The main symptoms and methods of treatment of cholangitis. Acute cholangitis The phenomenon of cholangitis

The date: 19.07.2019

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Cholangitis is a disease in which intrahepatic and extrahepatic bile ducts form inflammatory process. Pathology most often develops in women aged 50-60 years. It rarely occurs as an independent disease, most often in combination with hepatitis, cholelithiasis, cholecystitis, oncological diseases bile ducts and bubble.

Causes

The main reasons for the formation of cholangitis:

Classification

According to the nature of the course, the disease is divided into acute and chronic form.

Acute cholangitis

Acute cholangitis, depending on the type of inflammatory process, is divided into the following types:

diphtheritic. Mucous biliary tract covered with ulcers, necrosis (death, necrosis) of tissues is noted, due to this, the walls of the ducts are destroyed and the surrounding tissues and the liver are suppurated;
catarrhal. The mildest form of the course of the disease, with this form, the mucous membrane of the ducts swells and becomes hyperemic. If left untreated, this type becomes chronic, subsequently scarring of the ducts occurs;
Purulent. The ducts are filled with purulent contents mixed with bile. May spread to the liver gallbladder;
Necrotic. It is formed against the background of the entry of enzymes (protease, amylase) of the pancreas into the ducts, due to this, the mucous membranes die.

Chronic cholangitis

Chronic cholangitis has 4 types of course:

Latent (hidden), there are no symptoms of the disease;
Recurrent. Has a relapse (exacerbation) and remission (no symptoms);
Septic. The severe form proceeds according to the type of sepsis (blood poisoning);
Abscessing. Purulent process with the formation of abscesses (purulent cavity).

Chronic sclerosing cholangitis

Separately, chronic sclerosing (autoimmune, associated with a malfunction immune system, killer antibodies are produced against healthy tissues, cells of the body), the type of cholangitis is not an infectious process, but an inflammatory process is formed in the ducts.

Due to chronic sclerosing cholangitis, cirrhosis of the liver can occur!

The bile ducts harden, narrowing of the lumen occurs, cannot be treated, and the disease progresses slowly (within 10 years). As a result, it is possible to form fatal outcome.

Symptoms

Cholangitis in acute form has a rapid course, is characterized by Charcot's triad: hyperthermia ( heat), jaundice, pain in the right hypochondrium.

The disease manifests itself with the following symptoms:

In severe cases, the phenomenon of shock, impaired consciousness (Reynolds pentad) may join.

In children, cholangitis is rare disease, is characterized by acute, non-specific, intense symptoms, the clinical picture of the course, as in other pathologies of the gastrointestinal tract (dyspepsia, intestinal disorders, epigastric pain, etc.). This makes it difficult to make a correct diagnosis.

Chronic cholangitis in adults is characterized by the following symptoms:

Periodic rise in temperature;
Increased fatigue, weakness;
Itching skin;
Hyperemia (redness) of the palms;
Thickening of the terminal phalanges of the fingers;
Intense pain only in the presence of stones in the ducts.

In children chronic cholangitis manifests itself as follows:

Diagnosis of the disease

The diagnosis of cholangitis is made on the basis of patient complaints, history taking (when symptoms first appeared, diseases of relatives, past illnesses and other). The doctor conducts a thorough examination (palpation abdominal cavity, examination of the skin, sclera of the eyes), prescribes a complex of examinations to the patient.

To diagnostic studies include:

Treatment Methods

Treatment of acute cholangitis should be carried out in a hospital, as the patient may require emergency surgery. Depending on the degree of violation of the output of bile, the type of disease, the doctor selects an individual tactic of therapeutic measures.

Medical therapy

conservative (treatment medicines) therapy is carried out if the patient has no mechanical obstacles to the outflow of bile from the gallbladder.

The main drugs for the treatment of cholangitis:

Physiotherapy treatment

During the period of remission, physiotherapy is prescribed :

Surgical intervention

With ineffective drug treatment, violations of the outflow of bile, an operation is indicated:

Endoscopic technique. Drainage (introduction of a catheter for outflow of contents) of the biliary tract is performed, stenosis (narrowing) is eliminated, stones are removed without resorting to abdominal surgery. This method allows you to avoid bleeding, reduce the risk of surgical injury, speed up the period of rehabilitation (recovery) after the manipulation;
Abdominal surgery - resection (removal) of the affected (purulent, dead) areas.

ethnoscience

Recipes traditional medicine for the treatment of cholangitis:

Diet

AT acute stage diseases prescribe hunger, after the exacerbation subsides, nutrition should be in small portions, at least 5-6 times a day, the interval between meals is no more than 4 hours. All dishes are steamed, baked, boiled.

Approved Products:

Low-fat varieties of meat, poultry, fish;
Soups on vegetable broth, milk;
Bread with bran, pasta;
Cereals, cereals;
Dairy products;
Vegetables, greens;
Not sour berries, fruits;
Compotes, juices, weak tea.

Limit sugar intake to 70 grams. per day, up to 1 egg per day.

