Purulent cholangitis. Diagnosis and methods of treatment of cholangitis purulent cholangitis is most often due to

Cholangit - syndrome characterizing a non-specific inflammatory process with the lesion of out and / or intrahepatic bile ducts.

Prevalence.In recent years, there has been an increase in the incidence of this pathology by 40%.

What provokes / causes of cholangitis:

The condition for the occurrence of cholangitis is stagnant bile and the presence of infection. There are many reasons to prevent bile outflows. The obturation of bile ducts, being the result of the primary pathological process, contributes to the occurrence of bile hypertension, change physico-chemical properties bile, which serves as a prerequisite for infection. The most common causes of obstruction of boring paths - choledocholithiasis, benign strictures of bile ducts, duodo disease "tupest intestine, pancreatic glands, choledoch's cysts, caroli disease, dyskinesia of the Sphinteer Oddi, Bubble Culting Syndrome, Clean Culti Syndrome, invasion Preproscross the contents of the contents of a single intestine in biliary ways, complications after reconstructive operations on bile ducts. There are several ways to introduce infection into bile ductures. More often pathogenic pathogens enter the biliarium system enterogenic, hematogenic, lymphogenic paths. The pathogens leading to the development of cholangitis are microorganisms intestinal microfloraencountered in associations. Most frequently have bacterial origin cholangitis, among members of the family of pathogens found enterobacteria (E. coli, Klebsiellaspp., Serratiespp., Proteusspp., Enterobacterspp., Acinetobacterspp.), Gram-positive organisms (Streptococcus, Enterococcus), asporogenous anaerobes (Bacteroidesspp., Clostridiumspp. , fuzobacteria, pseudomonasspp., etc.).

Bacterial cholangitis tends to rising flow and spread to intrahepatic ducts. With a serious course of the disease, the development of an empiemy of the gallbladder, hepatitis, liver abscesses, septicemia, pylephlegitis, subdia-fragmal abscess, peritonitis, cetting-inflammatory walls of large bile ducts can be observed.

Classification of cholangitis.Topically distinguish with cholangitis or angiiology - the defeat of large intra and extrahepatic bile ducts; Kledochit - the defeat of the total gall duct; Papillitis is the defeat of the region of the Nipple Fatera. Septic and caused infectious factors cholangitis. Aseptic cholangitis includes autoimmune with primary biliary cirrhosis, autoimmune cholangiopathy, sclerosing (primary and secondary sclerosing) forms. On the clinical picture, they allocate sharp, chronic, sobering and septic cholangitis. The cholangitis caused by infectious agents is acute obstructive, recurrent, bacterial, secondary sclerosing.

Symptoms of cholangitis:

Features of clinical manifestations.Acute cholangitis occurs as a complication of choledocholiticiasis with a total or subtotal obstruction of the bile duct, less often it develops as a complication of cholangiography or after choledoch's endoprosthetics, conducting endoscopic papillosphinclineotomy. Clinical symptoms of acute cholangitis include malaise, jaundice, pain in the right hypochondrium with irradiation on the right shoulder, forearm, shovel, mixed fever with chills and abundant, nausea, vomiting, confusion, arterial hypotension (infectious-toxic shock), which constitute the so-called Pentad Reynolds. Patients often develop thrombocytopenia as a manifestation of intravascular coagulopathy, signs of hepatic cellular insufficiency.

Acute recurrent cholangitis is characterized by a less severe flow and arises against the background of a gall-eyed illness, Caroli disease. The recurrent cholant is inherent in the triad Charcot. In some cases, patients have uncertain dyspeptic disorders without fever, jaundice, owl syndrome. In the intervals between the sneakers, in the absence of liver disease, the symptoms of cholangitis may be absent or manifested by a light biliary dyspepsia. Jaundice under cholangitis may have a combined character, usually it is mechanical, due to the obstacle to the ottok of bile. In cases of concomitant liver damage, signs of parenchymal jaundice are joined. Sometimes the disease begins like sepsis: with intermittent fever and chills. Heavy forms of the disease are accompanied by the development of sepsis, complicating with septic shock, oliguria and renal failure.

The frequency of fever, the nature of the course of the disease in bacterial cholangitis depend on the causative agent and the degree of obturation of bile ducts. Pneumococcal cholangitis, which, as a rule, are complicated by the development of liver abscesses. Reducing bile hypertension leads to the disappearance of clinical manifestations. During the exacerbation of the disease, the liver increases in size due to polishing the hepatic capsule, becomes painful when palpation. The edge of the liver usually has a smooth surface. It should be noted that, since the leading link in the pathogenesis of cholangitis is the temporal obturation of bile ducts, mechanical jaundice has variable character and depends, similarly to temperature, on the degree of oration of biliary tract. Clinical manifestations of cholangitis in chronic flow can be characterized by a sense of pressure or blunt pain In the right hypochondrium, weakness, fast fatigue, often light yellowness of visible mucous membranes, leather, itching Frequent symptom There are long periods of unmotivated subfebristite accompanied by chills. Features of the course of the disease in the elderly - pronounced asthenic syndrome confusion confusion in the absence of fever and pain. In diagnosis, along with the described clinical picture, laboratory and instrumental research methods help.

Diagnosis of cholangitis:

Features of diagnostics.In clinical analysis of the blood, neutrophilic leukocytosis with a shift to the left, an increase in biochemical study shows an increase in the level of bilan biliary, triglycerides, alkaline phosphatase activity, AsaT, ALGGTP, decrease in content general protein and albumin, relative increase in the number of U-globulins. It is advisable to study the activity of amylase, lipase, trypsin and its inhibitors, as well as blood for sterility. IN general Analysis urine is observed an increase in the level of urobilin, bile pigments. Duodenal fractional sensing with bacteriological studies of portions B, C and determination of sensitivity to antibiotics of duodenal content, abdominal ultrasound give reliable information about the nature of the disorders available. With ultrasound, signs of biliary hypertension, expansion of intra and extrahepatic bile ducts are detected, signs of pancreatic damage caused by the development of cholangitis. Echographically under the cholants, the docks are unevenly linearly expanded, the walls are homogeneously thickened, weaklyogenne (edema). In the process of effective treatment, there is a narrowing of their lumen, the wall thinning to a complete merger with the parenchy liver.

In some cases, according to the echography, the diameter of bile ducts may not change, which requires computed tomography. It is advisable to conduct intravenous cholangiography or endoscopic retrograde pancreaticolangiography, with which you can reveal the expansion of bile ducts. If it is impossible to conduct these studies, percutaneous chrsecheny cholangiography is performed (CCHG).

When establishing the diagnosis of "cholangitis" it is advisable to find out whether it is isolated or combined with the damage to the gallbladder, liver, pancreas, etc. As already mentioned, in many cases, the cholangitis is a concomitant disease. It is also important to identify the leading etiological factor and the relationship of this process with the presence of concrections in the bustling bubble and bile ducts.

In differential diagnosis, it is necessary to keep in mind diseases such as malaria, pyelonephritis, paranefritis, subadiaphragmal abscess, sepsis, lymphogranulomatosis, infectious ENKOROCARD.

Treatment of cholangitis:

Features of treatment.The treatment of cholangitis primarily should be aimed at eliminating the stagnation of bile and fighting infection.

With acute obstructive cholangitis, it is advisable to use antibiotics wide spectrum For influence on the family of enterobacteria and anaerobes. Currently there is no single constructed approach to apply antibacterial drugs With ascending cholangitis.

Penicillins are most often used

• ampicillin has a bactericidal effect in relation to E. Soli
• ampicillin with Sulbactam affects the production of GTU-Nicyllinase strains of staphylococci, Bacteroides klebsiellaspp
• ureidopenicillin (Meslo Cyllain) is effective for enterococci

Aminoglycosides have a bactericidal effect on the bacteria of the Enterobacteria family.

Cephalosporins, antibiotics of a wide range of action, have a bactericidal effect, quickly accumulate in foci of inflammation. From the drugs of this group, ceftriaxone and cefoperason are excreted primarily with bile.

Preparations of choice in the treatment of heavy cholangitis caused by microorganisms that are resistant to most antibacterial agents are fluoroquinolones.

With a serious flow of cholangitis, ureidopenicyl-lin / pepperillalin is recommended for 3-4 g 4-6 times a day in / B or Meslocillin 3 g after 4 h in / in combination with metronidazole in a dose of 0.5 g after 8 h in / in. Instead of metronidazole, an amikacin of 0.5 g can be used after 12 h in / c.

It is advisable to the scheme comprising aminoglycoside (amikacin of 0.5 g after 12 h in / c in combination with ampicillin 1.0 g after 6 hours intramuscularly and metronidazole 0.5 g after 8 h in / c).

The use of cephalosporins of the third generation Ceftriaxone 1-2 g is once in / B or cefoxitin 2 g after 4 h in / in in combination with metronidazole 0.5 g after 8 h in / in or clindamy at 0.15-0, 45 g after 6 h in / c. Clindamycin can be replaced by Ami-Nogilikoside amikacin at 0.5 g after 12 h in / c.

