is diagnosed in women aged 50-60 years.

Doctors attribute this to the fact that the hormonal background changes, the metabolism slows down, the level of immunity decreases.

Additional risk factors are:

• unbalanced diet;
• insufficient sleep;
• susceptibility to stress;
• unfavorable ecological situation in the place of residence;
• smoking;
• alcohol abuse.

The key to successful treatment is timely access to the hospital.. If any failures are found that indicate the possible presence of cholangitis, the patient should urgently visit a therapist or gastroenterologist.

Reasons for the development of cholangitis

First of all, the doctor finds out why the inflammatory process appeared in the bile ducts. It is on this that the choice of tactics of further treatment depends.

To get rid of the disease completely, it is imperative to eliminate the root cause.

There are many factors that can cause cholangitis to develop.

In addition to the above factors, an unhealthy lifestyle can become an incentive for the development of cholangitis. The abuse of fatty and fried foods adversely affects the condition of the liver. If a harmful products use often, the bile ducts can become inflamed.

The course of therapy is prescribed strictly by a doctor. Self-medication can lead to serious complications. The main task of the patient is to seek help in time. The doctor determines the cause. Treatment is aimed primarily at eliminating the provoking factor, and then at relieving symptoms and alleviating the patient's condition.

Clinical picture and diagnostic methods for this disorder

The acute form is expressed quite clearly. The patient's body temperature rises sharply to 38-40 degrees. There is a sharp stabbing pain on the right under the rib. Sometimes the discomfort is excruciating.

A person during an attack complains of pain in the right shoulder blade, collarbone. Intoxication of the body is so strong that the patient feels weakness, nausea.

For acute cholangitis dyspeptic disorders appear. Diarrhea, bloating can also be signs of acute cholangitis. After a few days, jaundice appears. The skin and sclera acquire a yellow tint due to excessive release of toxins.

In some cases, patients with acute form disturbances of consciousness are noted. They manifest themselves in fainting, hallucinations, impaired speech and coordination of movements. In this case, it is necessary to urgently call an ambulance.

Chronic form proceeds less severely, however, it is dangerous because it is constantly progressing. At the initial stages of the disease, a person does not even realize that he is sick. Discomfort in the right hypochondrium area is insignificant. The patient feels heaviness, especially after eating.

Jaundice appears only a few months after the onset of the inflammatory process. Body temperature rises rarely and does not exceed 37.5 degrees. Dyspeptic disorders are mild or absent completely.

For an accurate diagnosis the doctor sends the patient to undergo laboratory tests and clinical research. Biochemical samples are taken, duodenal sounding is performed. In addition, tests for the presence of eggs of various helminths are mandatory. Ultrasound examination of the abdominal organs is also recommended.. The doctor insists on undergoing a CT scan of the bile ducts.

Methods for the treatment of cholangitis

Depending on the causes of the violation, the form and severity of the disease in traditional medicine medical or surgical treatment is carried out. Drugs are prescribed exclusively by the attending physician. You can’t choose medicines on your own, because out of ignorance you can harm the body more.

When a long-term remission occurs, the patient is sent to undergo physiological procedures. These include electrophoresis, ozokerite therapy, microwave treatment, inductothermy, baths with sodium and chloride. After completing the main course of treatment, the patient can be sent to a dispensary.

Surgery carried out only in cases where it is impossible to normalize the outflow of bile with the help of medicines. There are several types of surgical treatment. The doctor tells the patient about each of them at the reception.

It is not recommended to resort to alternative therapy methods. They can be used as additional treatment, however, completely exclude traditional medicine by no means is it possible. This can lead to serious consequences, up to cirrhosis of the liver.

Prevention of inflammation of the bile ducts

The disease is much easier to prevent than to deal with its consequences in the future. To prevent the development of primary or recurrent cholangitis, simple principles must be followed healthy lifestyle life:

• to give up smoking;
• refusal to drink alcoholic beverages;
• regular exercise;
• daily walks in the fresh air;
• full sleep;
• healthy eating;
• avoidance of stressful situations.

In no case should a preventive examination be neglected. It is better to spend some free time consulting a doctor than to treat a neglected form of pathology for a long and tedious time.

Prognosis for cholangitis

As a rule, with timely treatment, the prognosis is always favorable. The time of therapy depends on the reasons for which the disease arose. In general, the rehabilitation period lasts from two weeks to two months. If after that the patient is sent for rehabilitation to a dispensary or sanatorium, then the body quickly returns to normal, all processes are fully restored.

In advanced cases when treatment was started too late, complications such as abscess, acute liver failure, cirrhosis may develop. However, in most cases, the diagnosis is early dates so the consequences can be avoided.

