Acute cholangitis. Infections in abdominal surgery

Cholangitis is an inflammatory lesion of both the intrahepatic and extrahepatic bile ducts. In most cases, such a disease is diagnosed in women, men suffer from the disease less often. The main risk group is made up of older people - from fifty to sixty years. It is extremely rare that the disease develops in children.

The main prerequisites for the development of inflammation are the 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 severe 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.

V International classification diseases ICD-10 of such a pathology is 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;
• Escherichia coli;
• enterococci;
• proteas;
• non-clostridial anaerobic infection.

Disease-causing bacteria can enter the biliary tract in several ways:

• ascending - from the lumen of the duodenum;
• hematogenous - through the 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 such a disease. The first classifies the disease according to the cause of cholangitis. Thus, it happens:

• bacterial;
• viral;
• helminthic;
• autoimmune;
• oncological.

By the nature of the course, there are two forms of the disease:

• acute cholangitis - characterized by a vivid expression of clinical signs and a sharp deterioration in a person's condition;
• chronic cholangitis - characterized by the alternation of remission and relapse phases. 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 - while swelling of the mucous membrane 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 onset of purulent cholangitis is most often associated with a violation or complete blockage of the outflow of bile - which occurs against the background of closure of the ducts by calculi or cancer. Purulent cholangitis often spreads to nearby organs, such as gall bladder or liver;
• diphtheria - ulceration and necrosis of the mucous membrane of the ducts occurs. This leads to complete destruction their walls, which often causes purulent fusion of the surrounding tissues;
• necrotic - develops as a result of the influence on the biliary tract of aggressive pancreatic enzymes. The result of this process is mucosal necrosis.

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

• latent or hidden - this 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 the unchanged state of a person, as in the latent form, and during the second phase, the expression of clinical signs occurs, as in acute cholangitis;
• septic is the most severe course of chronic inflammation, which can be fatal;
• abscess - characterized by the formation of abscesses in the bile ducts.

We should also highlight autoimmune cholangitis, which is formed due to the production of antibodies by the body 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, acts as a predisposing factor for the development of liver cirrhosis.

Symptoms

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

• emergence of a strong pain syndrome in the projection of the affected organ, i.e. in the area of ​​the right hypochondrium;
• significant increase in body temperature;
• chills;
• the acquisition of a yellowish tint by the skin and mucous membranes;
• bouts of nausea, accompanied by severe 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;
• spread of pain to the area of ​​the right scapula, shoulder and neck;
• intense headaches;
• violation of the stool;
• redness of the skin of the palms;
• itching of the skin, which is characterized by increased 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 will occur, and the pain syndrome will not be so intense.

In addition, the clinical picture in children and the elderly will differ. 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;
• pallor of the skin;
• anemia;
• chronic headaches;
• slowdown in physical and general development.

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

Diagnostics

In order to make the correct diagnosis, the doctor relies 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 find out the presence, the first time of onset and the severity of the symptoms of the disease;
• the study by the clinician of the patient's medical history and anamnesis 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 palpating the entire surface of the anterior abdominal wall, but special attention is paid to the area under the right ribs.

Among laboratory tests, it is worth highlighting:

Instrumental diagnostic methods involve the implementation of:

• Abdominal ultrasound;
• CT - to obtain a clearer image of the problem area and identify their expansion, as well as to identify changes in the liver;
• ultrasonography of the bile ducts;
• cholecystography;
• electronic cholegraphy;
• MRPHG - 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;
• empyema of the pleura;
• right-sided pneumonia.

Treatment

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

• relief of the inflammatory process;
• detoxification of the body;
• 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.

The disease can be treated with the following physiotherapy procedures:

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

Diet for cholangitis implies compliance with the following rules:

• frequent and fractional food intake;
• complete rejection of fatty and spicy foods, smoked meats and preservatives;
• shredding 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 undergo 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 strong coffee and soda.

Cholangitis therapy will not be complete without restoring normal bile flow. This will require the following surgical operations:

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

Complications

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

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

Prevention and prognosis

There are no special preventive measures to prevent the appearance of angiocholitis, people just need to adhere to the general rules:

• give up drinking completely alcoholic beverages and smoking;
• eat rationally and balanced;
• timely treat diseases that can lead to the development of the underlying ailment;
• regularly pass preventive examinations at the gastroenterologist.

Only early diagnosis and therapy of cholangitis provides a favorable prognosis for 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.