Prohibited Products:

Fresh pastries, bread;
Canned food;
Smoked, fatty, spicy foods;
mushroom broth;
Semi-finished products;
Spicy seasonings, spices;
Ice cream, chocolate, confectionery with fat cream;
Coffee, carbonated drinks, alcohol, cocoa.

Complications

With untimely treatment, ineffective therapy, the patient may develop the following complications:

With cholangitis, a fatal outcome is possible, if symptoms appear, be sure to consult a doctor!

Viral hepatitis ( infection liver)
Cholecystitis (inflammation of the gallbladder);
Primary biliary cirrhosis of the liver (chronic, inflammatory disease liver);
Pleural empyema (accumulation of pus in the lungs - pleural cavity);
Pneumonia (inflammation of the lungs);
Fatal outcome.

Cholangitis is an inflammatory lesion of both intrahepatic and extrahepatic bile ducts. In most cases, this disease is diagnosed in females, men suffer from the disease less often. The main risk group is older people - from fifty to sixty years. It is extremely rare for the disease to develop in children.

The main prerequisites for the development of inflammation are infection of the body with pathological bacteria, as well as the course of other pathologies of the liver or gallbladder.

Cholangitis does not have specific symptoms, which is why a wide range of laboratory and instrumental examinations will be required to establish the correct diagnosis. The most characteristic clinical manifestations can be considered the development of jaundice, the appearance of strong pain under the right ribs, as well as an increase in body temperature.

In the treatment of the disease, conservative methods prevail, however, in severe cases, surgical intervention may be required.

AT International classification ICD-10 diseases, such a pathology was assigned a code value - K83.0.

Etiology

The source of any inflammatory process is the penetration into the body and reproduction of pathogenic microflora. In most cases, the causative agents of this disease are:

staphylococci;
coli;
enterococci;
proteas;
non-clostridial anaerobic infection.

Pathogenic bacteria can enter the biliary tract in several ways:

ascending - from the lumen of the duodenum;
hematogenous - through portal vein;
lymphogenous - with the flow of lymph through the lymphatic vessels.

Other predisposing factors for the appearance of a similar disease in adults may be:

Cholangitis in children is rarely an independent disease, and often acts as a secondary infection in the course of other ailments.

Classification

In gastroenterology, there are several classifications of this disease. The first of them shares the disease depending on the cause of cholangitis. Thus, it happens:

bacterial;
viral;
helminthic;
autoimmune;
oncological.

According to the nature of the course, there are two forms of the disease:

acute cholangitis - characterized by a pronounced expression of clinical signs and a sharp deterioration in a person's condition;
chronic cholangitis - characterized by alternating phases of remission and relapse. In the first case, the symptoms may not appear at all, and in the second, a similar picture is observed as in the previous form of the disease.

The acute form of the inflammatory process in the bile ducts can take the following forms:

catarrhal - in this case, swelling of the mucosa of the biliary tract occurs. In the absence of therapy, the disease becomes chronic and eventually becomes the cause of cicatricial narrowing of the ducts;
purulent - characterized by the fact that the bile ducts are filled with purulent fluid mixed with bile. The occurrence of purulent cholangitis is most often associated with a violation or complete blockage of the outflow of bile - which occurs against the background of blocking of the ducts by calculi or cancerous tumor. Purulent cholangitis often spreads to nearby organs, such as the gallbladder or liver;
diphtheritic - ulceration and necrosis of the mucous membrane of the ducts occurs. This leads to total destruction their walls, which often causes purulent fusion of surrounding tissues;
necrotic - develops due to the influence of aggressive pancreatic enzymes on the biliary tract. The result of this process is necrosis of the mucosa.

The chronic form of the course of such an ailment also has its own classification and is divided into:

latent or hidden - such a course is characterized by a complete absence of symptoms;
recurrent - characterized by alternating periods of retreat and exacerbation of symptoms. The first phase is expressed in an unchanged state of a person, as in a latent form, and during the second, clinical signs are expressed, as in acute cholangitis;
septic is the most severe course chronic inflammation, which can be fatal;
abscessing - characterized by the formation of abscesses in the bile ducts.

Separately, it is worth highlighting autoimmune cholangitis, which is formed due to the body's production of antibodies against its own healthy tissues and cells. In such cases, they talk about sclerosing cholangitis. This type of disease is characterized by slow progression and within ten years leads to irreversible changes. Inflammation leads to hardening of the ducts and overgrowth of the lumen, which, in turn, is a predisposing factor for the development of cirrhosis of the liver.

Symptoms

A wide variety of varieties and forms of the disease have the same Clinical signs. The main symptoms of the acute course of such a disease and exacerbation chronic course will be:

the appearance of a strong pain syndrome in the projection of the affected organ, i.e., in the region of the right hypochondrium;
a significant increase in body temperature;
chills;
the acquisition of the skin and mucous membranes of a yellowish tint;
bouts of nausea, which are accompanied by strong vomiting;
the appearance of a bitter taste in the mouth;
hepatomegaly - an increase in the volume of the liver, which is very well felt on palpation;
weakness, lethargy and fatigue of the body;
the spread of pain in the region of the right shoulder blade, shoulder and neck;
intense headaches;
violation of the chair;
redness of the skin of the palms;
skin itching, which is characterized by an increase at night, which leads to sleep disturbance;
fainting.

