Treatment of purulent cholangitis. Acute cholangit

The date: 19.07.2019

Cholant is a violation of the functioning of the liver, in which the bile ducts are inflamed.

In the risk area there are all people. A similar violation of the gastrointestinal tract is found in men and women of different age categories. However, the disease is most often diagnosed among weaker sex representatives aged 50-60 years. Doctors associate this with the fact that the hormonal background changes, the metabolism slows down, the level of immunity decreases.

What it is?

Cholangitis (cholangitis) - infection biliary tract. Arises due to bacterial infection. Allocate sharp and chronic shape. Sometimes develops as an independent disease, is more often a consequence of other diseases. internal organs. It usually occurs in women in old age.

This article will tell what is cholangitis, what are the symptoms, and how to treat him in adults.

Classification

The definition of the type of disease plays an important role in the preparation of the treatment regimen. Cholant is classified according to several signs. By the nature of the flow distinguishes acute and chronic forms. By pathological changes, the acute form is divided into subtypes:

purulent - characterized by melting the walls of biliary tract and the formation of a set of internal abscesses;
catarial - for him is characterized by the swelling of the mucous, lining interior surface biliary tract, excess flow of blood to them and leaking leukocytes with further peeling of epithelial cells;
difsteritic - begins with the appearance of ulcers on the mucous membranes, desquamations of the epithelium and leukocyte wall infiltration with subsequent fission of tissues;
nerctic - passes with the formation of dead plots arising under the influence of aggressive enzymatic activity of the pancreas.

Chronic cholangitis is divided into the following forms:

sclerosing (with the growth of connective tissue);
latent;
recurring;
septic long-term;
abscessant.

The location of the inflammatory process is distinguished:

kledochit (inflamed total duct);
angocholite (affected intra and extrahepatic biliary roads);
papillitis (great duodenal nipples inflamed).

By origin, the cholangitis happens:

The chronic form of the disease occurs more often acute and develops after exacerbation of the disease and as an independent disease, initially taking a protracted flow.

The cholangitis of the sclerosing type is a special form of the disease. Initially, having a chronic outline, inflammation in bile ducts occurs without prior penetration of infection. The inflammatory process leads to the sclerosation of tissues - hardened, they completely overlap the lumen of the ducts, thereby causing cirrhosis of the liver. This disease is not amenable to treatment, slow progress (about 10 years) ends with the formation heavy violations followed by fatal outcome.

Causes of development

The main cause of cholangitis is the violation of the patency of bile ducts and the attachment of infection. Violation of bile ducts often occurs when choledocholithiasis - the formation of gallstones in biliary tract. Other reasons for the disturbed ottock of bile can be the cricket narrowings of biliary paths due to chronic cholecystitis, removal of the gallbladder (post-olecistectomic syndrome), cysts or tumors of the total bile duct.

The infection in the bile pathways is mainly from the intestines, since with the stitching of the bile, the mechanism is disturbed, which prevents the penetration of intestinal content in the supervised parts of the gastrointestinal tract. In addition to the ascending (intestinal) path of infection, there is a descending path when the infection penetrates the biliary ways with a blood current or lymph from another inflammatory focus In the abdominal cavity.

Symptoms

The disease in acute form arises suddenly. But like any disease, the cholangitis symptoms and signs also have:

Very high temperature up to 40 ° C.
Characteristic pain on the right in the field of ribs.
Justice skin Pokrov and mucosa.
Chills, severe sweating.
The general intoxication of the body, which is characterized by diarrhea, total weakness, vomiting and loss of appetite.
Due to the jaundice, itching the skin.
If the form of the disease is severe, the patient may lose consciousness.

In the chronic form of cholangitis, the symptoms are not so pronounced, the pain is stupid character, the temperature is low, closer to normal. The patient is quickly tired, experiencing general weakness. If the disease is not treated, a number of dangerous complications may appear.

Sclerosing primary cholangitis (PSH)

Several 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 the liver cirrhosis;
Up to 20% of PSX patients suffer from cholangiocarcinoma (malignant tumor), which developed in the outcome of pathology.
These moments vividly indicate how difficult the diagnosis is complex. On the one hand, patients often do not pay attention to "insignificant" symptoms, which leads to late appeal medical help. On the other hand, not in every city there is a specialist who will suspect this rare, but dangerous pathology.

What way to find in this case? First of all, it is necessary to treat your health with cautiousness. The table below will provide the necessary information that will allow PSX to suspect. The main thing is not to neglect her and objectively analyze the state of your body. This will prevent PSH progression and avoid dangerous complications.

Diagnostics

Based on the clinical picture, in the diagnosis of acute cholangitis, you should navigate the Charcot triad or Pentad Reynolds. But in general, to form a diagnosis of this disease, it is also necessary to attract additional methods Diagnostics are physical (inspection, tackling, climbing and listening to the belly to the phonenadoscope), instrumental and laboratory.

In case of inspection, this patient is detected:

the jaggility of the skin, scool and visible mucous membranes;
language is dry, covered with a yellow raid;
on the skin, traces of combing are visible, sometimes quite pronounced, to blood (with a strong itch).

With jaundice phenomena, there will also be an informative part of feces and urine:

cal is characterized by a lighter shade than usual (but in general it is not white, as it can be when joyful about the blockage of biliary tract);
due to the fall of biliary pigments in the blood, and then in the kidney urine can darken ( characteristic symptom "Beer color").