With a non-heavy process, it is possible to use antibiotics in the form of monotherapy Piperillalin / Tazobaktam 4.5 g after 8 h in / s, ampicillin / sulbactam for 1.5-5 g after 6 h in / c, the cephalosporins of the third-fourth generations (Ceftriaxone 1 -2 g per day or 0.5-1 g after 12 h in / c).

The antibiotics of the reserve are carbapenes (imipenem-cilastatin at 0.5 g after 6 h in / in or Meropene 1 g after 8 h in / c). These drugs are used as empirical therapy in patients in critical state in the presence of E. coli, Acinetobacterspp, Paeruginosa.

Fluoroquinolones (Ciprofloxacin, Offlsacin, Mesfoxacin) and enjoy the selection of strains resistant to most antibiotics or during their intolerance, at a dose of 0.2-0.4 g after 12 hours in / c.

Nitro-furanovy compounds are highly antibacterial sensitivity, primarily Frazolin, Furazolidon, Furadonin (0.1 g 4 times a day during meals).

In some cases, 5-oxychinoline derivatives (5-nct, nitroxyoline) nigroxoline are appointed 0.1 g 4 times a day during meals for 3 weeks.

With complete insensitivity of microflora to all antibiotics or their intolerances, sulfonamides are prescribed etazol, phthalazole, sulfadimetoxine for 1 week.

In case of effective treatment, the improvement of the state occurs after 6-12 hours. The duration of antibacterial therapy is 14-21 days. The clinical effectiveness of the scheme used (even empirical) or a separate preparation indicates the expediency of its use during the entire period of treatment. When preserving the fever requires a drainage revision on its permeability, as well as the elimination of the possibility of developing complications.

Patients with cholangitis should be carried out for disinfecting therapy for generally accepted rules for the treatment of septic state.

• in ascariasis, Helmex is used for 10 mg / kg per day once, or vermocus 100 mg 2 times a day for 3 days, or levamizol 150 mg once,
• clonarhoz and opistorhosis are amenable to therapy with biltricide at a dose of 25 mg / kg 3 times a day for 1-3 days,
• with a fasciolese, a 2-week bitional rate is carried out in a dose of 1 g 3 times a day.

Patients with primary sclerosing cholangitis it is advisable to conduct symptomatic therapy of digestion disorders of the drugs of enzymes (Creon, pancreatophold, Mesform, and T P).

Heavy cholangitis is an indication for urgent ERCHP, which has an advantage over the emergency operation.

The main methods of the physiotherapeutic treatment of cholangitis are fresh and chloride-sodium baths and mud at the area of \u200b\u200bthe right hypochondrium in combination with the intake of antibiotics that are distinguished through bile and vitamins of the group in for 7-10 days. A good effect is noted when applying Galvanogryazhi to the area of \u200b\u200bthe right hypochondrium, as well as mudducotothermia to the area of \u200b\u200bthe right hypochondrium. At the same time, it must be remembered that before the physiologicalness, it is necessary to carry out antibacterial treatment aimed at suppressing infection in bile stocks, as well as a stimulating bile outflow.

Forecast.The forecast is determined by the basic suffering leading to a violation of bile outflow. Timely treatment, primarily operational, can lead to a significant improvement or recovery. In the later stages of cholangitis, the forecast is usually unfavorable. In multivariate analysis, the main features associated with the unfavorable Halgitis forecast are established:

• acute hepatic insufficiency;
• cholangitis complicated with liver abscess;
• secondary biliary cirrhosis of the liver;
• cholangitis, developed against the background of malignant strictures of high departments of biliary wood or after CHCh;
• female;
• age older than 50 years.

What doctors should contact if you have cholangitis:

Gastroenterologist

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Other diseases from the disease group of the gastrointestinal tract:

Cultivation (abrasion) teeth

Abdominal injury

Abdominal surgical infection

Abscess cavity of the mouth

Adenity

Alcoholic liver disease

Alcoholic cirrhosis of the liver

Alveolit

Nihina of the Wantilya - Ludwig

Anesthetics and intensive therapy

Ankylosis of teeth

Anomalies of dental ranks

Anomalies position of teeth

Anomalies of the development of the esophagus

Size Anomalies and Shapes

Atresia

Autimmune hepatitis

Ahalasia Cardia

Ahalasia Foods

Burnt of stomach

Disease and Badda Kiari Syndrome

Viooclusive biennial disease

Viral hepatitis in patients with CPNs located on chronic hemodialysis

Viral hepatitis G.

Viral hepatitis TTV.

Outdoor Ployer Fibrosis (PTT Oral Fibrosis)

Hairy leukoplakia

Gastroduodenal bleeding

Gemohromatosis

Geographical language

Hepatolenticular degeneration (Vilson-Konovalov Wilson's disease)

Hepatolyenal syndrome (hepatic spleen syndrome)

Hepatorenal syndrome (functional renal failure)

Hepatocellular carcinoma (ICC)

Gingivitis

Hyperplane

GUN hypertrophy (fibromatosis of adhesion)

Hypercitenosis (periodontitis assimicing)

Food Food Diverticulus

The hernia of the esophageal hole of the diaphragm (under)

Diverticulous esophagus purchased

Diverticula stomach

Diverticulus of the lower third of the esophagus

Diverticulus of esophagus

Diverticulus of esophagus

Diverticulus of the middle third of the esophagus

Discower of the esophagus

Dyskinesia (dysfunction) of biliary tract

Dystrophy liver

Sphynuncter dysbe dysfunction (postcholecistectomic syndrome)

Benign ne imitation tumors

Big bubble benign neoplasms

Benign liver tumors

Benign tumors of esophagus

Benign epithelial tumors

Cholelithiasis

Grease hepatosis (steatosis) liver

Malignant gallbladder neoplasms

Malignant tumors of bile ducts

Stomach foreign bodies

Candidose Stomatitis (thrush)

Caries

Carcinoid

Cysts and aberrant fabrics in the esophagus

Pickled teeth

Bleeding of the upper digestive tract

XantrNeleumatous cholecystitis

Leukoplakia mucous membrane

Medicinal lesions of the liver

Medicinal ulcers

Mukobovysidosis

Mukocele salivary gland

Violation of bite

Violation of the development and teething

Disorders of the formation of teeth

Inheritance coil apipaffia

Healthy violation of the structure of Enamel and Dentin (Stantona Capedeppon syndrome)

Non alcoholic steatohepatitis

Necrosis of the liver

Necrosis pulp

Urgent States in Mountains

Food obstruction

Imperfect osteogenesis of teeth

Survey of patients in extension surgery

Acute delta-superinfection in hepatitis viruses in

Acute intestinal obstruction

Acute intermittent (intermitting) porphyria

Acute disruption of mesenteric blood circulation

Acute gynecological diseases in the practice of surgeon

Acute bleeding from the organs of the digestive tract

Acute Ezophagitis

Acute alcoholic hepatitis

Acute apendescit

Acute apical periodontitis

Acute breedless cholecystitis

Acute viral hepatitis A (OWGA)

Acute viral hepatitis B (OVGV)

Acute viral hepatitis in a delta agent

Acute viral hepatitis E (OVGA)

Acute viral hepatitis with

Acute gastritis

Acute gingivit

Acute belly

Acute pericoronite

Separate types of intestinal obstruction

Even-ascitic syndrome

Perodontosis

Pathological resorption of teeth

Peptic ulcer of unspecified localization

The inflammatory disease of hepatic and extrahepatic biliary ducts is called cholangitis. The disease may develop independently or be the complication of inflammatory processes in the liver and the bustling bubble. Depending on the rate of occurrence and flow of the disease, acute and chronic cholangitis are isolated. It is possible to treat this pathology by surgical intervention or conservative method.

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  Causes

  Cholant refers to the pathologies of the hepatobiliary system. Women are more susceptible to the disease. The greatest increase in morbidity is celebrated in patients over the age of 50. In children this aless It occurs only against the background of congenital anomalies of biliary ducts.

  The main reason for the occurrence of cholangitis is infection.

  Most often, intestinal wand, protea and enterococcus become pathogens.With a purulent process, almost 90% of patients in the analysis of bile on sterility are revealed simultaneously several pathogens. It is extremely important to determine them to appoint effective antibacterial therapy.

  There are several ways to penetrate the infection in the gallways:

  1. 1. Ascending. Microorganisms penetrate the biliary ways from the lumen duodenal gut on the walls of the ducts.
  2. 2. Hematogenic. The pathogen falls into the ducts through a gate vein that collects blood from everything gastrointestinal tract.
  3. 3. Lymphogenic. In this embodiment, microorganisms fall into the ducts from the gallbladder, the pancreas or intestines on the lymphatic vessels.

  With aseptic cholangitis, the inflammatory process develops as a result of the cast of pancreatic enzymes in bile ducts. Due to the fact that the pancreas is distinguished by an aggressive action, he corps the wall of the ducts, leading to their necrosis.

  Sclerosing cholangitis develops as a result of autoimmune processes in the body - the immune system begins to produce antibodies to the mucous membrane of the biliary tract.