In acute cholangitis, the symptoms will be so pronounced that it cannot be ignored, but in the chronic course of the disease, the symptoms will be erased. The temperature will rise slightly, instead of severe vomiting- nausea and pain syndrome won't be as intense.

In addition, the clinical picture will differ in children and the elderly. Cholangitis in a child develops very quickly and in addition to the above symptoms may join:

decreased or complete lack of appetite;
signs of intoxication of the body;
pale skin;
anemia;
chronic headaches;
slowdown in physical and general development.

Cholangitis in elderly people will be expressed in severe fatigue, fatigue and an unreasonable increase in temperature, which returns to normal on its own.

Diagnostics

In order to make the correct diagnosis, the doctor is based on the symptoms of the disease and the data of laboratory and instrumental examinations.

Primary diagnosis of cholangitis includes:

conducting a detailed survey of the patient - to determine the presence, the first time of appearance and the severity of the symptoms of the disease;
examination by the clinician of the patient's medical history and life history - this is necessary to search for etiological factors;
a thorough physical examination, which is aimed at studying the condition of the skin and sclera, measuring body temperature and palpation of the entire surface of the anterior wall of the abdominal cavity, but special attention is paid to the area under the right ribs.

Among laboratory research worth highlighting:

Instrumental diagnostic methods involve the implementation of:

Ultrasound of the abdominal cavity;
CT - to obtain a clearer image of the problem area and identify their expansion, as well as to detect changes in the liver;
bile duct ultrasonography;
cholecystography;
electronic holography;
MRCP - to identify the causes of obstruction of the biliary tract.

Cholangitis should be differentiated from:

cholecystitis of non-calculous form;
viral hepatitis;
primary biliary cirrhosis;
pleural empyema;
right sided pneumonia.

Treatment

Therapy of such a disease is aimed at solving several problems, including:

relief of the inflammatory process;
body detoxification;
decompression of the bile ducts.

Depending on the predisposing factors and the presence of complications, the elimination of the disease can be conservative or surgical.

You can treat the disease with the help of the following physiotherapy procedures:

mud applications;
electrophoresis;
current or magnetic field;
ozokeritotherapy;
paraffin therapy;
taking sodium chloride baths.

Diet for cholangitis implies compliance with such rules:

frequent and fractional food intake;
complete rejection of fatty and spicy foods, smoked meats and preservatives;
grinding and thorough chewing products;
eating only warm food;
enrichment of the diet with dietary varieties of meat, fish and poultry, cereals, especially buckwheat and oatmeal, low-fat fermented milk products, fruits and vegetables after they have undergone heat treatment;
cooking should be carried out only by boiling, stewing, steaming or baking without adding fat;
plentiful drinking regime - you need to drink at least two liters of liquid. All drinks are allowed, except for strong coffee and soda.

Therapy of cholangitis will not be complete without restoring the normal outflow of bile. This will require the following surgeries:

removal of stones;
endoscopic papillosphincterotomy or duct stenting;
percutaneous transhepatic or external drainage of the biliary tract;
cholecystectomy.

Complications

Cholangitis is dangerous disease leading to the development of complications, many of which pose a threat to the life of the patient. Among the consequences of ignoring the symptoms or untimely treatment, it is worth highlighting:

liver failure;
biliary cirrhosis;
formation of liver abscesses;
development of peritonitis and sepsis;
infectious-toxic shock;
cholecystopancreatitis.

Prevention and prognosis

Special preventive measures, warning the appearance of angiocholitis, does not exist, people only need to adhere to the general rules:

completely abandon the drinking of alcoholic beverages and smoking;
rational and balanced diet;
timely treat diseases that can lead to the development of the underlying disease;
take place regularly preventive examinations at the gastroenterologist.

Only early diagnosis and cholangitis therapy provides favorable prognosis such a disease. In cases of complications, the outcome is unfavorable - very often the death of the patient occurs. The prolonged course of the chronic form of cholangitis leads to disability.

Cholangitis is an inflammatory lesion of the biliary tract, which most often has a non-specific nature - that is, it is caused by non-specific pathogens that can cause other inflammatory diseases.

This is a common disease that quite often goes hand in hand with other disorders of the gastrointestinal tract. Cholangitis is a problem of gastroenterology, but in case of complications, it requires surgical intervention.

Table of contents:

general information

The bile ducts can equally often be affected by cholangitis along their entire length - both small intra- and large extrahepatic ones.

note

The disease is most often diagnosed in the older age group - from 50 to 60 years, but in last years there is a trend towards rejuvenation of cholangitis, and more and more 40-year-old patients are admitted to the clinic with signs of this disease. Mostly women of this age category suffer.