When palpation at the peak of a painful attack is observed strong pain In the right hypochritary region. With percussion (tapping the edge of the palm on the right edge arc), the patient reacts very painfully.

Instrumental methods that are used to diagnose cholangitis, this is:

Ultrasonic diagnosis of liver (ultrasonic) and ultrasonicography (ultrasound) of biliary tract - these methods allow you to evaluate the gallways, to determine the pathological changes in them - in particular, their expansion, as well as changes in the liver, which occur due to the violation of the bile current in the biliary ;
Computed tomography of bile ducts (CT) - an assessment of the most parameters that are evaluated by ultrasound will help to carry out computer sections of the biliary tract;
Endoscopic retrograde pancreaticolangiography (ERPHG) - with the help of an endoscope introduced into the gastrointestinal tract, a contrast agent is injected into the bile paths, a x-ray is introduced and evaluated it;
Magnetic resonance pancreaticolangiography (MRPHG) - bile ducts with the entered contrast are studied using magnetic resonance imaging;
Percutaneous christsechen cholangiography - contrast in bile ducts are administered not through the digestive tract, but puncturing (piercing) skin and liver;
Duodenal probing - with its help, the bile is performed with the subsequent bacteriological sowing on the nutrient media.

The diagnosis of cholangitis uses such laboratory methods as:

Common blood test - its data is not specific, but are important to assess the progression of inflammation. Thus, the increase in the number of leukocytes and an increase in ESP will be revealed;
Biochemical liver tests - determine the increase in the number of bilirubin, alkaline phosphatase, as well as transaminases and alpha-amylases. Such data indirectly suggests cholestasis (bustling of bile), which is observed in cholants;
Bacteriological sowing of bile obtained at duodenal sensing - thanks to him, the causative agent of cholangitis is identified;
Calais analysis - due to it confirm or exclude the presence of helminths or protozoa in the body, which are able to cause inflammation of biliary tract.

Effects

If timely treatment is absent, then inflammatory process It 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 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.

Treatment of cholangitis

In the diagram of the treatment of cholangitis there are several fundamental moments that each patient should know:

In suspected acute process, hospitalization is needed to surgical hospital. This tactical nuance is explained by the unpredictable course of the disease - at any moment the inflammation of the duct system may cause blood infect (sepsis) or violations in the work of other bodies;
Each patient S. acute process Potentially requires an operation to restore the outflow from the biliary tract. Doctors try to choose the most gentle technique for the body and are trying to avoid large volume of interference and cuts on the skin. If possible, the surgeons perform all interference with the help of an endoscope, by conducting it through the mouth to the final choledoch. This allows not to injury extra tissues and reduce the risk of complications.
The patient must be aware of the possibility surgical intervention and not be afraid of this method of treatment;
Almost always chronic forms of the disease are treated outpatient - hospitalization, as well as an operation, with a protracted flow is not required, since pathology is relatively predictable in its development.

Treatment of acute process

As mentioned above, almost every patient with this form is a potential "candidate" to conduct an operation. Its time is determined by the patient's condition. With a relatively easy course of the disease and the preserved functions of all organs, surgery is possible in the first day after hospitalization.

The heavy version of the disease or the development of sepsis requires preliminary training of the body with medicines. In order to improve the condition of a person, the surgeon may assign the following therapy:

Intravenous infusion of solutions that improve the metabolism in tissues and reduce blood toxins concentration: solutions of glucose or sodium chloride, ringer solution, dish and trisole preparations, etc.;
Combination of antimicrobial drugs;
Hepatoprotectors, to maintain the work of hepatic cells: essential, admethionine, ursodeoxycholic acid and others;
If necessary, preparations are used for anesthesia and to eliminate spasms in the digestive tract (spasmolytics).

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

Treatment of chronic form

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

In addition to specific treatmentAll patients with chronic disease forms are recommended:

Stick to the diet (table number 5 by svnery), which implies frequent fractional power 5-6 times a day, in a small amount, with the exception of oily food;
If possible, eliminate physical and psychological loads;
Refuse smoking, drinking alcoholic and caffean-containing drinks;
Take multivitamin complexes with the presence of vitamins K, D, E and A. The absorption of these substances is broken during the protracted inflammation of the biliary system.

Prevention

The disease is much easier to prevent than to fight his consequences in the future. To prevent the development of primary or re-cholangitis, it is necessary to comply with simple principles of a healthy lifestyle:

to give up smoking;
refusal to eat alcoholic beverages;
regular sports;
daily walks in the fresh air;
full sleep;
healthy nutrition;
avoid stressful situations.

In addition, a complete medical examination is recommended systematically. This will detect chronic diseases on early stages. Preventive inspection In no case should not be neglected. It is better to spend some free time for a doctor's consultation than long and tediously treat launched shape pathology.

Forecast for life

Forecast for cholangitis is different.

With the catarrhal form of cholangitis, it is satisfactory, with purulent, diphtheritic and necrotic forms - more serious: in this case, the outcome can only be favorable for the patient only in the case of appointed presses and scrupulously adhered to the treatment. If the inflammation of biliary tract passes with complications, the forecast is unsatisfactory. This is especially stated with such diseases as:

the formation of abscesses in the biliary ways;
cirrhosis of the liver;
liver renal failure;
septic defeat of the body.