  The predisposing factors in the development of cholangitis are:

  • bile stagnation resulting from dyskinesia of biliary tract;
  • congenital abnormal bile ducts;
  • cystic education choledoch;
  • khdocholithiasis (stone in the choleret);
  • nipple stenosis.

  The emergence of cholangitis also contribute to mechanical damage to the mucous membranes of the ducts in diagnostic measures (installation of stents, retrograde pancreaticolangiography) and surgical operations on bile ducts.

  

  Obstructive jaundice

  Classification

  

  The structure of the biliary system

  The inflammatory process in biliary tracts are divided into forms depending on the course of the disease, etiology and type of pathological reaction.

  For course, the disease happens:

  • Sharp.
  • Chronic.

  Due to the occurrence of cholangitis:

  • Primary.
  • Secondary (due to other diseases of the hepatobiliary system or transferred surgical interventions).

  Depending on the type of inflammatory process, cholangitis distinguish:

  • Bacterial.
  • Sclerosing.

  The localization of the inflammatory process is distinguished:

  • Kaldochit - Inflammation of Kolado.
  • Angocholite is the defeat of intrahepatic and extrahepatic bile ducts.
  • Papillitis is an inflammatory process in a fare nipple.

  

  Chronic cholecystopancatitis

  Acute cholangit

  

  Symptoms of cholangitis

  Acute cholangitis is an infectious disease form with a sudden beginning. It is characterized by inflammatory processes in bile ducts with further development of stagnation of bile - right up to blockage of biliary tract. Most often develops on the background:

  • gallway disease;
  • cystic formations of intrahepatic tract;
  • gallbladder cancer;
  • chronic sclerosing cholangitis.

  Patients with cholangitis easy degree are subject to conservative treatment, and with complicated forms - surgical intervention.

  The following types of acute cholangitis are distinguished:

  • Purulent. At the same time, the type of disease in biliary ducts begins to accumulate the pus. This state is dangerous in that inflammation has the ability to quickly spread the arranged organs and tissues.
  • Catarial. Most light form, It is characterized by redness and swelling of the mucous membrane of biliary tract. This type of disease most often develops into a chronic form, since symptoms in this case are less pronounced.
  • Necrotic. In this case, there are foci of necrosis in the ducts due to the pancreatic enzymes in them, which corrode the walls of biliary tract. It is the most severe form, a dangerous development of serious complications, such as peritonitis and hepatitis.
  • Difteric. This form is characterized by the formation of ulcerative processes in the mucous membranes of the ducts. The ulcers are covered with dense films, under which the necrosis zones extend even faster. Quite often inflammation goes to the liver cloth.

  

  Symptoms of acute process

  Signs of acute cholangitis appear suddenly. Basic symptoms:

  • increasing body temperature;
  • yellowing scler, mucous membranes and skin;
  • the appearance of pain in the right hypochondrium.

  This symptom complex is called Triah Charcot. These are the most typical signs of acute cholangitis. The body temperature rises to high digits - 39-40 degrees, sweating and chills occur. The temperature during the day can fluctuate (with a peak in the evening) or be constant. Together with it there is a strong pain on the right in the hypochritary region, which gives to the neck area, right blade, clavicle and hand.

  After 1-2 days, the painting of the scler and skin begins to change in patients. This is due to the increase in bilirubin in the blood. The most sensitive to changes in its level is the mucosa of the occasion of the eyelids and the eye scler. Due to the deposit of bilirubin in the skin, an intensive itch begins to appear, which is not eliminated by antihistamine.

  If at this stage the patient does not assist, the disease can grow into infectious-toxic shock. It is manifested by a violation of consciousness, the appearance of nausea and vomiting. In clinical analysis of blood, the level of bilirubin continues to increase, the concentration of hepatic enzymes is growing and the platelet content is reduced.

  The presence of a large amount of toxins in the blood leads to the damage to the kidneys and the appearance of renal failure. The diuresis decreases, the concentration of creatinine and urea increases. In the future, there is a violation of the heart, the heart rate is expected, arrhythmia occurs and blood pressure decreases.

  Infectious-toxic shocks in the end leads to polyorgan deficiency, so it is extremely important to begin treatment of acute cholangitis in the early stages: this condition carries a threat to human life.

  Chronic cholangit

  

  Sclerosing cholangitis

  Chronic cholangitis meets much less often in contrast to other diseases of the hepatobiliary system. It is mainly happening again, that is, against the background of the existing pathologies of the gallbladder or the liver. In one third part of the cases, this state appears after removal of the gallbladder.

  Highlight The following forms of chronic inflammation of bile ducts:

  • Septic. It is characterized by grinding changes in the ducts.
  • Latent. It has a hidden course and may not be manifested for many years.
  • Recurrent. It is characterized by the emergence of periodic exacerbations of the disease.
  • Abscessant. With this form of illness in biliary tracts, limited purulent foci (abscesses) are formed.

  A separate type is. With this pathology, the inflammatory response in the ducts appears without the presence of infection. In the future, this leads to the sclerosis of the paths and disturbance of the outflow of bile. On recent stages Diseases there is a complete infection of biliary ducts, which, in turn, provokes the appearance of a liver cirrhosis. This disease relates to extremely heavy and cannot be treated. Most patients for 10 years this species Cholant leads to irreversible changes in the liver.

  Symptoms of chronic inflammation

  At the initial stages, chronic cholangitis may not have symptoms (or they will be expressed extremely weak). For this state, Characc Triad is also characterized, but the signs appear to a lesser extent. The patient is concerned about moderate pain in the right hypochondrium. Body temperature rises to 37-38 degrees. Jaundice appears in exacerbation of the disease, there is no remission during the remission.

  At the initial stages of patients concerned:

  • general weakness;
  • disgraceability;
  • headaches;
  • severity after meals;
  • nausea.

  Especially often symptoms appear in the error in the diet - the use of a large number of fatty products or overeating.

  Exacerbation chronic cholangita It has the same manifestations as acute inflammation of biliary ducts.

  Diagnostics

  The diagnosis of cholangitis is primarily based on a characteristic clinical picture - Charcot Triad. Often, patients come to the doctor to do with these symptoms, and in the future, the diagnosis is helped by laboratory and instrumental research.

  Find out the prevalence of the process using ultrasonic research Liver and biliary ducts. In suspected oncological disease, it is recommended to carry out computer tomography - it will help to identify the prevalence of the inflammatory process and the presence of metastases.

  To date, endoscopic diagnostic methods are widely used. Among them are distinguished:

  • Magnetic resonance pancreatocholangiography.
  • Expressive and cheap cholangography.
  • Retrograde pancreatocholangiography.

  These methods allow you to analyze the state of the internal shells of biliary tract, establish the prevalence of processes and their stage.

  Treatment

  First of all, the cholangitis is important to reduce the manifestation of inflammation. To this end, prescribe antibacterial therapy. The following combination of funds are most often used: the cephalosporins of the 2nd and 3rd generation are combined with metronidazole and aminoglycosides.

  • To reduce pain syndrome, antispasmodics (but-shpa, balallgan) are prescribed and painkillers (analgin and ketonal).
  • To improve the liver condition, hepatoprotectors are written - heptral, essential (only when normal level Alkaline phosphatases), Hep-Merz and others.
  • In order to reduce intoxication, prescribe infusion therapy with saline, reosorbilakt, glucose solution, reopolyiglucin, etc.

  In the case of infectious and toxic shock, plasmapheresis is carried out. It allows you to clear the blood from toxins in a short time and warns the development of polyorgan deficiency.

  With complicated cholangitis, the following operational interventions are carried out:

  • Endoscopic papillosphincterotomy. Used to eliminate the stenosis of the packer.
  • Extraction of biliary ducts by endoscopic methods (with stones).
  • Endoscopic stenting of choledoch - in case of its significant damage.
  • For purulent complications Set percutaneous transcript drainage of bile ducts or conduct outer drainage of biliary tract.

  Often, cholangitis is combined with cholecystitis, in which case the operation is carried out in two stages. Initially, they produce cholecystectomy (removal of the gallbladder), then apply one of the above techniques for the operational treatment of the disease.

  For the treatment of sclerosing cholangitis best method Recorded liver is recognized.

  Chronic cholangitis during the remission is treated using physiotherapy techniques. Patients are prescribed:

  • electrophoresis;
  • ozkeritotherapy;
  • medical baths;
  • diathermy.

  It is important to stick to the diet and normalize lifestyle. This will significantly improve the condition of the patients and extends remission.

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Cholangitis is an inflammatory process in bile ducts (cholangolit - damage to small bile ducts; cholangitis or angiocolite - the defeat of larger intravenous bile ducts; choledochitis - the defeat of the total bile duct; papillitis is the defeat of the Patera Nipple region). As a rule, it arises against the background of violations of the patency of biliary tract. Provice inflammation can infection of bile. Often, pathology is found together with the cysts of the total bile duct, as well as cancer of bile ducts. There is a disease against the background of hitting pathogens of a bacterial infection in bile ducts.