Primary sclerosing cholangitis, bacterial cholangitis

Version: MedElement Disease Handbook

Cholangitis (K83.0)

Gastroenterology

general information

Short description

Cholangitis- an inflammatory disease of the extra- and intrahepatic bile ducts, with an acute or chronic recurrent course. Much less common inflammatory diseases gallbladder.

Notes (edit)

1. To this subheading included:
1.1 Bacterial cholangitis.
1.2 Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease characterized by inflammation and progressive fibrosis Fibrosis is an overgrowth of fibrous connective tissue, which occurs, for example, in the outcome of inflammation.
intra- and extrahepatic bile ducts, which consequently leads to their narrowing, obliteration, ductopenia Ductopenia is a disappearing bile duct syndrome.
and, as a consequence, to the development of liver cirrhosis and cholangiocellular carcinoma.

2. From this subheading excluded NS:
- cholangitis with liver abscess ();
- cholangitis and choledocholithiasis (K80.3 -, K80.4);
- chronic destructive nonsuppurative cholangitis in primary biliary cirrhosis ().

Progressive cholangitis;

Cholangitis, unspecified;

Primary cholangitis;

Recurrent cholangitis;

Sclerosing cholangitis;
- secondary cholangitis;

Stenosing cholangitis;

Purulent cholangitis.

4. Synonyms:

Bacterial cholangitis;

Bacterial cholangitis;
- primary sclerosing cholangitis.

Classification

There is currently no clear, comprehensive classification of cholangitis. The following types of cholangitis are tentatively distinguished. Some forms of cholangitis (cholangitis with gallstone disease, ischemic cholangitis, and others) are classified in other headings.

I. According to the clinical course: acute and chronic cholangitis (some authors also distinguish recurrent cholangitis).

II. Primary and secondary(as complications of diseases, manipulations).

III. By the nature of the process:

2. Sclerosing:

2.1 Primary sclerosing cholangitis (PSC):
- in combination with ulcerative colitis (ulcerative colitis);
- without NUC.

2.2 Secondary sclerosing cholangitis:

2.2.1 Toxic damage:
- with the introduction of formaldehyde and absolute alcohol into echinococcal cysts;
- taking thiobendazole.

2.2.2 Ischemic injury:
- with thrombosis of the hepatic artery after liver transplantation;
- in case of a graft rejection reaction;
- with the introduction of 5-fluorouracil into the hepatic artery during tumor chemotherapy;
- during operations on the bile ducts.

2.2.3 Bile duct stones, including choledocholithiasis.

2.2.4 Congenital malformations of the bile ducts:
- common bile duct cyst;
- Caroli's disease.

2.2.5 Cytomegalovirus infection or cryptosporidiosis in AIDS.

2.2.6 Histiocytosis.

2.2.7 Cholangiocarcinoma.

Primary sclerosing cholangitis is also classified by stage(severity of damage to the bile ducts and fibrosis):
- Stage 1 (early changes) - damage to the bile ducts and inflammation limited to the area of ​​the portal tract;
- stage 2 - the spread of inflammation and fibrosis outside the portal tract;
- stage 3 - a decrease in the number of bile ducts and bridging fibrosis;
- stage 4 (terminal) - the development of liver cirrhosis.

Etiology and pathogenesis

Bacterial cholangitis

Etiology

Spectrum of pathogens bacterial infection with cholangitis, it corresponds to the spectrum of intestinal microflora (Escherichia coli, Proteus vulgaris, Enterococcus). With purulent cholangitis in more than 90% of patients, several pathogens are detected in the bile at the same time and, in addition, positive results of blood culture for sterility are recorded.

Pathogenesis

Microorganisms can enter the bile ducts as a result of dysfunction of the duodenal nipple (condition after endoscopic retrograde cholangiopancreatography, ERCP) or can enter the bile ducts by hematogenous or lymphogenous pathways.

(PSH)

The etiopathogenesis of PSC is unknown. Toxins, infectious agents and immune disorders are considered as possible etiological factors.
Excessive copper deposition in liver tissue was found in patients with PSC. However, chelation therapy in these patients turned out to be ineffective, which indicates a secondary nature of copper overload (in particular, this is typical for patients with primary biliary cirrhosis).
The epithelium of the intrahepatic bile ducts is affected by cytomegalovirus and reovirus type 3, but the likelihood of detecting these viruses in all patients with PSC remains hypothetical.
The possibility of a genetic predisposition to the disease is indicated by the high incidence of various autoimmune disorders (including liver - autoimmune cross syndrome) in patients with PSC. Loci HLA-B8 and HLA-DR3, which are often found in patients with autoimmune diseases, are also found in patients with PSC.
With PSC, T-lymphocytes and immune-mediated mechanisms are actively involved in damage to the bile ducts, the action of which is manifested by lymphoplasmacytic infiltration, accumulation of eosinophils and obliterating phlebitis.