- This is a non-specific inflammatory process of bile ducts, which arises as a result of a violation of the passage of biliary tract and contamination of bile.

Cholangitis is often combined with bile duct cysts, choledocholiticiasis and bile duct cancer.

The causes of the occurrence of cholangitis.

As a rule, cholangitis is formed as a result of the pathogen of a bacterial infection from the lumen of the duodenum into the bile ducts, lymphogenic or hematogenic path.

The nature of the flow of cholangitis can be both acute and chronic. The acute form of cholangitis can be purulent, catarrhal, necrotic and diphtheritic, depending on the degree inflammatory changes.

The chronic forms of cholangitis include recurrent, latent, long-term septic, sclerosing and abscessive.

Symptoms and signs of cholangitis.

The symptoms of this disease largely depends on the absence or availability acute form Destructive cholecystitis, which is often complicated by cholangitis.

Cholant begins with the manifestation of pain syndrome, which resembles colic, and is replaced by a mechanical jaundice, skin itching and an increase in body temperature.

The inspection is detected by the image of the skin, traces of combs on the skin and a wet language. With palpation of the abdomen area, muscle rigidity in the right hypochondrium and soreness are noted. With an in-depth palpation, an increase in the liver is marked, the edge of which is rounded. A chill may occur or a hectic temperature.

Due to the direct bilirubin there is hyperbilirubinemia, and a moderate increase in liver enzymes occurs due to damage to the toxins of hepatic parenchyma.

Complications of cholangitis.

In case of absence timely treatment, the inflammatory process can move from the walls of bile ducts to nearby fabrics, which can provoke an impregnation with bile of hepatic and duodenal bond and peritonitis, development sclerotic changes In the hepatic tissue, secondary biliary cirrhosis and the formation of intrahepatic abscesses.

Treatment of cholangitis.

The patient with cholangitis needs to be immediately hospitalized to prepare for surgical treatment. At the stage prefigure The patient is prescribed anti-inflammatory, as well as antispasmodic drugs, antibiotics wide spectrum Impacts that are not hepatotoxic.

It is advisable primarily to ensure the correct outflow of bile, which will make it possible to simultaneously reduce the manifestations of cholangitis and intoxication. Further action should be a radical intervention, which must be sent to eliminate the cause of the formation of this disease.

In the medical institution, the patient is carried out antibacterial and disintellation therapy, and also prepare the patient to surgical operation.

Under the acute form of cholangitis, endoscopic methods of drainage of bile ducts were obtained, which are able to provide the desired bile outflow.

Forecast for cholangitis.

With catarrial cholangitis, the forecast is favorable in case of timely treatment. In the diferitical, necrotic and purulent cholangitis, the forecast is more serious and largely depends on the degree of severity of morphological changes, the factor that caused this disease and general status Health patient. With a long chronic chronicle-shaped cholangitis, an abscessangeitis can be formed, which has an unfavorable forecast.

Halgitis Prevention.

Preventive measures At cholangitis include timely detection and treatment of diseases of biliary tract and places of a large duodenal pacifier.

For decompression of the biliary tract, endoscopic papillosphincterotomy is carried out after retrograde cholangiography.

After holding papilosophyrtherotomy, in the presence of residual stones of Kolado, the extension of the concrections arises. When chosening the phenomena of cholangitis, the question of holding a re-operation disappears.

Among disease digestive tract, Cholant is one of the most complex pathologies in terms of diagnosis and treatment. There are several different forms of this disease that differ from each other in symptoms and causes of occurrence. Some of them proceed hidden and do not have a specific reason. All these factors make it difficult to determine the disease and "move" the time of the start of therapy.

What can it lead to? Here is a far incomplete list of complications: sepsis (blood infection), liver cirrhosis, bile duct cancer or bubble, infectious toxic shock, etc. Each of these states arises either due to the lightning flow of pathology, or when it untimely diagnosis. About how to suspect the disease in the initial stages and start proper treatmentYou can learn from this article.

What is cholangitis and the basics of anatomy

The literal translation of the word "HALLGIO" from the Latin language is a "bile vessel". Accordingly, cholangitis is an inflammatory process in any of these vessels. In person, there is a complex network of ducts of various sizes for which bile. This network begins on the liver, and ends in the intestine, where it occurs to digest the fats and the destruction of malicious microbes.

Simplified, the path of this biological fluid can be described in the following steps:

During the intake of food or special medicines, bile in the slices of the liver begins to form. Further, it falls into intracranue bile capillaries;
From the entire liver, the capillaries gather in two large duct - one for each share of the organ (right and left);
From these formations is formed common liver duct.To which joins gall-bubble through bubble duct. Together, these two structures form a large "collector" of bile - choledoch (synonymous overall bile duct);
The cholester is opened in the 12th pans and allocates the required amount of bile. Unused residues are returned to the bubble on the same path.

Symptoms of cholangitis occur during the damage to intrahepatic or extrahepatic structures that are involved in the allocation of bile components.

Types of disease

As we have said, signs of cholangitis can significantly differ at various forms Diseases. For convenience, the doctors share this pathology for two main criteria - the duration of the flow and type of inflammation. These nuances are fundamentally important, as they determine the optimal assistance time (urgent / planned), the doctor's tactics and the need for operation.