Code of the ICD-10

This disease belongs to the cycle - other diseases of biliary tract (K83). True, in this case, states that belong to the bustling bubble (K81-K82), bubble duct (K81-K82) postcholycistectomic syndrome (K91.5) are excluded.

K83.0 cholangitis. Cholant: ascending, primary, recurrent, sclerosing, secondary, stenosing and purulent. Fully excluded: cholangitic liver abscess (K75.0) cholangitis with choledocholithiasis (K80.3-K80.4) chronic non-resident destructive cholangitis (K74.3).

K83.1 The blockage of gall duct. Occlusion, stenosis of bile duct without stones, narrowing. Fully excluded: with choletiasis (K80).

K83.2 Split bile duct. Gap duct. K83.3 Spisch of Gall Delta. Welded fistula. K83.4 sphincter sphincter Oddi. K83.5 bile cyst. K83.8 Other refined diseases of biliary tract. Spikes, atrophy, bile duct hypertrophy, ulcer. K83.9 Disease of biliary tract uncomplicated.

Code of the ICD-10

K83.0 Cholant

K80.3 bile duct stones with cholangitis

A frequent reason is the presence of benign pancreatic structures, caroli disease, sphincter dyskinesia. Certain the contents of the small intestine in biliary tract can lead to illness, as well as complications resulting from reconstructive operations on bile ducts. There are several ways for which infection gets into bile ducts. Often everything happens to the hematogenic way, or lymphogenic. The pathogens are able to become microorganisms of intestinal microflora, which are found in associations. Most often, the disease has a bacterial nature. Representatives of the Enterobacteria family, gram-positive microorganisms, unhorgemic-forming anaeros can provoke it.

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Pathogenesis

The main causal disease is to combine it with a violation of the outflow of bile. It is not so often in its pure form, mainly it is combined with cholecystitis or hepatitis. Basically, the problem is caused by a bacterial infection. To penetrate the bile moves, it can through the intestines or together with blood flow. Most often, the causative agent is an intestinal wand. It is extremely rarely enterococcus, staphylococcus and anaerobic infection.

Development mechanism lies in bile wet. This is observed when blocking stones stoke. Provoke a phenomenon that is capable of a cyst of bile duct, ulcer, endoscopic manipulations on a general bilent protocol. In general, any problems associated with bile outflows. Therefore, on time eliminated problems are able to reduce the risk of disease. By character, inflammation is divided into several species. So, the cholangitis can be catarrhal, purulent and diphtheric.

Symptoms of cholangitis

The acute form of the disease is able to occur on the background of complications with a total obstruction of the gallbladder. Extremely rarely everything happens as a complication of Kolado. The clinical picture of the manifestation includes malaise, jaundice, pain in the shovel, forearm. All this is capable of a flirt in fever, nausea, vomiting. Human is repulsted by the confusion of consciousness, arterial hypotension is observed. Patients have thrombocytopenia. It is a manifestation of intravascular coagulopathy.

The acute form of the disease has several other symptoms. More precisely, it has a sharper stream. In most cases, human dispersal disperses, which flow without fever and jaundice. There is no pain syndrome. In the intervals between exacerbations, symptoms can be completely absent. If the liver is also affected, then also those that correspond to a parenchymal jaundice are added to all signs.

Sometimes the disease can begin like sepsis. So, a person shakes the alternating chill and fever. A heavy form is accompanied by septic shock and renal failure. The frequency of fever depends on the causative agent, which provoked the disease. Pneumococcal cholangitis are extremely difficult. As soon as bile hypertension decreases, symptoms disappear. During the exacerbation, the liver is capable of increased in size.

In chronic current, everything is accompanied by blunt pains, a feeling of pressure, itching, the light yellowness of the mucous membranes. Often manifests itself unmotivated by subfebrile. Elderly people have a pronounced asthenic syndrome. It is characterized by fever and pain.

First signs

Much depends on what form of the alend is present in humans. So, for chronic cholangitis, the asymptomatic flow is characterized, which is accompanied by an acute form, but only occasionally. For this state, the presence of elevated temperatures, strong gravity pain in the abdomen and chest. Especially pronounced manifests itself weakness, nausea, vomiting and sharp decrease arterial pressure. According to these symptoms, it is possible to make a diagnosis.

Chronic cholangitis does not have the first symptoms, as practically asymptomatic proceeds. This is the main danger. Disease is able to lead to renal coma. Therefore, when there is any discomfort or the presence of problems of the concomitant development of cholangitis, it is worth seeking help in medical institution. For chronic shape, the appearance of painful syndrome of various intensity is characterized. A man feels fatigue, its skin turning it, as well as an increase in temperature. It is often observed redness of the palms. The end phalanges of the fingers are capable of thickening.

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Triad Shako with Cholant

For acute form The disease is characterized by the presence of Charcot triads. It is in the presence of three main symptoms. As a rule, it is pain in the right upper quadrant of the abdomen, fever and jaundice. Determine the presence of the last two signs is very simple. To do this, it is enough to explore the liver, it is clearly enlarged and this is noticeable when palpation.

There is also a symptom of Murphy. It is characterized by the presence of point sensitivity in the gallbladder. Determine it is simply during palpation. There is a sensitivity in the right hypochondrium. It usually applies across the entire width of the liver. The liver edema can have a different degree of severity. Therefore, to determine the presence this symptom just. If you correctly regard clinical manifestations, the treatment will be not only correct, but also effective.

Therefore, patients with the presence of cholecystitis or bile colic are directed to the ultrasound. This will allow you to confirm or disprove the fact of the problem. With a late definition of pathology, it is able to actively progress. At the same time, another pair of symptoms is added, namely the confusion and septic shock. These signs together with triad, Charcot able to lead to death. To make a decision on hospitalization and treatment must be taken in an hour.

Sclerosing cholangitis

Primary sclerosing cholangitis (PSX) is a state for which antibody production is characterized by bulls. All this is accompanied by a violation of bile outflow. The reasons for this form of the disease are unknown. It is assumed that the problem is related to the presence of an infectious agent, which is a provoking factor in people, with a genetic predisposition.

Men are subject to this phenomenon Much more often than women. There is a pathology aged 25-45 years. In some cases it happens in children early age. Virtually 70%, the cholangitis is accompanied by non-specific ulcerative colitis. It can be combined with diabetes mellitus, as well as thyroiditis.

The disease does not exhibit vividly. Symptomatomy is simple, it consists in changing biochemical indicators. Most often accompanied by the absence of signs. At the beginning of the disease, a person begins to lose weight dramatically, he has skin itching, pain in the right hypochondrium, as well as jaundice. If the symptoms began to show itself, it means that the process has a difficult course. Fever is not specific.

Diagnosis of the disease lies in the study of blood serum. It is characterized by an increase in alkaline phosphatase, as well as bilirubin, γ-globulin level, Igm. During the ultrasound, the walls of bile ducts are thickening. For the disease, the development of liver damage is characterized, which is accompanied by cirrhosis and hepatic cellular failure.

Acute cholangit

The acute course of the disease is characterized by chills, as well as fever. The abundant sweat, the appearance of bitterness in the mouth, as well as vomiting. Often there are pain in the field of right hypochondrium. Sometimes pain syndrome is too intense. The liver is capable of increased in size, accompanied by jaundice and skin itch.

Sometimes there is an elevated temperature, and pain in the field of right hypochondrium. There is a weakness, fatigue. Man quickly gets tired, his shiny. The liver and spleen are characterized by a considerable size. The disease may carry complications. They are characterized by the presence of suppuration, necrosis.

The disease often leads to the sclerosis of bile ducts. All this flows over time to the development of hepatitis. The outcome of the situation is cirrhosis of the liver. The diagnosis is made according to symptoms. When palpation, the liver is significantly increased. To confirm the diagnosis, a number of radiological and laboratory studies are carried out. Anamnesis is a gallbladder disease.

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Chronic cholangit

For this disease, chills are characterized, which are accompanied by or alternating fever. A man urins abundant sweating, bitterness in the mouth, as well as vomiting and painful syndrome in the right hypochondrium. The liver can increase significantly. Often the jaundice arises, as well as skin itch. In the blood there is an elevated level of leukocytes.

Chronic form of illness arises against the background of previously available acute period. The clinical picture is similar. A man pins an increased subfearing temperature, as well as a yellow scler. There are new pains in the field of right hypochondrium. The victim quickly gets tired, he has a weakness, sharp weight loss. The liver and spleen are rather increased.

Chronic form can lead to a number of complications. It may occur, hepatitis and even cirrhosis of the liver. Therefore, it is impossible to allow this disease, the more its progression. When palpation feels a sharp increase in the liver. It is important to diagnose the disease on time and proceed to its treatment.

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Bacterial cholangit

Most often manifest itself classic form, Namely, Triad Charcot. Human is picked up, accompanied by all jaundice and fever. Pain sensations are localized mainly in the epigastric area. Most often, patients complain about intense or pickup pain. In rare cases, discomfort is felt.

This pathology is characterized by an increase in temperature, up to 39 degrees. Sometimes it is significantly higher. In addition, there is a headache, chills. During the inspection, the doctor notices an enlarged liver, as well as pain in the right side. Almost in all cases leukocytosis is observed.