Pathogenesis of ductopenia and cholestasis in PSC:

Decreased secretion due to exposure to pro-inflammatory cytokines;

Impaired expression and functional activity of carrier molecules;

Blockade of the patency of the bile ducts as a result of chronic inflammation and fibrosis;

Retention of bile acids and activation of apoptosis Apoptosis is a programmed cell death by internal mechanisms.
hepatocytes.

Epidemiology

Cholangitis

The mortality rate varies between 13-88%.

Geography. There is an increase in frequency in Southeast Asia.

Floor. No difference

Age. It is mainly found in adults, the average age of the onset of the disease is 50-60 years.

Primary sclerosing cholangitis

The prevalence is estimated at an average of 6.3 cases per 100,000 population.

Gender and age. The disease usually begins at the age of 20-30, although it can also manifest itself in childhood. About 70% of patients with PSC are men. The average age at diagnosis for them is about 40 years.
Patients with PSC but no inflammatory bowel disease are more likely to be older women at the time of diagnosis.

The true frequency of PSC in the population is unknown, but it is increasing every year due to the improvement of diagnostic methods. It is assumed that in some countries the underestimation of the prevalence of the disease is significant (underestimated by 3-4 times).

Factors and risk groups

- young men (25-45 years old);
- patients with ulcerative colitis of any age and gender;
- patients with type 1 diabetes mellitus;
- patients with a burdened family history.

Symptoms, course

Bacterial cholangitis

Classic symptoms of cholangitis: pain in the right hypochondrium, chills, fever, Charcot's triad (combination of fever, chills and jaundice).

The pain is usually localized in the epigastric region, is intense and colicky.
Fever, as a rule, is intermittent, but in elderly patients and those in a state of immunosuppression, it can be subfebrile.
In the case when signs of sepsis in the form of arterial hypotension and mental disorders join the described symptoms, this symptom complex is called Reynold's pentad.

Primary sclerosing cholangitis

In patients with primary sclerosing cholangitis (PSC), many clinical signs characteristic of primary biliary cirrhosis (PBC) are revealed. The disease usually begins imperceptibly and retrospectively it is difficult to fix the time interval of the disease onset.
Some signs of the disease may appear in 75% of patients with PSC within 1-2 years before diagnosis.

Main complaints associated with increasing general weakness and pruritus, to which jaundice subsequently joins. This triad of symptoms is typical for 2/3 of patients.
When clinical signs of cholangitis appear (pain in the right hypochondrium, fever and jaundice), it is necessary to exclude the possibility of complications (choledocholithiasis and others). At the stage of clinical manifestations, jaundice in combination with hepatosplenomegaly is found in 75% of patients. Melasma and xanthelasma (xanthomas) are less common than in patients with PBC.

Initial symptoms in 29 patients with PSC(after S. Sherlock, J. Dooley, 1999)

Symptom	Number of patients	%
Jaundice	21	72
Itching	20	69
Decrease in body weight	23	79
Pain in the right upper quadrant of the abdomen	21	72
Acute cholangitis	13	45
Bleeding from varicose veins of the esophagus	4	14
Malaise	1	3
Asymptomatic course	2	7
Total	29

PSC is often combined with lesions of other organs and systems. Diseases associated with PSC:

Chronic inflammatory bowel disease (NUC, Crohn's disease);

Pancreatitis;

Diseases of the joints;

Sarcoidosis;

Celiac disease;

Thyroiditis;

Type 1 autoimmune hepatitis.

Always, even in the absence of symptoms of bowel disease, UCN (and in rare cases Crohn's disease) should be ruled out by performing sigmoidoscopy and biopsy of the rectal mucosa. PSC can be detected earlier or later than colitis. Colitis is usually chronic, diffuse, mild or moderate. The activity of cholangitis is inversely proportional to the activity of the colitis. Remissions are usually long-term.

Diagnostics

The basis for the diagnosis of any cholangitis is the study clinical symptoms diseases.