Depending on the duration of the flow, the following pathology options are allocated:

Fulminant or fulminant. The most severe I. dangerous formIn which all signs of the disease and blood infection appear suddenly and quickly progress (within a few hours). Fulminant ends with death in 90-100% of cases, even despite timely and qualified medical care;
Acute. The most common option in which typical symptoms developing within 1-2 days are manifested;
Chronic. The most difficult option for diagnostics. It can occur independently or in the outcome of an acute form. The clinical picture is often erased - often the only complaint of patients is a liquid chair or periodic abdominal pain.

The second principal moment in determining the form of pathology is the type of inflammatory process. In any diagnosis, this nuance is necessarily indicated, since further therapeutic tactics depends on it. Currently, the doctors allocate the following options:

Form of the disease	a brief description of	Acute or chronic?
Serous	The most favorable pathology option, in which blood is extremely rarely developing. In the cavity of the ducts there is no pus - inflammation is manifested by the increase in the production of serous fluid.	May be sharp and chronic, however, more often the first option.
Fibrino-serous	Proceeds by analogy with the serous form. The main difference is due to the inflammatory process - in the organ, in addition to the liquid, there are protein (fibrinous) overlays.
Purulent	Severe form in which in the cavity of the organ is a large number of Bacteria and aggressively flows inflammation. It often marks the development of sepsis and the occurrence of infectious-toxic shock is possible.	As a rule, sharp.
Necrotic	It is the final stage of purulent cholangitis, in which the walls of the organ begin to die. The greatest danger is the possibility of penetrating the particles of dead tissues, bile and pus in the blood. The natural result of this is the development of infection of blood and shock.	Only sharp.
Sclerosing	Hidden a slow-ending form of pathology at which there are practically no characteristic features. It is dangerous by the development of severe irreversible damage to the liver, right up to biliary cirrhosis.	Only chronic.

Causes of occurrence

The greatest role in the occurrence of cholangitis (all except for the sclerosing) plays the presence of two factors - malicious microorganism and stagnation of bile. What leads to their occurrence? Bacteria causing an inflammatory process can penetrate the ducts from the gallbladder or from the intestinal cavity. That is why there are often cholangitis after acute cholecystitis, in the presence of intestinal (fine-turn) deficiency or biliodyagisal reflux - cast intestinal content into the duct system.

Stagnation bile appears when it is violated her outflow. Such a situation may occur in the following states:

Blockage of duct by stone against the background of bile-named disease;
The development of acute pancreatitis and the edema of the pancreas head;
The presence of a tumor, squeezing choledo or preventing bile outflow;
Stricking (pronounced narrowing) of the biliary tract;
The defeat of the header nipple is the place where the clearance of choledoch and pancreatic duct opens.

Separately, it must be said about the causes of sclerosed cholangitis. This form differs from all others. It is unambiguous to determine the cause of its development is not possible, even at the modern level of medicine. Most doctors believe that the disease arises in the development of an autoimmune process.

Because of the "error" of immunity, in which the protector cells begin to produce antibodies against healthy tissues, the tissue of the protocal system is affected. Prolonged sluggish inflammation leads to the growth of connective tissue, narrowing the lumen and violation of the outflow of bile. A frequent "target" of this disease is intrahepatic bile capillaries, which often leads to the formation of the liver cirrhosis.

Symptoms

As already mentioned, this disease is quite complicated in terms of diagnosis. One form can manifest themselves in different ways in two identical patients, disguised as a different pathology or is hidden at all. However, there are certain signs that suggest the correct diagnosis.

At the same time, it is necessary to remember that the symptoms that disturbing a person can differ significantly in acute and chronic flow. Its characteristic features has a sclerosing primary cholangitis, which will be described below.

Acute option

The treatment of cholangitis, in this case, is carried out only under the conditions of a surgical hospital. it threatening Life a state that is in late treatment for medical help Or in inadequate therapy can lead to blood infection and even death. That is why if there is typical signs It is strongly recommended to consult a doctor, and not try to easily get rid of the manifestations of the disease.

Unlike most other pathologies, with inflammation of the doctor's joyful pathways, not separate symptoms, but their specific combination. For this state, the most characteristic of the appearance of the following set of features:

Increased body temperature. As a rule, fever increases in a few hours and persists on enough high level (38-40 o C). Patients feel pronounced weakness, chills and headaches. Often, a person has severe sweating, because of which it can lose a large amount of fluid per day. Some patients fever may have a "jump-like" current and change to 1-2 ° C throughout the day. Such temperature fluctuations are exacerbated by a person, his well-being worsens so much that he is hard to get out of bed. Consciousness is bold, there is no appetite, fainting may occur;
Jaundice / intrusive itching. These two symptoms have the same origin and are associated with a delay in bilirubin in the body. Bilirubin - toxic substance formed after decay blood cells and outlined with urine and bile. Since the inflammation of the biliary system leads to a violation of this process, bilirubin compounds are beginning to be deposited in various tissues. The session in the skin leads first to a strong obsessive ferry, and then to change its color. The bilirubin hit in the sclera explains the yellow shade of the eyes (around the iris). Attempting the body to remove the toxic substance with urine manifested by its darkening - up to the color of "dark beer";
Pain in the right half of the abdomen (directly under the ribs). This place corresponds to the approximate location of the bubble and choledoch. If a person makes it difficult to determine the area where there are easy sensations, You can spend a simple test - the edge of the palm of the palm of the lower edge of the rib arc on the right and left. With cholegite / cholecystitis, the pain increases when the right is tight.