Diagnostics is carried out by passing laboratory tests. Instrumental research is actively conducted. Usually, enough blood delivery. Additionally, it is possible to hand over the coprogram and urine analysis, but after the approval of the doctor. Ultrasound, ECG and CT are held. It is important to diagnose the problem in time and begin treatment.

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Lymbaliose cholangit

This disease cause ordinary giardia. Pathology is found in both adults and children. Transmitted mainly through the unwashed hands, by penetrating the mouth. Live bacteria in a duodenalist, as well as upper departments intestines. Sometimes found in the bustling bubble.

It is not so easy to determine the presence of a problem, because it is closely related to other intestinal diseases, as well as biliary tract. Diagnose pathology can be exclusively when the simplest giardies are detected. Despite this, symptoms are still observed. So, a person brings pain in the right hypochondrium, nausea, dizziness, as well as problems with the gastrointestinal tract. Heartburn may appear, diarrhea or constipation. Sometimes there is an increase in temperature, as well as pain syndromes in the liver area. Eliminate the problem can be exclusively by compliance with the special nutrition. Observation at the gastroenterologist is mandatory.

Purulent cholangit

Clinically manifest this pathology In the form of fever and jaundice. A person can have confused, as well as arterial hypotension. Over time can develop renal failureAs a result of this - thrombocytopenia. The state must be eliminated by medical intervention.

Diagnose everything can be diagnosed with the delivery of laboratory studies. Usually, a person is guided by blood sowing, the number of leukocytes. Consider the indicators of the functionality of the kidneys. Ultrasound is held. Even with its negative results, it is recommended to carry out endoscopic cholangography.

Treatment is to use wide spectrum antibiotics. Detailed information on the medications of this type will be provided below. Eliminate the problem is not so difficult, but the work is painstaking. Therefore, it is desirable when the first symptoms appear to seek help from the doctor. A comprehensive elimination of the problem will help once and forever remove the disease.

Cholant after removal of gallbladder

From the liver bile should flow into the gallbladder. Here it accumulates and comes to a certain concentration. As soon as food goes into the body, concentrated bile is sent to the duodenum and after it is involved in digestion and assimilating fats.

When an operation was carried out to remove the gallbladder, the bile begins to directly enter the duodenum. This is coming directly from the liver. But the bile less concentrated, it is simply unable to perform its basic function. In the process of digestion, it does not participate, more precisely does not give the desired result.

In order not to be complications, a person must comply with a special diet. Otherwise, the bile will occur in the liver. The danger of the development of the inflammatory process is at a high level. The first can appear cholangitis. The patient must eat gradually and often, just 6-7. In this case there will be no complications.

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Calculse cholangit

This pathology does not arise simply so. For its development should have a special push. As a rule, it is in the presence of an infectious focus in the body. In order to defeat the immune system, the infection must be very strong, and the function of the body is significantly weakened. Only, therefore, the development of the disease is possible.

Often everything occurs against the background of the presence of cholecystitis. The fact is that the focus of infection is located too close to the liver and ducts. Therefore, its penetration in the gallways is quite likely. Plus, there is a stagger of bile, which significantly exacerbates the situation. Stagnation always leads to a strong infection.

Inflammation can lead to edema and redness. They are satellites of inflammation. It is important in time to pay attention to the main symptoms and begin treatment. For a man suffering from cholangitis at this stage, the presence of high temperature, jaundice and stupid pain in the liver area is characterized.

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Autoimmune cholangit

The disease in their histological features resembles primary billiard cirrhosis. However, it is characterized by the presence of antimiochondrial antibodies, as well as antinuclear antibodies and / or antibodies to smooth muscles. Thus, the disease is considered idiopathic, with the presence of a mixed picture of the manifestation of hepatitis and cholestasis.

The main symptoms are enforced by immune cholangitis. However, the definition of the disease is ambiguous. After all, it is not clear for what reasons it developed. More precisely, how the disease intersects with the primary billiard cirrhosis syndrome, as well as hepatitis. Cholangitis of this type may have a form independent disease. See this thin line is not so simple. The problem occurs not so often, but only in 5-10% of cases.

It is important to start diagnosing the disease on time. Moreover, it is necessary to correctly determine in what form is pathology. Proper diagnosis And the treatment will help to cope with the problem.

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Bilyiary cholangit

The disease is idiopathic liver pathology. Basically affects the problem of exclusive adults. They suffer mostly women of middle age. His young men are subject to him. Diffuse diffuse inflammatory and fibrous changes in the entire biliary tree.

The main reason for the appearance of the problem has not yet been detected. There are several basic signs that indicate the presence of a disease. So, often cholangitis is associated with other autoimmune diseases. The presence of antibody circulating antibodies often provoke the development of pathology. During him, bile ducts are amazed. Wrong disease is capable of family predisposition.

Detect the problem is not so easy. It usually goes in combination with another problem. It is necessary to take blood tests and explore the liver. This will help track leukocyte levels, as well as other main indicators. Then a qualitative treatment is prescribed.

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Stenzing cholangitis

The beginning of the disease is asymptomatic. Everything develops gradually, therefore for a long time A person does not bother anything. The first manifestation consists in increasing the activity of G-glutamlitranspendase (GGTP) and alkaline phosphatase (CFC) serum. That you mean, there are no visual manifestations. It is possible to identify the problem only by passing blood.

Asymptomatic flow is particularly dangerous, because it is capable of developing a liver cirrhosis, as well as portal hypertension. But at the same time, signs of cholestasis is not observed. Most often diagnosed directly "cryptogenic cirrhosis".

Much better when the disease begins to show. This will avoid possible complications and save man. It is manifested in the form of fever, fast fatigue, permanent pain. It is possible to change body weight, as well as skin itch. The progressive stage develops jaundice. Gradually appears pepperconductable failure, as a result of this - a billiard cirrhosis is formed.

Diagnose pathology can be solely due to laboratory research. The disease is manifested by insignificant hyperbilirubinemia and an increase in IGM level, an increase in the level of CEC (70% of cases).

Recurrent cholangit

If the outflow of bile is broken constantly, then the disease progresses and goes into a chronic form. The multiple repetition of this process leads to the fact that the pathology is constantly present and manages man everywhere. Naturally, everything alternates the satisfying periods and a serious manifestation of the disease.

For the exacerbation period, the presence of acute pain In the right hypochondrium. All this is accompanied by fever, jaundice and skin itch. The outflow of bile is capable of spontaneously recover. But this is happening in the so-called periods of the clutch. Then the pain gradually subsides, the state of a person is improving, signs of jaundice is not observed. Man feels much better. But this state is briefly. Over time, the phase of active manifestation of pathology will come. Symptomatics is constantly repeated. It is important to maintain a person's condition. After all, otherwise the condition will deteriorate significantly. Constantly emerging recurrences prophesy the development of chronic form.

Hematogenic cholangit

It is characterized by hematogenous distribution of the causative agent of infection. The disease can flow in different ways. So, its forms can be diverse. The development option depends on the reason for which the cholangitis appeared.

At the heart of all forms of development lie bacteria or the simplest microorganisms penetrating into the body. Most often it is a conditional pathogenic microflora, giardia, helminths. The inflammation of the gallbladder can serve as a background for the development of the disease, the presence of stones in it, as well as a glisted invasion. Stagnation bile provokes the development of cholangitis.

For pathology, a sharp start is characterized. Typically, a sharp rise of temperature is fixed, up to 40 degrees. In parallel with this, a person feels pain in the right side. Moreover, pain syndrome may be different intensity. Sometimes he just resembles a colic. The whole right half, side, shoulder, neck and spatula area can pull. In these places there are beams of nerve endings. When progressing, skin itching, nausea, vomiting, as well as impaired appetite appears.

Cholant in children

The acute form of the disease in kids is extremely rare. Basically it carries a secondary form. Initially, the baby can transfer streptococcal etiology, and then this pathology will also arise. Sometimes she carries heavy consequences. So, the pleurisy, the abscess of light, sepsis and pancreatitis is not excluded. If the treatment technique is chosen incorrectly, the development of toxic liver dystrophy is possible.

Primary pathology has acute symptoms. If it is chronic, then there are no signs. Only occasionally, the baby feels pain in the right hypochondrium, his weakness, chills and temperature pester. Typically, such a manifestation is characteristic of the acute phase. With secondary development, the billyarium liver cirrhosis is not excluded. Conduct diagnostics is very hard, and the disease itself has a difficult course.

Treat this form is better surgically. Because the further condition of the child depends on this. It is not worth allowing chronic form. The consequences may be much. It is important to comply with proper nutrition.

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Classification of cholangita

By etiology:

1. Bacterial.
2. Helmintous.
3. Toxic and toxic-allergic.
4. Viral.
5. Autoimmune.

With the flow:

1. Acute.
2. Chronic.

By pathogenesis:

Most often, cholangitis have a bacterial nature and pathogens most often are intestinal wand, enterococci, friedland bacillos, pneumococci, streptococci.