Video on the topic: Gallbladder

The statistics show that for last years the number of patients with cholangitis has increased significantly. This is due to the fact that people are little aware of this disease. Raising awareness can significantly reduce the number of patients with this diagnosis.

People must know the following facts:

1. Cholangitis is an inflammatory process in the liver. At the same time, the bile ducts become inflamed, metabolism is disturbed.
2. The causes of the disease are bacterial infections, helminths, hepatitis and bad habits.
3. Symptoms manifest as pain in the right hypochondrium, jaundice, fever, diarrhea.
4. Treatment is carried out by conservative methods. Sometimes surgery may be needed.
5. Timely initiated therapy guarantees a speedy recovery and the absence of complications.

Cholangitis is one of the most complex diseases of the digestive system of the human body. Pathology is difficult to diagnose and difficult to treat.

The disease can have various forms of severity, expressed in the corresponding symptoms. The causes of the development of the disease, in turn, can be very diverse.

The disease can proceed completely unnoticed by a person and manifest itself at the stage of complications, such as: blood poisoning, destruction (cirrhosis) of the liver, the formation of cancerous tumors, and so on.

The name of this most serious disease consists of two words ("bile" and "vessel" - translated from the Latin dialect). AT human body there are a huge number of channels designed to transport various fluids, which include bile components. Before reading the article, be sure to watch the video:

These channels originate in the liver and end directly in the intestinal tract. Harmful microbes, fats and other microorganisms are removed from the body in this way.

The entire process described above can be divided into the following steps:

• during the meal, an active digestive process begins, as a result of which large amounts of bile are formed in the hepatic organ, from where it enters the transport arteries and begins its further movement;
• the fluid duct formed as a result of the work of both lobes of the liver in tandem with the secretions of the gallbladder attached to it rushes into the intestine for further disposal;
• as a result, the fluids end up in the duodenum, where the required volume of fluid is released, and the excess moves in the opposite direction and returns to the gallbladder.

Primary cholangitis begins its development as a result of disruption of the kidneys and other related tissues involved in the formation of bile.

Varieties of the disease

As described earlier, chronic cholangitis can manifest itself in different forms. Practitioners conditionally divide the disease into two groups based on:

1. The total duration of the course of the disease;
2. degree and type of inflammatory processes.

It is on these indicators that the doctor is able to choose the optimal treatment regimen for the patient, as well as determine the latter for surgical intervention.

The list of stages of development of cholangitis, depending on the duration

• Lightning (fulminant). The most dangerous and most severe form, accompanied by the rapid appearance and further development of signs of the formation of pathology (this may take only a few hours). A similar stage of the disease in 95% of cases ends in death;
• acute. The most common option, flowing within up to 48 hours;
• chronic. At this stage, the disease is very difficult to diagnose. Symptoms of the disease may be completely absent, and the patient may complain only of instability of the stool and pain in the stomach.

Forms of development of pathology depending on inflammation

• Serous. The most favorable stage, productive cholangitis is characterized by the absence of infection of the blood environment and the absence purulent discharge in the ducts;
• fibrinous-serous. Similar to the form described above, except for the presence of protein deposits in the liquid;
• purulent. Dangerous stage, bacterial cholangitis, accompanied by the presence of a large number of microorganisms and severe inflammation (possibly, the development of concomitant complications in the form of blood poisoning);
• necrotic. Acute purulent cholangitis in the final phase. The tissues die, and their particles begin to fester, causing shock and sepsis;
• sclerosing. Symptoms are latent, the disease progresses slowly. Perhaps the development of a severe stage of cirrhosis of the liver.

Symptoms of the disease in a chronic form

Chronic severe cholangitis is accompanied by aching, dull or weak painful sensations. The clinical picture of the course of the disease is reflected in a combination of: pain in the right hypochondrium, chills, fever and jaundice in some cases.

Pain in chronic cholangitis is insignificant, but after the end of colic, patients begin to fever and shiver. The disease is recurrent in nature, so the first symptoms of the disease are often not given due attention.

Primary sclerosing cholangitis can cause damage skin and mucous membranes of the body.

It is especially difficult to diagnose the disease in patients over 55 years of age, since the general symptoms at this age may not correspond to the general picture of the patient's condition.

The occurrence and course of purulent cholangitis can lead to infection of the blood and in addition to the appearance of shock (25% of cases - death). A liver abscess, blood thrombosis and other negative consequences may form.

Methods for diagnosing a disease

Primary sclerosing cholangitis is diagnosed by carrying out the following list of activities:

1. With the manifestation of initial signs, it is necessary to seek help from a gastroenterologist;
2. further, laboratory tests are carried out (a blood test helps to detect an excess of the concentration of leukocytes, bilirubin and other related components);
3. additional methods can be applied instrumental diagnostics(CT scan of the bile ducts, ultrasonography of the pancreas);
4. again, retrograde cholangiopancreatography is performed to visualize the expansion of the bile ducts;
5. magnetic resonance pancreatocholangiography helps to identify primary sclerosing cholangitis, the prerequisites for its formation and helps prevent secondary sclerosing recurrent cholangitis;
6. cutaneous transhepatic cholangiography by means of contrast and drainage of the bile arteries by mechanical needle insertion may also be used.