The following complaints can be complemented by a number of other pathological signs: decline arterial pressure less than 90/60 mm.rt; the appearance of feelings of heartbeat; Pulse increases more than 90 UD / min, etc. However, the combination of the three above mentioned diseases is specific for this disease.

Chronic form

To suspect and confirm the presence of this form is much more complicated than diagnosing a sharp cholangitis in humans. The fact is that during chronic flow, pathology can slightly disturbing human well-being, and it does not appeal for medical help. Additional difficulty represents the diversity of manifestations of pathology - for this form, the characteristic combination of symptoms has not been detected. Each patient has a disease individually.

The only significant tip can be the past patient, and more precisely transferred operations and associated diseases:

After the removal of the gallbladder (the operation is called "cholecissectomy") of each third patient there is chronic cholangitis;
The presence of gallposted disease significantly increases the risk of this disease;
The acute process transferred in the past may result in the occurrence of a chronic disease.

People with listed risk factors are most susceptible to this pathology. To suspect the protracted inflammatory process in the ducts in the presence of the following complaints:

Stool violation. The appearance of a liquid / cascidular chair with a bright color having a brilliant surface is difficult to flush from the walls of the toilet;
Jaundice or skin itchthat appear mainly in the evening and night time;
Pain in the upper half of the abdomen. In most cases, unpleasant sensations are located in the right hypochondrium, but they can be left or in the middle between the ribs (in the epigastric region);
Development of asthenovegetative syndrome - constant weakness, reduction of working capacity, reducing body weight;
The appearance of fever is obscurely;
The feeling of "breakdown", in the afternoon;
The taste of bitterness in the mouth, mainly after meals.

Sclerosing primary cholangitis (PSH)

Several 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 the liver cirrhosis;
Up to 20% of PSX patients suffer from cholangiocarcinoma (malignant tumor), which developed in the outcome of pathology.

These moments vividly indicate how difficult the diagnosis is complex. On the one hand, patients often do not pay attention to "insignificant" symptoms, which leads to late appealing for medical assistance. On the other hand, not in every city there is a specialist who will suspect this rare, but dangerous pathology.

Risk group	Men aged 30-50 years; Children 5-15 years old. Children in children arises much less often - they constitute only 10% of the number of all patients.
Diseases - "Satellites" PSX In 60-70% of patients, the inflammation of the ducts is combined with other chronic lesions of the digestive tract.	Autoimmune hepatitis; Crohn's disease; Ulcerative colitis of non-specific nature (nym); Granulomatous Ileokolite; Granulomatosis of Vegener.
Symptoms of the disease at an early stage	Constant fatigue and pronounced weakness; Obsessive permanent skin itching, amplifying at night; Episodes of short-term increase in temperature to 37-38 o C.
Symptoms of late Stage	Any symptoms characteristic of classical chronic form.
Possible complications	Biliary cirrhosis - This is an irreversible lesion of the liver, which leads to a gradual loss of all organ functions. As a result, a person violates the process of digestion, blood coagulation, neutralization of toxic substances, significant edema and many other disorders appear; Cholangiocardioma - malignant tumor, which grows from the walls of the ducts. Able to completely block their clearance, germinate into the surrounding organs and give metastases throughout the body Progressive osteoporosis - violation of the normal bone structure, leads to their increased fragility. It may cause a bone fracture even with a slight injury or load.

Diagnostics

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

But, unfortunately, in most provincial cities medical institutions Do not even be equipped with a standard minimum. In this case, the doctor cannot assign required surveysSo patients often have to contact private clinics / laboratories.

Laboratory diagnostics

Type of research		Normal indicators	Possible changes
Clinical blood test	Soe	Up to 15 mm / hour	In the acute process there is an increase in all listed indicators. Against the background of a chronic flow, a clinical blood test may remain within the norm (with the exception of SE).
	Leukocytes	4,1-9.0 * 10 9 CL / l
	Neutrophila	or 2.0-5.4 * 10 9 kl / l
General urine analysis	Bilirubin	Negative
Blood chemistry	C-reactive protein	Up to 5 mg / l
	Common Bilirubin	5.1-17 μmol / l
	Direct (related) Bilirubin	1.7-5.0 μmol / l
	GGTP	Men 10-50 E / L; Women 7-31 E / L
	Alkaline phosphatase	Or 0.5-2.0 μcat / l
Immunological analysis of blood serum (for PSH diagnostics only)	Antinuclear antibodies	Titre less than 1/160	With a sclerosing version of pathology, an increase in the titer listed antibodies occurs.
	Anti-thunder autoantibodes	Titre less than 1/40.
	Analysis on Panca.	Titre less than 1/40.

Instrumental examinations

MRHP

At the moment, the "Gold Standard" among the hardware research methods is considered to be MRHPG - magnetic resonance cholangiopancratography. Despite the complex name, the principle of this survey is quite simple. A special substance is introduced into the blood of a person, the staining ducts of the biliary system and the gallbladder are studied on the MRI apparatus.