Effects

If there is no timely treatment, the inflammatory process can become more serious. Gradually, he shifts on the peritoneum, because of this, peritonitis is possible. Pathology can "move" to the surrounding tissues. As a result, subiaphragmal and intrahepatic abscesses begin to form. Often occurs sepsis, as well as toxic shock. The latter complication develops against the background of the bacterial form of cholangitis.

The patient's condition becomes extremely difficult. Sometimes it is impossible to do without resuscitation events. The inflammatory process for a long time is able to lead to sclerotic changes. As a result, the disease takes a chronic form and leads to the development of a billiard liver cirrhosis.

Self-medication and attempts to eliminate pathology by folk remedies, on the contrary, aggravate the situation. And in general, such an intervention is unacceptable. After all, time may be lost, and pathology will be more serious. In the later stages, the forecast is far from the most favorable.

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Complications

If a person does not appointed timely treatment, complications may be aggravating. Most often, everything ends with cirrhosis of the liver. In order to prevent such a development of events, it is enough to begin treatment in time. Often, the cholangitis leads to peritonitis. The peritone is inflamed, the surrounding fabrics are also amazed. As a result of this, the development of toxic shock is possible. The patient is seriously tolerated all the symptoms, he needs help in the form of resuscitation activities.

The long-term inflammatory process leads to the appearance of a chronic form of the disease. This is capable of entrusting changes in liver tissues. Ultimately takes its development of the billarium cirrhosis of the liver.

To engage in self-elimination of the problem in this case is stupid. While a person will try to remove all signs, the disease will begin to progress and you can not always save the victim. It is worth it to treat with full seriousness.

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Diagnosis of cholangita

To suspect the presence of a problem simply by Triad Charcot. So, the diagnosis is carried out against the background of laboratory and instrumental research. Biochemical samples are able to testify to cholestasy. In the presence of cholangitis, an increase in the level of bilirubin, as well as A-amylase and alkaline phosphatase, is noted.

There are visualizing methods for evaluating the state. As a rule, it is an ultrasound abdominal cavity and liver. It will determine the presence of an inflammatory process, an increase in organs. Not so often computed tomography. This will allow you to see the exact image of the bile ducts and the expansion of them, as well as the availability focal changes.

Instrumental diagnostics are widely used. It occupies a leading position in the definition of pathology. So, as its endoscopic retrograde pancreaticolangiography, as well as magnetic resonance pancreatocholangiography. On the captured pictures you can see the biliary paths and the reason for their obstruction.

Differential diagnosis It is only necessary in the presence of viral hepatitis, right-sided pneumonia, as well as a primary billiard cirrhosis.

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Halgite tests

An experienced specialist is able to diagnose one after a survey. After all, it is worth listening to the patient and hold a palpation so that the picture becomes more and less understandable. But, nevertheless, the tests are necessary in order to clarify in which phase there is a disease. This will allow to identify the processes related to it and assess the situation as a whole. After all, an important place in this case is given to the functionality of the liver and other bodies.

The first thing to the patient is offered to pass the blood test. It is determined by the leukocyte level. Significant increase in their inflammatory process in the gallbladder. The urine analysis is also surrendered. For this pathology, the presence of positive reaction on bilirubin.

A biochemical blood test is carried out. It shows the level of bilirubin, as well as gamma globulins, amylases, alkaline phostropha and alpha-2 globulins. It is recommended to hand over blood test for sterility. This will eliminate or confirm the presence of bacteria. This analysis is carried out exclusively in specialized establishments, because it requires compliance with certain rules. Duodenal probing are prescribed. This procedure will allow you to make a fence of bile and explore it.

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Instrumental diagnostics

This research methodology includes several main directions. So, the first of them is an ultrasound study, simply speaking, usually ultrasound. Thanks to it, you can reveal an increase in the size of the liver and notice the expansion of bile ducts.

The second version of the instrumental diagnosis is retrograde cholangiparatography (ERCP). This method is the main one. It is a radiographic study of bile ducts by introducing a special contrast agent with an endoscope. The technique allows you to study changes in the biliary ways. In the primary cholangitis, the changes are visible.

Magnetic resonance cholangiography is widely used. A special place is given to computed tomography. Duodenal probing also applies. It allows you to explore bile and see any changes in it. All techniques can be used both independently and in the aggregate. Much depends on the state of the patient itself.

Ultrasound diagnostics

It is possible to notice changes in the liver and abdominal cavity using ultrasound. The foci of infections, changes in size and forms should immediately push a specialist for the idea that the victim has a cholangitis. Naturally, everything combines together with laboratory analyzes and manifested symptoms.

In the study, the uneven width of the lumen of bile ducts is clearly visible. They increase significantly inside the kidneys or outside, in addition they are echogenne. Unevenness is clearly visible. Portal arteries occupy a speaker. In complications, changes in liver contours are visible. There is an echogenic material in the lumen of the duct.

Ultrasound examination allows you to make an accurate diagnosis. It is possible to confirm it using endoscopic retrograde cholangiography. Naturally, all biopsy and clinical data are supported. Based on the data obtained, a qualitative treatment is appointed and man is appointed.

Differential diagnostics

This technique includes a blood test. Thanks to it, it is possible to identify the presence of an inflammatory process in the body. Usually this is evidenced by an increase in ESP and leukocytes. Not the last role is assigned biochemical analysis blood. This study shows the level of bilirubin, especially the direct fraction. The level of alkaline phostropha and gama-glutamylTranspendase is determined. These indicators are closely related to bile outflow. Any changes in them testify to the presence of violations during this process. Increased activity of transaminase indicates a toxic lesion of the liver. Without differential diagnosis, it is impossible in principle. Laboratory tests are particularly important.

A general urine analysis is also conducted. Here you can see the appearance of biliary pigments. Cal is rendered for the presence of Eggs of helminths and other simple organisms. Differential diagnosis strictly interacts with the instrumental.

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In case of conservative elimination, the patient during the first three days should refuse food, and then proceed to a gentle diet. This will allow to suppress the vital activity of pathogens. After all, to get a feedback for them is nowhere. Along with special nutrition applies wide spectrum antibiotics. Usually used metronidazole. In order to reduce pain syndrome, spasmodics and analgesics are used. It is recommended to pay attention to DroTaver and Meperin. If a person has severe intoxication, it is introduced glucose-saline.

Operational intervention is a liver transplantation. This is usually used in cirrhosis, recurring bacterial cholangitis and persistent jaundice.

Medicine

As mentioned above, preparations that reduce pain syndrome are widely used, eliminate the infection and contribute to the rapid restoration of the body. The most popular drugs are: DROTAVERIN, memerin, albendazole, ademeteonine, hollesticine, ursodeoxycholic acid and rifampicin. Antibiotics are considered separately.

A broad spectrum antibiotics are used to suppress infection. These include metronidazole, tetracycline and levomecitin. You can take them no more than 2 weeks in an individual dosage.

• Metronidazole. it antimicrobial preparation. Apply it on one tablet 2-3 times a day. In special cases, the dosage increases to 4-5 tablets. It is not necessary to make adjustments to yourself, the remedy has a number of side effects. So, it is possible nausea, vomiting, weakness, availability metal Tribus In the mouth, dizziness. When symptomatics appears, it is worth consulting a doctor. Contraindications: pregnancy, children's age, hypersensitivity and breastfeeding period.
• Tetracycline. This preparation has a bacteriostatic action. It is necessary to apply it to 200 -250 mg 2-3 times a day. For children, enough - 20-25 mg / kg. The duration of treatment is assigned individually. Contraindications: Hypersensitivity, pregnancy, lactation period, violation of the liver and kidney function. Side effects: skin pigmentation, inflammation of mucous membranes, dysbacteriosis, allergic reactions. Typically, the drug is moved well.
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Popular treatment

It should be immediately noted that in the presence of such a disease, resort to help folk Medicine Do not. After all, the person will pick up optimal treatment, pathology will begin to progress. Cirrhosis of the liver and other complications carry a colossal threat to a person's life. This fact should be understood and independently not attempt to eliminate the problem. Yes, exist folk Methods treatment, but still without specialized drugs it is impossible to do.

• Recipe 1. For its preparation you need to take 6 tablespoons of nettle of dwarm, 3 tablespoons of the grass rebels and the sand mill flowers. In the amount of 2-tablespoons, corn and grass of the Hypericum are taken. All this is mixed with each other. To prepare, it is enough to take only 2 spoons of collecting and mix them with honey. After that, everything is poured with boiling water in the amount of 500 ml. It is necessary to insist the tool for 2 hours. Then apply 3-6 times a day at half a cup.
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Treatment of herbs

Herbs can help in many situations and even cope with the problems of bile outflow. True, they can be used exclusively as supportive therapy. It is not necessary to apply them yourself.