Isolated cholangitis is less common than combined - therefore, if it is detected, other diseases of the gastrointestinal tract should be diagnosed, which may or may not appear, or their symptoms may be lost against the background of signs of cholangitis. Most often, inflammatory lesions of the bile ducts are combined with acute or chronic forms of such acute and chronic diseases. digestive tract, as:

gastroduodenitis;
in some cases - violations of the papilla of Vater (the place where the common bile duct and the pancreatic duct flow into the duodenum).

Causes

Inflammatory changes in the biliary tract are directly caused by an infectious agent that has entered them in different ways. Most often it is:

different forms;
enterococci;
anaerobic infection of the non-clostridial series.

Damage by an infectious agent that causes specific infectious diseases, passes quite rarely - but it should also be remembered (in particular, if typical cholangitis does not lend itself classical treatment). These can be the following pathogens:

bacillus Koch (mycobacteria);
pale spirochete (pathogen).

note

Often the symptoms of such cholangitis, provoked specific infection, may not be noticed, as they are lost against the background of the main symptoms caused by this infectious agent. This is especially true of latent (hidden) and sluggish forms of inflammatory lesions of the biliary tract.

The infectious agent most often penetrates the bile ducts:

by normal migration, being nearby in the duodenum and getting out of it through the papilla of Vater;
hematogenously - with blood flow through the portal vein (central vein of the liver);
lymphogenous way - with lymph flow (mainly with inflammatory lesions of the gallbladder, pancreas or small intestine).

Also, a viral agent can play a role in the development of cholangitis - basically, with such a lesion, small bile ducts that pass inside the liver are involved (in particular, this is observed in viral hepatitis).

But inflammation of the biliary tract can develop without the participation of any pathogens. This so-called aseptic (literally - sterile) cholangitis. Basically it happens:

enzymatic nature, when activated pancreatic juice irritates the wall of the biliary tract from the inside (this is observed with the so-called pancreatobiliary reflux, when the secret of the pancreas is "poured" into the biliary tract, which should not normally be). At first, inflammation occurs without the participation of an infectious agent, but it can join later at different stages of the disease;
sclerosing cholangitis - occurs due to autoimmune inflammation of the bile ducts (when the body reacts to own fabrics as for others).

The suspicion that cholangitis is of an autoimmune nature should appear if, in parallel, the patient has signs of such immune diseases as:

(formation of ulceration of the mucous membrane of the large intestine throughout its entire length);
(formation of granulomas all over gastrointestinal tract);
(inflammation and subsequent destruction of the walls blood vessels);
(disease connective tissue, which passes with deformation of the joints);
thyroiditis (inflammation of the thyroid gland)
and some other diseases.

The penetration of infection into the biliary tract is facilitated by cholestasis - stagnation of bile. It is mainly found in pathologies such as:

(violation of their motor skills);
congenital anomalies of the biliary tract (kinks, compression);
choledochal cyst;
cancer of the biliary tract;
choledocholithiasis (stones in the common bile duct);
stenosis (narrowing) of the papilla of Vater.

The trigger for the onset of cholangitis can also be damage to the walls of the bile ducts during endoscopic manipulations - most often such as:

retrograde cholangiopancreatography (injection of a contrast agent with a probe through the duodenum into the bile ducts);
stenting (installation of special frames that support the normal shape of the bile ducts);
sphincterotomy (dissection of the sphincter of Oddi - the muscle at the confluence of the common bile duct and the pancreatic duct into the duodenum);
surgical treatment of diseases of the biliary system of the liver.

Flow

Downstream cholangitis can be:

sharp;
chronic.

Depending on what pathological changes occur in the wall of the bile ducts, acute cholangitis is:

catarrhal;
purulent;
diphtheric;
necrotic.

At catarrhal cholangitis in the walls of the biliary tract, the usual uncomplicated inflammation is observed in its classical manifestation - this is redness and swelling of the mucous membrane, exfoliation of its surface layer.

Purulent form cholangitis is characterized by the formation of small multiple abscesses (limited abscesses) and further purulent fusion of the bile ducts.

At diphtheria cholangitis in the walls of the biliary tract, multiple ulcerations are formed, which lead to the gradual destruction of the walls. Also characteristic- the walls of the bile ducts are covered from the inside with a fibrous film.

For necrotic form characteristic is the formation of foci of necrosis (necrosis) of the wall of the biliary tract.

Chronic cholangitis is more common. It may develop:

as a primary process with a protracted course;
as a result of acute inflammation.

There are such forms of chronic cholangitis as:

latent - this is a latent form, during which there are morphological changes in the bile ducts, but symptoms do not appear;
recurrent - a form with alternating exacerbations and periods of calm;
long-term septic - protracted form with infectious lesion the whole organism;
abscessing - with this form, abscesses form in the bile duct system;
sclerosing - in the walls of the bile ducts there is a pronounced proliferation of connective tissue, which causes their narrowing and deformation.