It should be noted that this method Safe for a person, does not irradiate his body with X-rays and requires the use of special surgical instruments. It does not need hospitalization for it - the procedure itself takes 15-30 minutes and can be performed outpatient. Contraindications to MRHP are not so much, they include:

Allergy to a contrast agent;
The presence of some implants in the body: pacemakers, cochlear implants, intravascular stents and metal clips in the brain. If there are others artificial devices In the body, you must first consult with a doctor who performs a survey. He will analyze the situation and determine the possibility of diagnostics.

Preparation for the examination includes a refusal to eat and fluid a few hours before the procedure. Also immediately before the examination, it is necessary to remove all metal accessories and clothing items. If necessary, additional training, the attending physician individually advises the patient before the study.

Other research methods

Despite the fact that the MRHA is recommended as the main diagnostic method, far from each hospital has an MRI apparatus and trained specialists in his staff. As alternative methods Detection of disease, doctors can recommend the following instrumental examinations:

Name of the procedure	Principle of conduct	Preparation for the examination
Abdominal ultrasound	Using an ultrasonic sensor, the doctor examines the gallbladder and choledo. The study is fully safe and does not bring significant discomfort to a person. Lack of methodology - the inability to inspect small bile ducts. In pathology, the doctor may detect the presence of a stone in the lumen of the biliary tract or the extension of the choledoch (more than 6 mm).	During the day before the study, it is not recommended to take oily foods (any products roasted in oil; nuts; pork; lamb, etc.) and products with high tissue content: fruits, vegetables, fresh bread, flour products; 6-8 hours before the procedure should be refused to eat, smoking, drinking alcohol and beverages with caffeine (coffee, power engineers, coca-cola and others); Before ERCP, the doctor can recommend a short course of antibacterial agents to prevent the intestinal microflora in the gallways.
Endoscopic retrograde pancreato-cholangiography (abbreviated ERHP)	In the recent past, this method was the main in the diagnosis of diseases of the biliary system. It is performed as follows: Through the mouth patient introduced special device - Fibrogastroduodenoscope; By promoting the apparatus through the esophagus and the stomach, the doctor finds the final department of a choledoch and fills it with a contrast agent; This substance is distributed over the entire protocal system, which allows it to be seen on a radiographic picture. Radiography of the abdominal cavity is performed. Main flaw - High probability of developing complications after the procedure. The most frequent of them is damage to the final choledoch (fabric chipboard) and the development of pancreatitis.
Percutaneous chrsecheny cholangiography (abbreviated CCH)	The method, according to its own principle, similar to ERCP. The gallways are filled with contrast after which radiography is performed. The main difference in the method of delivery of a contrast substance - with CCH, the doctor introduces it directly into the duct, conducting a needle through the skin and the liver under the control of the ultrasound. Chief flaw - The ability to injure the internal organs.

Treatment

In the therapy of this disease there are several fundamental moments that each patient should know:

In suspected acute process, hospitalization is needed to surgical hospital. This tactical nuance is explained by the unpredictable course of the disease - at any moment the inflammation of the duct system may cause blood infect (sepsis) or violations in the work of other bodies;
Each patient with an acute process potentially requires an operation to restore the outflow from the biliary tract. Doctors try to choose the most gentle technique for the body and are trying to avoid large volume of interference and cuts on the skin. If possible, the surgeons perform all interference with the help of an endoscope, by conducting it through the mouth to the final choledoch. This allows not to injury extra tissues and reduce the risk of complications.
The patient must be aware of the possibility of surgical intervention and not be afraid of this treatment method;
Almost always chronic forms of the disease are treated outpatient - hospitalization, as well as an operation, with a protracted flow is not required, since pathology is relatively predictable in its development.

Treatment of acute cholangitis

Intravenous infusion of solutions that improve the metabolism in tissues and reduce blood toxins concentration: solutions of glucose or sodium chloride, ringer solution, dish and trisole preparations, etc.;
Combination of antimicrobial drugs;
Hepatoprotectors, to maintain the work of hepatic cells: essential, admethionine, ursodeoxycholic acid and others;
If necessary, preparations are used for anesthesia and to eliminate spasms in the digestive tract (spasmolytics).

Therapy of chronic form

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

Stick to the diet (table number 5 by svnery), which implies frequent fractional power 5-6 times a day, in a small amount, with the exception of oily food;
If possible, eliminate physical and psychological loads;
Refuse smoking, drinking alcoholic and caffean-containing drinks;
Take multivitamin complexes with the presence of vitamins K, D, E and A. The absorption of these substances is broken during the protracted inflammation of the biliary system.

Disability time

Since the vast majority of patients with cholangitis students or able-bodied people, this issue needs to pay attention. For acute versionThe period of stay in the hospital is 10-30 days, depending on the state 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 the restoration of the body.

About chronic cholangitaAt the moment, there are no unambiguous recommendations. In each case, the doctor itself determines the duration of the patient's disability, depending on its well-being and the possibility of conducting therapy.

FAQ

Question:
How dangerous for life is this disease?

Inflammation of the duct system is a life-degrading state at which there is always the likelihood of sepsis, irreversible liver damage and other organs.

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

In some cases, similar symptoms can be detected at acute pancreatitis, on the background of acute / exacerbation of chronic cholecystitis. To correctly set the diagnosis, it is enough to use laboratory and tool methods The studies described above.

Question:
Is it possible to diagnose "acute cholangitis" only in symptoms and data ultrasound?