• Recipe 1. It is necessary to take a tablespoon of the Grass of the Hypericum and pour her glass of boiling water. After that, put on fire and boil about 15 minutes. The resulting agent is taken at a quarter of a glass 3 times a day. The decoction is able to have a pronounced anti-inflammatory effect, as well as provoke bile outflow.
• Recipe 2. The spoonful of the herb of the souls is worth pouring a glass of boiling water. The means for 2 hours is insisted. Take it is necessary at a quarter of a glass 3 times a day. The product is really effective, but it is impossible to take it to pregnant girls.
• Recipe 3. 100 grams of cornflowers are taken and mixed with 75 grams of marigolds and yarrow. All this is poured with two glasses of boiling water (collecting enough to take 2 tablespoons). At night, the remedy is left alone. In the morning everything is fixed and used in 100 ml to 4 times a day.

Homeopathy

Homeopathic remedies have long managed to gain popularity and special distribution. But still, it is recommended to resort to the help of standard treatments. If we talk about homeopathy, it is effective, but not suitable for everyone. A variety of means are used to combat cholangitis.

• Arsenikum Album. It is a poisoning substance. Assign it to people who suffer from skin itching, increasing at night. Often the drug causes an allergic reaction, nausea and stomach disorder.
• Baptisia Tinctoria (Wild Indigo Bob Family). The drug is widely used in the chronic form of the course of the disease. Especially if it proceeds together with elevated temperature, bright dreams and feelings of heat in the morning.
• Berberis Vulgaris (Barbaris). It is used in the presence of bitterness in the mouth, buttering pains, as well as dryness in oral cavity. It is possible to develop pain syndrome when driving.
• Bronya Alba (white space). A means of a very painful palpation and the presence of a pathological process in the liver is prescribed.
• Cupup (copper) and zincum (zinc). Widely used in pronounced gallbladder spasms. Capable anti-inflammatory effect.
• Likopodium clawatum. Used in cholangitis accompanied by liver diseases. Especially when pronounced symptoms are observed. In this case, there is a bitter in the mouth, a violation of appetite, heartburn.

FROM full list Medications can be found at the homeopath doctor. It is he who prescribes this or that means depending on the state of man and symptoms.

Diet with cholangitis

• Diet number 5. Eating is necessary 5 times a day, in small portions. It is forbidden to eat before bedtime, in any case, to eat greatly. Sharp i. spicy dishes are under the ban. Refuse will have garlic, horseradish and radish. Alcohol is strictly prohibited. Fatty meat and fish must be deposited until better. On the day, a person consumes up to 3,500 kokalorius. Daily rate 90-100 grams of proteins, 100 grams of lipids and 400 grams of carbohydrates. Include in the diet is buckwheat, lean meat, fish, cottage cheese and oatmeal. As soon as the condition is improved, you can go to vegetables and dairy soups. Permitted lean meat and fish. You can eat cookies, fresh vegetables (cabbage, carrots and potatoes). Allowed bread, but slightly dried. Honey, sugar and infusions from berries are very helpful. You can create a diet independently, pushing out the list of permitted products.
• Diet number 5a. You can eat absolutely any cereals, but they need to sharpen much. Meat and fish are in vapor form. It is impossible to fry! Do not eat raw fruits and vegetables. Under the ban is located rye bread. It is advisable to carry out monodic days on apples or cottage cheese. To exclude constipation, the diet is diluted with dried fruits, beet and vegetable juices. When the state is improved, you can switch to a diet at number 5.

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All patients who suffer from a chronic form of pathology should always be under dispensary supervision. It is important to carry out anti-relaxed treatment, this is done 1-2 times a year, depending on the state of the person and the progression of pathology. It is necessary to constantly use mineral water, choleretic agents and medicinal nutrition. It is advisable to periodically send patients to health resorts and the pretender.

Forecast

The disease prognosis is completely dependent on the state of the person and the form of the flow, as well as the outflow of bile. If the treatment was carried out in a timely manner, then no complications should be. Fast intervention leads to positive results. But it is important to maintain the body so that there is no relapse. Permanent repeating pattern of pathology leads to chronic flow. In this case, the forecast can be extremely unfavorable.

If we talk about late stages of pathology, then everything depends on treatment. But all, the probability of an unfavorable forecast is several times higher. Save a person is not always possible, especially if he has cirrhosis of the liver. Here you need exclusively organ transplantation. Additional symptoms relating to acute liver failure, cirrhosis and liver abscess are capable of worsening the forecast. In the risk group there are women over the age of 50. Therefore, it is important to pass surveys and react to any symptoms in a timely manner.

- This is sharp purulent inflammation biliary tract, developing due to violation or complete blocking of bile outflow. The disease is characteristic clinical picture: Rapid increasing jaundice against the background of hyperthermia with chills and pain in the right hypochondrium. In the absence of decompression, a biliary sepsis with a violation of hemodynamics, consciousness, kidney works and other organs is rapidly developing. The diagnosis is based on the visualization of the mechanical obstacle in ultrasound or CT of the abdominal organs. Treatment surgical (decompression of biliary tract with elimination of obstruction) in combination with antibiotic therapy, hemodynamic correction and other violations.

General

Despite the continuous improvement of diagnostic and therapeutic techniques, purulent cholangitis remains acute problemSince often leads to biliary sepsis. Especially severely disease occurs in senior patients age groups, in the presence of severe concomitant pathology, which prevents the effective surgical elimination of the causes of the disease.

Causes

Normally, this flora supports the tone of the immune system, causing the response of the lymphoid nodes of the intestine and the chipper liver cells. Microorganisms are captured by the reticuloendothelial system, partially enter the gallways, but at normal outflow of bile, infection does not develop. In conditions of disturbed outflow, and even more so with complete obturation, the number of bacteria in bile is equal to that in the contents of the intestine. The most often purulent cholangitis causes a gram-negative flora, less often - staphylococci, streptococci, pseudomonades.

An important pathogenetic mechanism for the development of purulent cholangitis is bacteremia. The reason for the contact of microorganisms into the bloodstream is an increase in pressure inside the liver's protocal apparatus, in which the resistance of bile ducts is disturbed and their contents fall into collective veins. In the blood, the monobacteric flora occurs much more often than polybacterial; In most cases, intestinal wand or klebseyella is determined.

Microorganisms entering systemic blood flow leads to severe hemodynamic disorders - a biliary septic shock develops. The cause of the clinical picture of Sepsis is also endotoxmia. The endotoxins of bacteria have a pyrogenic effect, activate the blood coagulation system and intravascular thrombosis, a humoral immune response, disturb the work of the kidneys. A large role in the development of toxmia is given to violation of the mechanisms of local intestinal and general immunity.

Symptoms of purulent cholangitis

Pathology has a characteristic clinical picture. The disease always begins acutely, symptoms develops violently. The main signs of acute purulent cholangitis are united in the Charcot Triad: Hypertermia, pain in the field of right hypochondrium and jaundice. The patient is concerned about pronounced weakness, chills. A biliary sepsis is always observed - in abdominal surgery and gastroenterology, this term is used to describe the extremely severe condition of the patient with a given disease.

In acute obstruction of the biliary ways, sepsis develops quickly, within a few hours; It may occur lightly with the formation of multiple liver abscesses and polyorgan deficiency. In essence, acute purulent cholangitis and biliary sepsis are morphological substrates of the same pathological process, but changes in intrahepatic ducts are local manifestations, and sepsis is generalized inflammation, the response of the body to the infectious process. The main symptoms of biliary sepsis are arterial hypotension, violation of consciousness, oliguria.

Diagnostics

The diagnostic examination begins with a detailed assessment of patient and history complaints. In favor of the diagnosis of purulent cholangitis, data may indicate the transferred diagnostic or therapeutic endoscopic interventions in the biliododenal area, operations on the biliary tract. Consultation of the abdominal surgeon makes it possible to determine the preliminary diagnosis with high probability, since the symptomatology is sufficiently characteristic: the rapid increase in pain syndrome, jaundice, an increase in body temperature.

With a combination of these symptoms with tachycardia, Tahipne, arterial hypotension is talking about the development of biliary sepsis. Its criteria are thick pus in biliary tract, confirmed by bacteriological studies of bacteremia, the absence of an organism's response to the introduction of 0.5 liters of physiological solution of sodium chloride intravenously. Laboratory methods allow you to reveal the symptoms of acute inflammation. In general blood test, neutrophilic leukocytosis is observed, the acceleration of ESO, in hepatic samples - hyperbilirubinemia, increasing cholesterol, hyperphosphatemia. In the case of acutely developed choledoch obstruction, it is possible to increase the activity of transaminase.

The ultrasound of the abdominal cavity organs, which allows you to identify the cause of purulent cholangitis and visualize a mechanical barrier, signs of intrahepatic hypertension (expanding biliary strokes above the mechanical obstacle level), and in the formation of liver abscesses - characteristic changes in parenchyma. CT liver is used to clarify the data. The obligatory method of the survey is esophagogastroduodenoscopy - against the background of changes in the duodenal mucosa, papallitis is found, as well as the absence of bile in the lumen of the DPK. The visualization of the concrement in a large duodenal papillary, scar changes is possible.

In the case when the methods described do not give full information, ERCP (endoscopic retrograde cholangiopancopyography) is carried out, if it is impossible to carry out its exercise - percutaneous christsechen cholangiography. During these studies, the contents of biliary tract are obtained for bacteriological research (The causative agent and its sensitivity to antibiotics are detected), visually evaluated bile: the presence of pus confirms the diagnosis of purulent cholangitis.