Even absolutely healthy person you should check your body for the presence of this dangerous disease with minimal suspicion, since almost 100% result can be obtained even at the stage of carrying out general analysis blood. Ascending dangerous cholangitis is easier to prevent.

chronic stage

This form of the disease may practically not manifest itself; at this stage, cholangitis and its treatment in most cases are not the same concepts. It can proceed in an individual order for each person and not have common characteristic features. In this case, timely detection of a problem can happen by studying the following data from the patient's biography:

• Gallstone disease is an important prerequisite for the formation of the disease;
• pathology can also occur after complete removal of the gallbladder;
• acute disease in the recent past of the patient.

The presence of these procedures indicates the most likely entry of a person into the risk group.

Causes of the onset and development of the disease

The causes of cholangitis, with the exception of the disease in the sclerosing form, depend on the presence of several things, namely:

1. Entry and development of a dangerous microorganism in the bile ducts;
2. the occurrence of stagnant processes in the above channels.

1 reason

hit dangerous bacteria causes an inflammatory process. A harmful microorganism can enter the bile ducts from the bladder of the same name or from the intestinal tract due to some diseases of the latter, such as: acute cholecystitis, intestinal failure, biliary reflux.

2 reason

Congestive processes in the bile ducts occur with disorders associated with the free outflow of bile. This may precede:

• Gallstone disease (clogging of the canal with sand);
• acute pancreatitis;
• tumor development in the vicinity of the ducts;
• narrowing of the ducts (strictures);
• dysfunction of the Futter nipple.

Primary sclerosing cholangitis has a significant difference from all other forms of pathology. The disease occurs when the immune system which is why it is also called autoimmune cholangitis.

Methods and means of treating cholangitis

It can be said for sure that the treatment of the disease should take place exclusively stationary under the supervision and control of a doctor. Cholangitis in children and adults occurs under similar circumstances.

Treatment of cholangitis folk remedies better to avoid. The method of treatment directly depends on the degree of damage to the bile ducts, it can be:

1. Conservative;
2. operational.

Conservative method of treatment

It consists in prescribing antibacterial, antispasmodic and choleretic drugs to the patient. medicines and enzymes. Cholangitis is a serious inflammation of the bile ducts, in which the normal outflow of fluid from the gallbladder is disrupted, so this method of treatment is relevant only when the ducts are working normally.

Medicines are administered through a vein or directly into a muscle. The treatment course lasts at least 12 days.

To remove dangerous toxins, glucose solution (5%) and saline are administered. In the case when primary sclerosing cholangitis is present, choleretic drugs are used in order to exclude fluid stagnation.

In some cases, the use of painkillers is acceptable. medicines by doctor's prescription.

Operative method of treatment

In the absence of a positive effect from medical method and in case of violations of the normal outflow of bile, surgical intervention is used. The most widely used in this case was the endoscopic method of treating pathology.

It allows non-surgical drainage, removal of stones and normalization of the bile ducts with just a small incision. When inflammation is accompanied by profuse suppuration of internal tissues, abdominal surgery cannot be avoided.

Possible Complications

Pathology causes inflammatory processes in the bile arteries and, in the absence of timely medical care, neighboring tissues and organs may become inflamed.

The hepatic duodenal ligament can become saturated with bile, which, in turn, can provoke the occurrence of peritonitis, biliary cirrhosis, pathologies in the liver, and others. dangerous diseases. Intrahepatic abscesses and malignant tumors can also form.

Therapeutic diet

The correct diet during the treatment process helps to achieve the best result much faster, since this disease is a pathology in the human digestive system. With an exacerbation of the disease, fasting is recommended.

• Fatty, fried, baked fish and meat are excluded from the diet;
• sugar is allowed to take no more than 65 grams per day; similarly, it is forbidden to consume bakery products;
• the use of hot spices is not allowed;
• creams, coffee and alcohol are excluded from the diet.

To improve metabolism and eliminate fluid stagnation, in addition to the diet, it is recommended exercise stress within reasonable limits.

Conclusion

Timely detection and qualified medical care in tandem with the right diet and exercise- this is the key to a complete cure for the mild stages of this disease. The onset of inflammatory processes in the bile arteries, on the contrary, does not bode well.

Such lesions can provoke various serious complications and become a precedent for the emergence of new diseases of the digestive system. In any case, do not despair, because modern medicine capable of doing miracles.