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

Question:
What operation can do the doctor, when acute flow Diseases?

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

Endoscopic method. With the help of an endoscope that is entered into purph cavity and moves along the digestive tract, the doctor penetrates himself in a choledo, through his mouth in a 12-risen intestine;
Expressive christsect drainage. Ultrasound under control of the ultrasound, the surgeon through the skin and the hepatic tissue penetrates the needle in the choledoch and sets drainage - a thin tube to create bile outflow;
Open method. It is extremely rare. The doctor dissects the fabric, starting with the skin in the upper part of the abdomen, after which it highlights a large bull duct and sets drainage. There is a variant of this operation, in which, instead of a large section, the surgeon makes only 2-3 small wounds, for endoscopic tools. It is with the help of them and drainage is carried out.

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

Prevalence.IN last years There is 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, changing the physicochemical properties of 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 Preprip out the contents of the contents of a small intestine in biliary paths, complications after reconstructive operations on bile ducts. There are several ways to introduce infection into bile ducts. More often pathogenic pathogens enter the biliary system by enterogenic, hematogenic, lymphogenic paths. Pathways leading to the development of chorelgites are intestinal microorganisms Microflora, found in associations. Most often, cholants have a bacterial nature, among the pathogens, representatives of the Enterobacteria family (E. coli, Klebsiellaspp, Serratiespp, Proteuspp, Enterobacterspp., AC inetobacterspp.), gram-positive microorganisms (Streptococcus, Enterococcus), Unfortunate 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 by cholangitis infectious factors. 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 acute cholangitis includes malaise, jaundice, pain in the right hypochondrium with irradiation in right shoulder, forearm, blade, intermittent 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, painful 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. Severe forms of the disease are accompanied by the development of sepsis, complicating septic shock, Oligira 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 because the leading link in the pathogenesis of cholangitis is the temporary obturation of bile ducts, mechanical jaundice It has variable character and depends similarly to the temperature, on the degree of frustration of the biliary tract. Clinical manifestations Chronically, 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, the skin of the skin is frequent symptoms are long periods of unmotivated subfebilite, 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 blood, neutrophilic leukocytosis with a shift to the left is defined, an increase in biochemical study shows an increase in the level of bilica bin, triglycerides, alkaline phosphatase activity, ASAT, ALGGTP, reduction in the content of common 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 of urine, there is an increase in the level of urobilin, biliary pigments. Duodenal fractional sensing with bacteriological research Portions B, C and the definition of sensitivity to antibiotics of duodenal content, ultrasound of the abdominal cavity 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). During effective treatment There is a narrowing of their lumen, the thinning of the wall to a complete merger with the parenchyma 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 lead ethiological factor and relationship 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 a wide spectrum antibiotics to influence 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 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

Does something bothers you? Do you want to learn more detailed information about cholangitis, its causes, symptoms, methods of treatment and prevention, course during the course of the disease and observance of the diet after it? Or do you need an inspection? You can make an appointment to the doctor - Clinic Euro.lab always at your service! Top doctors They will examine you, examine external signs and will help determine the disease in symptoms, they will advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor. Clinic Euro.lab Opened for you around the clock.

How to contact the clinic:
Phone of our clinic in Kiev: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select you a convenient day and an hour of visiting to the doctor. Our coordinates and travel scheme are indicated. Look more detailed about all clinic services on it.

(+38 044) 206-20-00

If you have previously been performed any research, be sure to take their results for a consultation to the doctor. If the studies have not been fulfilled, we will do everything you need in our clinic or our colleagues in other clinics.

You? It is necessary to carefully approach your health as a whole. People are not paying enough attention. symptoms of disease And do not realize that these diseases may be vital. There are many diseases that at the beginning do not show themselves in our body, but in the end it turns out that, unfortunately, they are already treated too late. Each disease has its own specific signs, characteristic external manifestations - the so-called symptoms of Disease. The definition of symptoms is the first step in the diagnosis of diseases in general. For this you just need several times a year take a survey from a doctorSo as not only to prevent terrible disease, but also maintain a healthy mind in the body and the body as a whole.

If you want to ask a question to a doctor - use the online consultation section, you may find answers to your questions and read tips for care. If you are interested in reviews about clinics and doctors - try finding the information you need in the section. Also register with Medical Portal Euro.labTo be constantly aware of the latest news and information updates on the site that will be automatically sent to you by mail.

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 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 alcohol 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

Filtering toxins, stockpiling of vitamins, production of glycogen - these basic tasks perform liver in the body of each person. If for some reason these functions cannot full degree Complete, then. The yellowing of the skin or the scool of the eyes is the obvious signs that the liver begins to fail.

What is it - cholangitis?

What is it - cholangitis? This is inflammation of bile ducts. Their obstruction with the addition of infection is a sure sign of the disease.

Types and forms

Hallet has its own types and forms of development. By forms is divided into:

Acute. By inflammatory nature, acute cholangitis is divided into types:

Catarial - swelling of bile ducts with their further scarring and narrowing.
Purulent - affects the liver and gallbladder, characterized by the accumulation of pus and bile in bile ducts.
Non-necrotic is the formation of necrosis of bile duct sites after entering it the pancreatic enzymes.
Diphtheratic - emotion and necrotization of the mucous membrane, the destruction of the walls of the bile duct, purulent melting of the surrounding tissue.