Cholangitis can occur in the form of such varieties as:

choledochitis - inflammation of the choledochus (common bile duct);
angiocholitis - damage to smaller bile ducts;
papillitis - an inflammatory lesion of the Vater papilla (the place where the common bile duct enters the duodenum);
total defeat of the entire biliary tract system.

Symptoms of cholangitis

Signs of cholangitis depend on its form.

Acute cholangitis always begins suddenly. Its symptoms are:

fever and hyperthermia;
signs of intoxication;
dyspeptic phenomena;

Hyperthermia and fever are symptoms that usually start acute cholangitis:

body temperature rises to 39-40 degrees Celsius;
observed;
sweating is pronounced.

Pain characteristics:

begin almost simultaneously with fever;
by localization - in;
by irradiation (spread) - give to right hand, shoulder, right half of the neck;
by nature - cramping, reminiscent of hepatic colic;
intensity - strong.

Signs of intoxication are:

progressive weakness;
loss of appetite;
decrease in performance.

Soon, dyspeptic phenomena develop:

which does not bring relief;

Later, jaundice occurs - yellowing of the skin, sclera and visible mucous membranes. Due to the accumulation of bile pigments and their irritation of nerve endings, jaundice provokes itchy skin.

Characteristic is increased itching at night, which disturbs the patient's sleep.

The main signs of acute cholangitis are three symptoms that make up the so-called Charcot triad:

significant hyperthermia (rise in body temperature);

If the course of acute cholangitis is especially difficult, then disturbances in consciousness and manifestations of shock are added - these are the five most important symptoms this disease called the Reynolds pentad. We can say that this is the main landmark, thanks to which clinicians make the diagnosis of acute cholangitis.

Signs of a chronic form of cholangitis similar to signs acute form, but erased - on the other hand, with the progression of the disease, they gradually increase . In this case, abdominal pain:

stupid;
weak;
in some cases, these are not pains, but a feeling of discomfort and fullness in upper divisions belly.

Jaundice is present in chronic cholangitis, but it occurs quite late, when inflammation has long arose and worsened in the bile ducts - in fact, these are far-reaching pathological changes.

Common signs in chronic cholangitis are also present, but they are not as pronounced as in acute. In particular, there are:

an increase in body temperature to subfebrile numbers;
fatigue, but not critically affecting performance;
feeling of weakness.

Complications

If cholecystitis is not diagnosed and stopped in time, the following complications may occur:

Diagnostics

Based clinical picture, in the diagnosis of acute cholangitis, one should focus on the Charcot triad or Reynolds pentad. But in general, to make a diagnosis of this disease, it is also necessary to involve additional methods diagnostics - physical (examination, palpation, tapping and listening to the abdomen with a phonendoscope), instrumental and laboratory.

When examining such a patient, the following are revealed:

yellowness of the skin, sclera and visible mucous membranes;
tongue dry, coated with yellow coating;
traces of scratching are visible on the skin, sometimes quite pronounced, up to blood (with severe itching).

With the phenomena of jaundice, an examination of feces and urine will also be informative:

feces are characterized by a lighter shade than usual (but in general it is not white, as it can be with jaundice about);
due to the entry of bile pigments into the blood and then into the kidneys, the urine may darken ( characteristic symptom beer color).

On palpation at the peak of the pain attack, there is strong pain in the right hypochondrium.

With percussion (tapping with the edge of the palm on the right costal arch), the patient reacts very painfully.

Auscultation is not informative.

Instrumental methods that are used to diagnose cholangitis are:

In the diagnosis of cholangitis use such laboratory methods, as:

– its data are not specific, but are important for assessing the progression of inflammation. So, an increase in the number of leukocytes and an increase in ESR will be detected;
biochemical- determine the increase in the amount of alkaline phosphatase, as well as transaminases and alpha-amylase. Such data indirectly indicate cholestasis (stagnation of bile), which is observed in cholangitis;
bacteriological culture of bile obtained with duodenal sounding- thanks to him, the causative agent of cholangitis is identified;
- thanks to him, they confirm or exclude the presence in the body or protozoa that can cause inflammation of the biliary tract.

Differential Diagnosis

Differential (distinctive) diagnosis of cholangitis should be carried out with diseases such as:

Treatment of cholangitis

Cholangitis is treated with conservative or surgical method. The choice of method depends on:

causes of illness;
degree of manifestations;
complications.

The most important tasks that are pursued in the treatment of this disease are:

elimination of inflammation;
detoxification;
decompression (unloading) of the biliary tract.

At the core conservative treatment are the following appointments:

If acute phenomena were overcome, then during the period of remission, physiotherapeutic methods of treatment are successfully practiced, such as:

inductothermy;
microwave therapy;
electrophoresis;
diathermy;
mud applications (application of therapeutic mud);
ozokeritotherapy;
paraffin therapy;
salt baths (in particular, sodium chloride).

All these methods can be carried out in the physiotherapy room of the clinic or during the spa treatment, which is recommended to the patient at the stage of remission.

