Cholangitis - inflammation is intrahepatic or extrahepatic bile ducts.
Most often, cholangitis occurs as a complication of cholecystitis and cholelithiasis, but also occurs as a primary process. Contribute to the emergence of cholangitis bile stasis, damage to the mucous membrane of biliary tract stones, cicatricial narrowing of bile ducts and outlets, blockage of the biliary tract with intestinal worms (roundworm). In the stagnation of bile and mucosal injury to the bile duct joins the process of microbial flora (E. coli, staphylococci, enterococci, etc.). Most occur in parasitic cholangitis lesions of the gastrointestinal tract. Opisthorchiasis, giardiasis, schistosomiasis.
Acute cholangitis begins suddenly. There is a high body temperature, accompanied by fever, severe pain in the right upper abdomen, the type of biliary colic. Yellowing of the sclera appears, or even a third of patients with severe jaundice. Give pain (radiating) into the right shoulder blade, shoulder, right side of the neck. Revealed an enlarged liver and spleen.
If acute cholangitis caused due to blockage of bile ducts, it can not be cured until it is eliminated obstruction of bile outflow. Complication of acute cholangitis can be a spread of the inflammatory process in the liver, gallbladder, pancreas, abdomen and lungs.
Diagnosis of acute cholangitis on the basis of the clinical picture, changes in general and biochemical blood tests. Duodenal intubation is carried out, which reveals inflammatory changes in the bile, and to determine the type of organism causing the inflammation.
Treatment of acute cholangitis. The patient is admitted to the surgical department of the hospital. Assigned to antibiotic therapy. The most common antibiotic tetracycline group, and sulfa drugs nitrofuranovogo. By means of treatment is added cholagogue, antispasmodic. When the blockade of the outflow of bile surgical treatment.
This is the most common form of cholangitis. Chronic cholangitis occurs after acute or chronic develops as a process from the beginning. Contributes to chronic cholangitis presence of cholelithiasis, chronic cholecystitis and other diseases of the biliary tract. Get sick more often elderly patients. Manifestations of the disease is usually not very noticeable. Patients complain of a dull pain in right upper quadrant, bloating or pressure in the right upper quadrant. Gradually, there is weakness and fatigue. Perhaps a long slight increase in body temperature. Yellowing of the sclera may appear, at least the skin. But jaundice occurs late.
Chronic cholangitis also may be complicated by the development of hepatitis and eventually cirrhosis, the development of chronic pancreatitis. The main method of diagnosis of chronic cholangitis is duodenal intubation, in which all portions of the bile are inflammatory changes.
To diagnose narrowing of the large bile ducts performed retrograde (endoscopic) cholangiography.
Treatment of chronic cholangitis.
Patients were assigned to a diet with frequent meals. To improve the outflow of bile used cholagogue drugs. In the process of sharpening appointed antibiotics. When a significant narrowing of the biliary tract surgical treatment.
This kind of disease is also called bile duct primary sclerosing cholangitis. In this disease, infection can be found. However, there is progression of biliary tract inflammation, as a result of which, developed multiple sclerosis and the gradual overlap of the lumen of the bile ducts. In the future, develop cirrhosis of the liver.
Causes of primary sclerosing cholangitis is unknown. Get sick more often men and 40 years. There is a permanent or recurring jaundice, accompanied by itching skin. In the right upper quadrant and the upper half of the abdomen appear dull pain. Against the background of narrowing of biliary tract may develop acute cholangitis with the accession of the infection.
Primary sclerosing cholangitis is often associated with ulcerative colitis, Crohn's disease. The prognosis of this disease is poor. In the later stages of the disease status of patients is rapidly deteriorating. Patients do not live more than 10 years.
Treatment of symptomatic primary sclerosing cholangitis. Attempts to apply a liver transplant. Survival of patients after liver transplantation is 50% after 5 years.