Bacterial cholangitis

1. Ultrasound... In acute cholangitis, the following are often detected: thickening of the walls of the bile ducts, an increase in their echogenicity, the presence of gas bubbles in the bile ducts, sometimes some expansion of the ducts and indistinct visualization of the lumen.
Cholangitis quite often can lead to the development of acute cholecystitis or develop in parallel with it. After clinical recovery from cholangitis in the echographic picture of the liver, multiple hyperechoic point and small focal inclusions in the parenchyma can be detected Parenchyma is a set of basic functioning elements of an internal organ, limited by the connective tissue stroma and capsule.
in the zones of the location of the intrahepatic ducts.
One of frequent reasons cholangitis and cholecystocholangitis in some regions can serve as opisthorchiasis Opisthorchiasis - helminthiasis from the group of trematodes caused by a feline fluke (Opisthorchis felineus) or a squirrel fluke (Opisthorchis viverrini); manifests itself in the early phase by the phenomena of cholangitis, pancreatitis and allergies; human infection occurs when eating infested fish
.

2. CT scan also allows you to see the expansion of the intra- and extrahepatic bile ducts.

3. If you suspect obstruction of the biliary tract, perform ERCP ERCP - endoscopic retrograde cholangiopancreatography
.

Primary sclerosing cholangitis

1. ERCP- the method of choice, transhepatic cholangiography can also be used with success. The diagnostic criterion is the identification of areas of uneven narrowing and expansion (clearness) of the intra- and extrahepatic biliary tract.

2.Ultrasound reveals thickening of the bile duct walls and signs of portal hypertension Portal hypertension is venous hypertension (increased hydrostatic pressure in the veins) in the portal vein system.
.

3. CT scan allows visualization of minimally dilated areas along the bile ducts.

Laboratory diagnostics

Bacterial cholangitis

1. Signs of inflammation:
- leukocytosis with a shift of the formula to the left;
- increased ESR ESR - erythrocyte sedimentation rate (non-specific laboratory blood index, reflecting the ratio of plasma protein fractions)
.
2. Cholestasis: increased activity of alkaline phosphatase, GGT Gamma-glutamyl transpeptidase (GGT) - an enzyme involved in the exchange of amino acids
, the concentration of bilirubin.

3. Cytolysis (rare): increased activity of serum transaminases.

Notes:
1. High levels of bilirubin occur mainly in patients with malignant obstruction.
2. A simultaneous increase in amylase indicates a possible obstruction in the area of ​​the Vater's nipple.
3. Blood culture results are positive in almost 50% of patients. Bile culture results are positive in almost all patients.
Several organisms are identified as the most common (approximately 60% of patients): Escherichia coli, Klebsiella, Enterococcus species. Of the anaerobic pathogens, the most frequently isolated culture was Bacteroides fragilis.

Primary sclerosing cholangitis(PSH)

1. Cholestasis:
- an increase in the activity of alkaline phosphatase 3 times higher than normal Attention! ;

The bilirubin level fluctuates significantly and in rare cases exceeds 170 μmol / l;
- in all patients with severe and prolonged cholestasis, the content of ceruloplasmin and copper in the blood serum may increase.

2. Levels of gamma globulins and IgM are increased in 30 and 50% of cases, respectively.

3. Low titers of antibodies to smooth muscle (SMA) can be detected in serum, p-ANCA is present in 84% of patients; anticardiolipin (ACL) antibodies - in 66% of cases; antinuclear antibodies (ANA) - in 53% of cases. Antimitochondrial antibodies (AMA) are usually absent.

4. Eosinophilia (rare).

Notes:
1. Some patients with hypothyroidism, hypophosphatemia, magnesium or zinc deficiency may have normal level alkaline phosphatase.
2. Sometimes there is hypoalbuminenmia, which occurs either in the late stages of the disease, or in the presence of an active stage of inflammatory bowel diseases.

Biopsy and morphological examination of liver tissue
Morphological studies of liver tissue are carried out to confirm the diagnosis of PSC (morphological data are especially valuable in the case of lesions of small bile ducts).

Stage 1. The early stage of damage to the bile ducts has no specific signs. Focal atrophy and impaired epithelial alignment are typical. Hyperplasia is not characteristic Hyperplasia - an increase in the number of cells, intracellular structures, intercellular fibrous formations due to increased organ function or as a result of pathological tissue neoplasm.
bile epithelium, characteristic of patients with primary biliary cirrhosis. Focal obliteration is possible Obliteration is an infection of the cavity of an internal organ, canal, blood or lymphatic vessel.
and division of the bile ducts. The portal tracts show signs of moderate lymphocytic inflammatory infiltration. Lymphoid follicles without germinal centers are sometimes visible, rarely granulomas.