If necessary, they resort to surgical correction of disorders of the biliary tract - these are:

endoscopic papillosphincterotomy - dissection of the narrowed vater of the papilla;
endoscopic extraction of stones from the bile ducts;
endoscopic stenting of the common bile duct - the introduction of a framework into it, which will help maintain the normal lumen of the common bile duct;
percutaneous transhepatic drainage of the bile ducts - removal of bile from the duct system through a puncture of the skin and liver.

In the case of sclerosing cholangitis, the most effective way is a liver transplant.

Prevention

The basis of measures that will help prevent inflammatory lesions of the biliary tract are the following:

Forecast

The prognosis for cholangitis is different. With the catarrhal form of cholangitis, it is satisfactory, with purulent, diphtheritic and necrotic forms it is more serious: in this case, the outcome can be favorable for the patient only in the case of verified prescriptions and scrupulously adhered to treatment.

If the inflammation of the biliary tract passes with complications, then the prognosis is unsatisfactory. This is especially true in diseases such as:

the formation of abscesses in the biliary tract;
cirrhosis of the liver;
hepatic and renal insufficiency;
septic damage to the body.

Kovtonyuk Oksana Vladimirovna, medical commentator, surgeon, medical consultant

Filtering toxins, storing vitamins, producing glycogen - these are the main tasks that the liver performs in the body of every person. If for some reason these functions cannot be full degree be executed, then . Yellowing of the skin or sclera of the eyes are clear signs that the liver is starting to fail.

What is it - cholangitis?

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

Types and forms

Cholangitis has its own types and forms of development. The forms are divided into:

Spicy. According to the inflammatory nature, acute cholangitis is divided into types:

Catarrhal - swelling of the bile ducts with their further scarring and narrowing.
Purulent - affects the liver and gallbladder, characterized by the accumulation of pus and bile in the bile ducts.
Necrotic - the formation of necrosis of sections of the bile duct after the ingestion of pancreatic enzymes.
Diphtheritic - manifestations and necrosis of the mucosa, destruction of the walls of the bile duct, purulent fusion of the surrounding tissue.

Chronic. According to the inflammatory nature, they are divided into types:
- Hidden (latent).
- Septic.
- Recurrent.
- Abscessing.
Sclerosing (autoimmune) cholangitis - it is assumed that it develops as a result of autoimmune reaction organism on itself. Hardening, narrowing and overgrowth of the bile ducts occurs, which leads to cirrhosis of the liver.
Bacterial.

Causes

What could be the causes of such an unpleasant disease as cholangitis? Consider the most common:

Gallstone disease in the bile ducts (choledocholithiasis).
Scarring and narrowing of the bile duct due to removal of a cyst, tumor, or chronic cholecystitis.
Roundworm, helminthic invasion.
Hepatitis.
Penetration of infection from the intestines, through the flow of lymph or blood. A favorable environment for her becomes a violation of the outflow (stagnation) of bile.

Predisposing factors for these anomalies are:

genetic predisposition.
psychogenic factor.
congenital anomalies.
Giardiasis.
Dyskenesia.
endocrine disorders.
immunological reactions.
Pancreatobiliary reflux.
Dyscholia, which develops for the following reasons:
- Eating disorder.
- Obesity.
- Overweight.
- Hormonal disruptions.
- Taking hormonal medications.
- Violation of the blood supply to the liver and gallbladder.
- Dishormonal disorders.
- Alcoholism, smoking.

Symptoms and signs of cholangitis of the bile ducts

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

Spicy:
- Attack of pain in the right side chest(shoulder, shoulder blade) and abdomen.
- Raising the temperature to 40ºС.
- Nausea.
- Lowering blood pressure.
- Weakness.
- Vomit.
- Skin itching.
- Chills.
- Yellowness of the skin, mucous membranes, sclera.
- Violation of consciousness.
- Perhaps the development of hepatic coma.
Chronic:
- Pain is mild, but intense in the presence of stones.
- Skin itching.
- Bursting or squeezing in the right hypochondrium.
- Weakness.
- Intermittent high fever.
- fatigue.
- Thickening of the fingers, redness of the palms.
Sclerosing:

Pain in the upper abdomen and right hypochondrium.
Violation of the stool, as in ulcerative colitis or Crohn's disease.
Jaundice and pruritus.
Temperature up to 38ºС.

Cholangitis in children

In children, cholangitis occurs mainly due to genetic or innate character. In other cases, the disease is not observed in children.

Cholangitis in adults

In adults, cholangitis develops due to genetic, congenital and in women, it occurs when hormonal disruptions during pregnancy or childbirth. It occurs in men due to the presence bad habits or untreated diseases. An unhealthy lifestyle and poor-quality nutrition are the main factors of cholangitis in adults.