Chronic. In inflammatory nature, divide:
- Hidden (latent).
- Septic.
- Recurrent.
- Abscessant.
Sclerosing (autoimmune) cholangitis - is assumed that it develops as a result autoimmune reaction The body is on yourself. There is a bustling, narrowing and overgrowth of bile ducts, which leads to cirrhosis of the liver.
Bacterial.

Causes

What could be the causes of such an unpleasant illness like cholangitis? Consider the most common:

Breast disease in biliary ducts (choledocholiticiasis).
Scarring and narrowing of the biliary duct due to the removal of cysts, tumor or chronic cholecystitis.
Askarida, Glice Invasia.
Hepatitis.
The penetration of infection from the intestine, through the Lymph or blood current. A disruption of the outflow (stagnation) of bile becomes a favorable medium.

The predisposing data factors of the anomalies are:

Genetic predisposition.
Psychogenic factor.
Congenital anomalies.
Giardiasis.
Dispense.
Endocrine disorders.
Immunological reactions.
Pancreatoatobiliary reflux.
Discholia, which develops for the following reasons:
- Nutrition.
- Obesity.
- Overweight.
- Hormonal failures.
- Receiving hormonal medicines.
- Violation of blood supply to the liver and gallbladder.
- Domor monomal disorders.
- Alcoholism, smoking.

Symptoms and signs of cholangitis of bile ducts

Symptoms and signs of cholangitis of bile ducts should be considered in the form of their flow:

Acute:
- Pain attack on the right side of the chest (shoulder, blade) and abdomen.
- Raising temperatures up to 40ºС.
- Nausea.
- Lowering blood pressure.
- Weakness.
- Vomiting.
- Skin itch.
- Chills.
- The yellowness of the skin, mucous membranes, sclera.
- Violation of consciousness.
- The development of hepatic coma is possible.
Chronic:
- Pains are poorly expressed, but have an intense character in the presence of stones.
- Skin itch.
- Drinking or squeezing in the right hypochondrium.
- Weakness.
- Periodically high temperature.
- Fatigue.
- Thickening fingers, redness of palms.
Sclerosing:

Pain in the top of the abdomen and right hypochondrium.
Stool violation like ulcerative colitis or Crohn's disease.
Jaundice and skin itch.
Temperature up to 38ºС.

Cholant in children

Children, cholangitis meets primarily for the reasons for a genetic or congenital character. In other cases, the disease is not observed in children.

Cholangitis in adults

In adults, cholangitis develops due to genetic, innate and women, it occurs when hormonal failures During pregnancy or childbirth. Men occurs due to the presence of bad habits or untreated diseases. Unhealthy lifestyle and poor-quality meals are the main factors of cholangitis in adults.

Diagnostics

Diagnosis of inflammation of bile ducts begins with a general inspection and collection of complaints. For some external signs, the doctor appears for the following procedures:

Uzi liver.
Blood test.
Magnetic resonance cholangiography.
Analysis of the feces on the eggs of worms.
Endoscopic retrograde cholangiparatography.
Analysis of urine.
Duodenal probing.
X-ray chopper.
Cholangiomanometry.
Choledochoscopy.
Liver biopsy.
Radioisotope examination of bile ducts.

Treatment

Treatment of cholangitis is carried out only in the hospital. Folk remedies that a person wants to spend at home does not contribute to recovery. Here is needed by medication, therapeutic and sometimes surgical treatment.

How to treat cholangitis? The doctor prescribes medicines if a normal bile outflow is observed:

Antibiotics.
Spasmolytics.
Sulfanimamides.
Medications that reduce intoxication.
Medicines that improve bile outflows.
Anthegermic drugs.

In case of ineffectiveness conservative treatment Surgery surgical. Endoscopy is carried out with the drainage of bile ducts, eliminating the narrowing, the removal of stones. With purulent inflammation extensive operation to remove purulent or necrotic sites. Sometimes cholecystectomy is carried out - removal of the gallbladder or a complete liver transplant.

In the treatment of cholangitis, a hard diet is actively used:

Nutrition with small portions at least 5 times.
Ban on meal before bedtime.
Exception from the menu of fresh bread, sharp, roasted, spicy, bow, sludge, acidic berries and fruits, garlic, strong tea, alcohol.
Fish, Cottage cheese, buckwheat, oatmeal, warm milk, egg proteins, boiled meat, vegetables, dairy soups, kefir, stale bread, honey, jam.
Ban on the hunger strike.
Tea drinking special fees Herbs Compote, Kissel, Mineral Waters.

Sclerosing cholangitis is treated as follows:

Vitamin therapy.
Antihistamine preparations.
Ursodeoxizole acid.
Sedative preparations.

The physiotherapy procedures are used:

Amplipalserapy.
Diathermy.
Microwave therapy.
Paraffin and mud appliqués.
Sanatorium treatment.
Physiotherapy.

Life expectancy

How many do cholangita live? The disease itself does not affect the life expectancy, but provokes such complications that lead to fatal outcomes:

Peritonitis.
Abdominal abscess.
Liver failure.
Intrahranny abscesses.
Sepsis.
Billion cirrhosis.
Cholangiocarcinoma.

Here should not be tightened with treatment and not engage in self-medication. Contact medical care at the first symptoms.