Stage 2. Characterized by signs of lobular hepatitis, often resembling autoimmune hepatitis or chronic hepatitis C. Proliferation of the bile ducts is typical (usually has focal character). Moderate fibrosis of the portal tracts is possible. At this stage, signs of hepatitis have a more serious prognostic value than damage to the bile ducts.

Stage 3. Typical (not pathognomonic Pathognomonic - characteristic of a given disease (about a sign).
) a sign of PSC - periductular fibrosis ("onion peel symptom"). The presence of ductopenia and fibrous fields in places of loss of bile ducts is very characteristic.
In the portal tracts, only the branches of the portal vein and the hepatic artery are visible (the bile ducts are obliterated). The parenchyma is dissected by portoportal fibrous septa, the inflammatory infiltrate is less pronounced An infiltrate is a tissue site characterized by an accumulation of cellular elements usually not characteristic of it, an increased volume and increased density.
... In the periportal zones, copper deposits, intralobular cholestasis, and in some cases, Mallory's little bodies are detected.

Stage 4. Characterized by widespread fibrosis of the biliary type with signs of biliary cirrhosis of the liver. This fact can complicate the differential diagnosis between PSC and primary biliary cirrhosis.

Differential diagnosis

Bacterial cholangitis should be differentiated from infectious hepatitis, as well as infectious and non-infectious lesions of other parts of the biliary tract, gallbladder, pancreas.

Primary sclerosing cholangitis differentiate with the cholestatic form of sarcoidosis (granulomatous lesions of the bile ducts are uncommon for sarcoidosis).

Primary biliary cirrhosis is another more common cholestatic disease in which the result is immune inflammation the bile ducts are affected. In diagnostically unclear cases, the determination of antimitochondrial antibodies is shown.

Complications

Bacterial cholangitis
The main complication is "septic" or "acute biliary septic" shock, which is hemodynamic disturbances that develop as a result of the penetration of microorganisms from bile into the systemic circulation. Such shock is diagnosed in 10-30% of patients with biliary tract infection; its development is accompanied by high mortality.
An abscess may develop Abscess - a cavity filled with pus and delimited from the surrounding tissues and organs by a pyogenic membrane
liver, phlebitis Phlebitis - inflammation of the vein wall
portal vein and other septic complications.

Primary sclerosing cholangitis:
- bacterial cholangitis;
- cholangiocarcinoma (10-30%);
- increased risk of developing colorectal cancer.

Treatment abroad

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Cholangitis is an inflammatory process in the bile ducts (cholangiolitis is a lesion of the small bile ducts; cholangitis or angiocholitis is a lesion of the larger intra- and extrahepatic bile ducts; choledochitis is a lesion of the common bile duct; papillitis is a lesion of the Vater's nipple region). As a rule, it occurs against the background of violations of the patency of the biliary tract. Bile infection can provoke inflammation. Often the pathology occurs together with cysts of the common bile duct, as well as cancer of the bile duct. A disease occurs against the background of the entry of pathogens of a bacterial infection into the bile ducts.

ICD-10 code

This disease belongs to the cycle - other diseases of the biliary tract (K83). True, in this case, conditions that relate to the gallbladder (K81-K82), cystic duct (K81-K82), postcholecystectomy syndrome (K91.5) are excluded.

K83.0 Cholangitis Cholangitis: ascending, primary, recurrent, sclerosing, secondary, stenosing and purulent. Completely excluded: cholangitis liver abscess (K75.0) cholangitis with choledocholithiasis (K80.3-K80.4) chronic nonsuppurative destructive cholangitis (K74.3).

K83.1 Blockage of bile duct Occlusion, bile duct stenosis without stones, narrowing. Completely excluded: with cholelithiasis (K80).