Diagnostics

Diagnosis of inflammation of the bile ducts begins with a general examination and collection of complaints. For some outward signs the doctor has reasons for the following procedures:

Ultrasound of the liver.
Blood test.
Magnetic resonance cholangiography.
Analysis of feces for eggs of worms.
Endoscopic retrograde cholangipancreatography.
Analysis of urine.
duodenal sounding.
X-ray cholegraphy.
Cholangiomanometry.
Choledochoscopy.
Liver biopsy.
Radioisotope examination of the bile ducts.

Treatment

Treatment of cholangitis is carried out only in a hospital. Folk remedies that a person wants to carry out at home do not contribute to recovery. This requires medical, therapeutic and sometimes surgical treatment.

What is the treatment for cholangitis? The doctor prescribes medications if there is a normal outflow of bile:

Antibiotics.
Antispasmodics.
Sulfonamides.
Drugs that reduce toxicity.
Medications that improve the outflow of bile.
Anthelmintic drugs.

In case of ineffectiveness of conservative treatment, surgical treatment is resorted to. Endoscopy is performed with drainage of the bile ducts, elimination of narrowing, removal of stones. At purulent inflammation held abdominal operation to remove purulent or necrotic areas. Sometimes a cholecystectomy is performed - the removal of the gallbladder or a complete liver transplant.

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

Small meals at least 5 times.
Avoid eating before bed.
Exclusion from the menu of fresh bread, spicy, fried, spicy, onions, bacon, sour berries and fruits, garlic, strong tea, alcohol.
Included in the menu are lean fish, cottage cheese, buckwheat, oatmeal, warm milk, egg whites, boiled meat, vegetables, milk soups, kefir, stale bread, honey, jam.
Prohibition on hunger strike.
tea drinking special charges herbs. Compotes, jelly, mineral waters.

Sclerosing cholangitis is treated as follows:

Vitamin therapy.
Antihistamines.
Ursodeoxysolic acid.
Sedative drugs.

Physiotherapy procedures are used:

Amplipulse therapy.
Diathermy.
microwave therapy.
Paraffin and mud applications.
Sanatorium treatment.
Physiotherapy.

Lifespan

How long do people live with cholangitis? The disease itself does not affect life expectancy, but provokes such complications that lead to death:

Peritonitis.
Abscess of the abdomen.
Liver failure.
Intrahepatic abscesses.
Sepsis.
biliary cirrhosis.
Cholangiocarcinoma.

Here you should not delay treatment and do not self-medicate. Contact for medical assistance at the first symptoms.

Cholangitis is an inflammation of the external or internal hepatic ducts. Pain in the right hypochondrium, radiating to the shoulder? Pulling pain Or a feeling of distension? It's most likely cholangitis. It is impossible to postpone a visit to the doctor with such symptoms, since dysfunction of the liver ducts leads, in the absence of therapy, to serious illnesses. How to determine the presence of pathology, how to treat the inflammatory process and whether it is possible to prevent it - the answers to all questions in the article.

The general code for cholangitis according to ICD-10 is K83.0, which combines all varieties of the disease. This term refers to nonspecific inflammation of the bile ducts of the liver, which occurs due to different reasons. In the risk group for morbidity are, first of all, women in the postmenopausal period. Usually this pathology accompanied by other disorders of the gastrointestinal tract: gastroduodenitis, hepatitis, cholelithiasis, pancreatitis and inflammation of the gallbladder itself.

Classification

The inflammatory process can be acute or chronic, both stages have several varieties. Acute cholangitis is divided into:

Catarrhal, accompanied by edema and hyperemia of the mucous ducts. At the same time, the epithelium is exfoliated, the walls of the vessels are infiltrated by leukocytes.
diphtheria, in which inner surface ducts fibrinous films are formed.
Purulent cholangitis leads to the melting of the walls of the biliary vessels and the occurrence of multiple abscesses.
Necrotic is the formation of foci of dead tissue.

However, more often the disease is diagnosed already in chronic phase(or may initially take a protracted sluggish character). There are the following types of this process:

latent;
septic;
recurrent;
abscessing;
sclerosing.

The last form of chronic inflammation - sclerosing cholangitis of the liver leads to deformation of the ducts due to the growth of connective tissue, their narrowing or complete infection (obliteration).

Prerequisites for the development of the inflammatory process can be various factors. Stagnation of bile, ductal dyskinesia or their congenital anomalies, cyst common duct, malignant neoplasms, cholelithiasis usually lead to inflammation. It can also be provoked by surgical interventions and other medical manipulations: cholangitis after removal of the gallbladder, sphincterotomy, pancreatocholangiography is also possible.

Most often, cholangitis is a consequence of infection pathogenic microorganisms that enter the liver ducts from duodenum(ascending path), with blood flow through the portal vein or together with lymph in case of inflammation of the gallbladder, small intestine, pancreas. The most common pathogens are coli, entero- and staphylococci, proteus and anaerobes. Sometimes there is an infection caused by mycobacterium tuberculosis, pallidum spirochete or typhoid salmonella. With hepatitis of a viral nature, small ducts are also affected.