Treatment of purulent cholangitis

The disease requires immediate adequate assistance, and in the case of a developing biliary sepsis, only drug treatment is not enough, it is necessary to carry out emergency decompression of the biliary tract. Despite continuous improvement surgical methods, resuscitation, Classic stripe operations are highly assembled for patients, very often accompanied by complications, have high mortality, especially in the presence of severe concomitant diseases.

Therefore, at present, preference is given to minimally invasive interventions (endoscopic papilosophynetotomy, percutaneous christprise cholangiostomy, mechanical lithotripsy and others). The choice of decompression method is determined individually for each patient and depends on the degree of violation of the outflow of the bile, the level of the location of the mechanical obstacle. If the cause of purulent cholangitis are scar changesAdequate decompression is ensured by installing endoprosthesis in the choledoch.

Endoscopic papillosphincterotomy is the method of choice in calculating-inflammatory etiology of the disease and completely eliminates the stasis of bile and mechanical jaundice. Expressive christsechen cholangiotomy is considered as a preoperative preparation method, ensures bile leads to surgical elimination of the obstacle. With severe concomitant pathology, the outer drainage of the choledoch can be the final method of treatment. After emergency decompression can be held radical treatment: cholangiodeodenostomy, cholecystectomy. If the purulent cholangitis is caused by cutting stroying biliodigenative anastomosis, its recanalization is produced.

After an emergency decompression, a decisive role in treatment belongs to adequate antibiotic therapy. The complexity of antibacterial treatment of purulent cholangitis is that the determination of the pathogen is a long process, and after external drainage, the composition of the flora can vary significantly. Empirically antibiotics are appointed from the first day of the disease to prevent bacteriamia and sepsis before obtaining the results of bacteriological research: in the initial stages, preferably the use of cephalosporins and ureidopenicillins in combination with the metronidazole.

Since one of the most severe manifestations of the disease is endotoxmia, an important pathogenetic method of treatment is considered to be detoxification. Specific endotoxin-binding antibiotic is Polymixin B; High efficiency has lactulose that reduces the plasma concentration of lipopolysaccharide.

With a detoxification purposes, it is used that allows you to remove from plasma endotoxin, circulating immune complexes, cytokines. Enterosorption is used - sorbents remove toxins from the lumen of the gastrointestinal tract, preventing them from entering portal blood flow. Correction of hemodynamic and respiratory disorders, immunocorrection, nutritional support is carried out.

Prediction and prevention

Purulent cholangit - severe surgical pathology, the forecast for which is defined as a degree of overlapping of biliary tract, and the timeliness of the provision of specialized assistance - decompression and antibiotic therapy. Mortality with this disease is very high, biliary sepsis, endotoxic shock, DVS syndrome and polyorgan deficiency develop often. However, the improvement of surgical equipment, the timely endoscopic treatment of gallstone disease, as the method of prophylaxis, allows for severe complications.

Patients with existing episodes of mechanical jaundice, as well as after the operational treatment of purulent cholangitis, must be constantly observed at the gastroenterologist, regularly undergo a scheduled survey on the availability of concrections and scar strictures of biliary tract, comply with all the recommendations of the doctor ambulatory treatment and diet.

- Nonspecific inflammatory lesion of bile ducts of acute or chronic flow. At cholangitis, there is pain in the right hypochondrium, fever with chills, dyspeptic disorders, jaundice. The diagnosis of cholangitis includes the analysis of biochemical blood indicators, carrying out fractional duodenal sensing with bile bacquisure, ultrasound, percutaneous christsechen cholangiography, RHPG. In the treatment of cholangitis, antibiotic therapy, disintellation therapy, appointment of enzymes, FTL (mud, chloride sodium baths, paraffin- and ozoeceratotherapy, UHF, diathermy), sometimes - surgical decompression of the biliary tract.

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General

When cholangitis can be affected by intra- or extrahepatic bile ducts. The disease occurs more often in women aged 50-60 years. In gastroenterology, cholangitis is usually diagnosed in conjunction with gastroduodenitis, cholecystitis, hepatitis, gallstone disease, pancreatitis.

Classification of cholangita

The flow of cholangitis can be sharp and chronic. Depending on the pathological changes, acute cholangitis can take a catarrhal, purulent, diphtheric or necrotic form. Catarial cholangitis is characterized by hyperemia and swelling of the mucous ducts, leukocyte infiltration of their walls, desquamation of the epithelium. With purulent cholangitis, the walls of the bile strokes and the formation of multiple abscesses occurs. The difficult course is noted in the formation of fibrinous films on the walls of bile strokes (diphtheric cholangitis) and the appearance of necrosis foci (necrotic cholangitis).

The most frequently found chronic cholangitis, which can develop as the outcome of acute inflammation or from the very beginning to acquire a protracted flow. Latent, recurrent, long-term septic, abscess and sclerosing forms of chronic chillenty. With sclerosing cholangitis in the walls of biliary grows connective tissueWhat causes strictures of bile ducts and even greater deformation.

Causes of cholangitis

Aseptic enzymatic cholangitis can develop as a result of irritation of the walls of bile strokes with activated pancreatic juice, which has a pancreatoatoatar reflux. In this case, first arises aseptic inflammation, and the addition of infection occurs again, in a later period.

Aseptic type also flows the sclerosing cholangitis due to autoimmune inflammation of bile ducts. At the same time, along with sclerosing cholangitis, non-specific ulcerative colitis, krone disease, vasculitis, rheumatoid arthritis, thyroiditis, etc., are often noted.

The prerequisites for the development of cholastasis is cholestasis, occurring at the discrete of biliary tract, anomalies of bile strokes, a choledochny cyst, a gallway cancer, choledocholithiasis, stenosis of the Patestian chipboard, etc. Preceded by the beginning of cholangitis, cannogenic damage to the walls of the ducts during endoscopic manipulations (retrograde pancreaticolangiography, installation stents, sphincterotomy), operational interventions on the biliary ways.

Symptoms of cholangitis

The clinic of acute cholangitis develops suddenly and is characterized by triad Charco: high body temperature, pain in the right hypochondrium and jaundice.

Acute cholangitis manifests from fever: sharp lifting of body temperature up to 38-40 ° C, chills, severe sweating. At the same time, intense pains appear in the right hypochondrium, resembling a bile colic, with irradiation on the right shoulder and a shovel, neck. In acute cholangitis, intoxication is rapidly increasing, weakness progresses, the appetite is worse, the headache is concerned, nausea with vomiting, diarrhea. A slightly later jaundice appears in acute cholangitis - the visible yellowing of the skin and the scler. Against the background of jaundice, skin sebum develops, as a rule, amplifying at night and violating normal sleep. As a result of a pronounced itching on the body of a patient with cholangitis, skin combs are determined.

In severe cases, violations of the consciousness and phenomenon of shock can join the Triad of Charco - in this case, a symptom complex is developed, called Pentada Reynolds.

Clinical manifestations of chronic cholangitis are worn erased, but progressive character. The disease is characterized by stupid pain in the right side of weak intensity, a feeling of discomfort and cutting in the epigastria. Jaundice in chronic cholangitis develops late and testifies to the far-seated changes. Common disorders in chronic cholangitis include subfebilitation, fatigue, weakness.

Cholecystopancatite, hepatitis, billier liver cirrhosis, multiple liver abscesses, peritonitis, sepsis, infectious and toxic shock, hepatic insufficiency may become complications.

Diagnostics

Suspect the cholangitis, as a rule, it is possible on the basis of the Characc Character Triad; Clarifying diagnostics is carried out on the basis of laboratory and instrumental research.

The visualizing methods of diagnosis of cholangitis include abdominal ultrasound and liver, ultrasonography of the biliary tract, CT. With their help, it is possible to obtain the image of bile ducts, identify their expansion, determine the presence of structural and focal changes in the liver.

Among tool methods Diagnostics of cholangitis The leading role is assigned to endoscopic retrograde pancreaticolhangiography, magnetic resonant pancreaticolangiography (MRPHG), percutaneous christmaspere cholangiography. On the resulting radiographs and tomograms, the structure of biliary tract is well visualized, which allows you to identify the reason for their obstruction.

The differential diagnosis of cholangitis is necessary with the HCRs, non-calculous cholecystitis, viral hepatitis, primary biliary cirrhosis, the epipherable of pleura, right-sided pneumonia.

Treatment of cholangitis

Under cholant, complicated by abscess, cirrhosis, hepatic renal failure, generalized septic process, is unsatisfactory forecast. Timely therapy of catarrhal cholangitis allows you to achieve cure; With purulent, diphtheritic and necrotic form - the forecast is more serious. Long flow of chronic cholangitis can lead to disability.

Cholangitis prevention dictates necessity timely treatment gastroduodenitis, branded cholecystitis, boards, pancreatitis, gliste and protozoal invasions; Observations at the gastroenterologist after transferred surgical interventions on the biliary ways.