K83.2 Perforation of bile duct Rupture of the bile duct. K83.3 Fistula of bile duct Choledochoduodenal fistula. K83.4 Spasm of sphincter of Oddi K83.5 Biliary cyst K83.8 Other specified diseases of biliary tract Adhesions, atrophy, bile duct hypertrophy, ulcer. K83.9 Disease of biliary tract, not subtle

ICD-10 code

K83.0 Cholangitis

K80.3 Calculus of bile duct with cholangitis

A common cause is the presence of benign pancreatic structures, Caroli's disease, sphincter dyskinesia. Throwing content can lead to illness small intestine in the biliary tract, as well as complications arising from reconstructive operations on the bile ducts. There are several ways in which the infection enters the bile ducts. Often everything happens by hematogenous, or lymphogenous. The causative agents can be microorganisms of the intestinal microflora, which are found in associations. Most often, the disease is bacterial in nature. It can be provoked by representatives of the enterobacteriaceae family, gram-positive microorganisms, non-spore-forming anaerobes.

, , , , , ,

Pathogenesis

The main causal disease is its combination with a violation of the outflow of bile. V pure form it does not occur so often, mainly it is combined with cholecystitis or hepatitis. Mostly the problem is caused by a bacterial infection. It can penetrate into the bile ducts through the intestines or together with the blood stream. The most common causative agent is Escherichia coli. It is extremely rare that it is enterococcus, staphylococcus and anaerobic infection.

The mechanism of development lies in the stagnation of bile. This is observed when blocking the passages with a stone. A cyst of the bile duct, an ulcer, endoscopic manipulations on the common bile duct are capable of provoking the phenomenon. In general, any problems associated with the outflow of bile. Therefore, problems eliminated in time can reduce the risk of developing the disease. By the nature of inflammation, the disease is divided into several types. So, cholangitis can be catarrhal, purulent and diphtheria.

Cholangitis symptoms

The acute form of the disease can occur against the background of complications with total obstruction of the gallbladder. It is extremely rare that everything happens as a complication of common bile duct. The clinical picture of manifestation includes malaise, jaundice, pain in the scapula, forearm. All this can flow into fever, nausea, vomiting. The person is pestered by confusion, arterial hypotension is observed. Patients have thrombocytopenia. It is a manifestation of intravascular coagulopathy.

The acute form of the disease has a slightly different symptomatology. More precisely, it has a more acute course. In most cases, a person is pestered by dyspeptic disorders that occur without fever and jaundice. There is no pain syndrome. In the intervals between exacerbations, symptoms can be completely absent. If the liver is also affected, then those that correspond to parenchymal jaundice are added to all the signs.

At times, the illness can start like sepsis. So, a person is pestered by alternating chills and fever. The severe form is accompanied by septic shock and renal failure. The frequency of the fever depends on the pathogen that provoked the disease. Pneumococcal cholangitis is extremely difficult. As soon as the biliary hypertension subsides, the symptoms disappear. During an exacerbation, the liver is able to increase in size.

In a chronic course, everything is accompanied by dull pain, a feeling of pressure, itching, slight yellowness of the mucous membranes. Often manifests itself as an unmotivated subfebrile condition. The elderly have a pronounced asthenic syndrome. It is characterized by fever and pain.

First signs

Much depends on what form of the disease is present in a person. So, for chronic cholangitis an asymptomatic course is characteristic, which is accompanied by an acute form, but only occasionally. This condition is characterized by the presence of fever, severe cramping pains in the abdomen and chest. Weakness, nausea, vomiting and a sharp drop in blood pressure are especially pronounced. From these symptoms, it is possible to make a diagnosis.

Chronic cholangitis does not have the first symptoms, since it is practically asymptomatic. This is the main danger. The disease can lead to kidney coma. Therefore, if any discomfort appears or there are problems associated with the development of cholangitis, you should seek help from medical institution... The chronic form is characterized by the appearance of pain syndrome of varying intensity. A person feels tired, itchy, and fever. Redness of the palms is often observed. The terminal phalanges of the fingers are able to thicken.

, , ,

Charcot triad with cholangitis

The acute form of the disease is characterized by the presence of the Charcot triad. It consists in the presence of three main symptoms. Typically, this is pain in the right upper quadrant of the abdomen, fever, and jaundice. It is very easy to determine the presence of the last two signs. To do this, it is enough to examine the liver, it is clearly enlarged and this is noticeable on palpation.

There is also Murphy's symptom. It is characterized by the presence of point sensitivity in the gallbladder region. It is easy to determine this by palpation. There is sensitivity in the right hypochondrium. It usually spreads across the entire width of the liver. Liver edema can vary in severity. Therefore, determine the presence this symptom simply. If the clinical manifestations are correctly evaluated, then the treatment will be not only correct, but also effective.