Aseptic inflammatory process occurs for various reasons. For example, autoimmune lesion(primary biliary cholangitis), leading to sclerosis and often accompanied by vasculitis, thyroiditis, nonspecific ulcerative colitis, Crohn's disease. aseptically in initial stage inflammation provoked by enzymes also occurs: with pancreatobiliary reflux, pancreatic juice enters the bile ducts and irritates them. Later, a bacterial infection will join.

Diagnostics

The primary diagnosis in the acute phase can be made on the basis of a specific symptom complex - Charcot's triad. To clarify, a number of instrumental and laboratory studies are carried out. The visualization method is an ultrasound examination - ultrasound signs of cholangitis are deformations of the ducts (expansion or narrowing, the presence of cysts, inflammatory foci). There are also CT scan, ultrasonography of the liver.

Main instrumental research- endoscopic pancreatocholangiography, MRCP (computer scan in a magnetic field), as well as percutaneous transhepatic cholangiography. The latter involves an x-ray examination of the bile ducts after they are filled with a contrast agent.

Symptoms and treatment of cholangitis

The course and manifestation of acute and chronic cholangitis differ significantly. The first is characterized by the so-called Charcot triad:

Fever that begins suddenly with a sharp increase in temperature to 38 ° C and above, chills and intense sweating.
Severe pain under the ribs on the right, radiating to right side body (neck, shoulder and shoulder blade) and similar to biliary colic.
Jaundice, which will join later. The sclera and skin turn yellow, itching occurs, due to which multiple scratches are revealed during examination.

Due to the increase in temperature, symptoms of intoxication appear. The patient experiences nausea, his appetite worsens, weakness progresses. Complaints of headaches are also characteristic, and in especially severe cases, shock phenomena and impaired consciousness are added.

The chronic stage of the disease is characterized by mild symptoms that progress over time. For example, the symptoms of sclerosing cholangitis appear quite late in the form of abdominal pain, itching, weight loss, jaundice, and general weakness. Jaundice, as a rule, indicates that the pathological process has gone far enough.

Treatment of cholangitis can be either conservative or surgical. Its main tasks are the elimination of intoxication, the relief of inflammation and the decompression of the bile ducts. The patient is recommended bed rest and fasting, medicines, in some cases - surgical intervention up to liver transplantation.

Treatment of cholangitis with drugs

Purpose medicines carried out in accordance with the exact diagnosis. The list of drugs may include:

Hepatoprotectors are also used to restore and protect liver cells.

Surgical treatment

conservative drug therapy shown only in the case when the patency of the bile ducts is not broken. However, it is often necessary to restore bile excretion with the help of surgical procedures. Surgical treatment cholangitis can be minimally invasive: endoscopic papillosphincterotomy or choledochal stenting, percutaneous or external drainage, etc. With a sclerosing variety of the pathological process the best option is a liver transplant.

Physiotherapy

The list of physiotherapeutic methods includes the following:

ultra- and microwave therapy;
inducto- and diathermy;
electrophoresis;
mud treatment;
paraffin therapy;
salt baths.

Physiotherapy is prescribed only during the period of remission of the disease.

Treatment of cholangitis with folk remedies

In the acute phase, only qualified health care and recipes alternative medicine can be used for chronic inflammation. The most effective are:

Cholagogue infusion from a mixture of knotweed, calendula and yarrow. Two tablespoons of the crushed collection should be infused for about an hour in 0.5 liters of boiling water, then strain and take half a glass three times a day before meals.
In the same proportions, you can also brew a collection of corn stigmas, immortelle and chamomile. You can drink it instead of regular tea.
Peppermint-honey bile-secreting mixture is prepared from an equal amount of flower honey and dried leaves. peppermint. You need to take it in a teaspoon twice a day.

Treatment folk methods should be agreed with the doctor, as there may be individual contraindications.

Diet for cholangitis

During an exacerbation, the patient is shown fasting (24-48 hours, with a gradual expansion of the diet).

When the condition is normalized, a special diet is prescribed, from which fatty foods, muffins, marinades, smoked meats, hot spices, chocolate, legumes, garlic and onions are excluded. Do not drink coffee, soda and alcoholic drinks. Of particular importance is the method of preparation: food must be boiled, baked or stewed, and frying food is prohibited.

Diet for cholangitis involves frequent meals in small portions. Food should not be cold or too hot, the maximum break between meals is 4 hours. The patient is allowed to eat lean fish and meat, cereals, pasta, bread, soups in the secondary broth, vegetables, dairy products, non-acidic berries and fruits. You can drink tea with milk, diluted juices, compotes. From sweet, marmalade, jam, pastille are acceptable in a limited amount.

Forecasts and prevention

Complicated by cirrhosis, abscesses, sepsis, cholangitis is an extremely unfavorable diagnosis from the point of view of recovery. Diphtheria, purulent and necrotic are difficult to treat, often leading to disability. With a catarrhal form, the prognosis is the most favorable. Help prevent inflammation of the bile ducts timely treatment diseases of the gastrointestinal tract, helminthic invasions.