Therefore, patients with cholecystitis or biliary colic are referred for ultrasound. This will allow you to confirm or deny that there is a problem. With an untimely determination of the pathology, it is able to actively progress. This adds a couple more symptoms, namely confusion and septic shock. These signs, together with the Charcot triad, can lead to lethal outcome... The decision on hospitalization and treatment must be made in an hour.

Sclerosing cholangitis

Primary sclerosing cholangitis (PSC) is a condition characterized by the production of antibodies against the bile ducts. All this is accompanied by a violation of the outflow of bile. The causes of this form of the disease are unknown. It is believed that the problem is associated with the presence of an infectious agent, which is a provoking factor in people with a genetic predisposition.

Men are susceptible to this phenomenon much more often than women. Pathology develops at the age of 25-45 years. In some cases, this happens in young children. Almost 70% of cholangitis is accompanied by ulcerative colitis. It can be combined with diabetes mellitus, as well as thyroiditis.

The disease does not manifest itself vividly. The symptomatology is simple, it consists in a change in biochemical parameters. Most often accompanied by the absence of signs. At the beginning of the disease, a person begins to lose weight dramatically, he has itching, pain in the right hypochondrium, as well as jaundice. If the symptoms began to manifest themselves, then the process has heavy course... Fever is not specific.

Diagnosis of the disease consists in the study of blood serum. The condition is characterized by an increase in alkaline phosphatase, as well as bilirubin, the level of γ-globulins, IgM. During the ultrasound, thickening of the walls of the bile ducts is observed. The disease is characterized by the development of liver damage, which is accompanied by cirrhosis and hepatocellular failure.

Acute cholangitis

The acute course of the disease is characterized by chills and fever. Profuse sweat, bitterness in the mouth, and vomiting are not excluded. Often there are pains in the right hypochondrium. Sometimes the pain syndrome is too intense. The liver can grow in size, accompanied by jaundice and itching.

Sometimes there is a fever, aching pain in the right hypochondrium. There is weakness, fatigue. A person quickly gets tired, he shivers. The liver and spleen are of considerable size. The disease can carry complications. They are characterized by the presence of suppuration, necrosis.

The disease often leads to hardening of the bile ducts. All this over time spills over to the development of hepatitis. The outcome of the situation is liver cirrhosis. Diagnosis is by symptomatology. On palpation, the liver is significantly enlarged. To confirm the diagnosis, a number of X-ray and laboratory tests are performed. History of gallbladder disease.

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Chronic cholangitis

This disease is characterized by chills, which are accompanied or alternating with fever. The person is pestering profuse sweating, bitterness in the mouth, as well as vomiting and pain in the right hypochondrium. The liver may enlarge significantly. Jaundice often occurs, as well as itchy skin. In the blood is observed elevated level leukocytes.

The chronic form of the disease occurs against the background of a previously existing acute period. The clinical picture is similar. A person is pestered by increased subfebrile temperature, as well as yellowness of the sclera. There are aching pains in the right hypochondrium. The victim quickly gets tired, he has weakness, sharp weight loss. The liver and spleen are rather enlarged.

The chronic form can lead to a number of complications. Suppuration, hepatitis, and even cirrhosis of the liver may occur. Therefore, it is impossible to admit this disease, especially its progression. On palpation, a sharp increase in the liver is felt. It is important to diagnose the disease in time and start treating it.

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Bacterial cholangitis

Most often manifests itself classic form, namely the Charcot Triad. The person is pestered by pain, accompanied by all jaundice and fever. Pain sensations are localized mainly in the epigastric region. Most often, patients complain of intense or colicky pain. In rare cases, discomfort is felt.

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

Diagnostics is carried out by passing laboratory tests. Instrumental research is being actively carried out. Usually, donating blood is sufficient. Additionally, you can take a coprogram and a urine test, but after the approval of the doctor. Ultrasound, ECG and CT are performed. It is important to diagnose the problem on time and start treatment.

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Giardous cholangitis

This disease is caused by common lamblia. Pathology occurs in both adults and children. It is transmitted mainly through unwashed hands, by entering the mouth. Bacteria live in the duodenum, as well as the upper intestines. Sometimes found in the gallbladder.

It is not so easy to determine the presence of a problem, because it is closely related to other diseases of the intestine, as well as the biliary tract. It is possible to diagnose pathology only when the simplest lamblia is detected. Despite this, the symptoms are still observed. So, a person is pestered by pain in the right hypochondrium, nausea, dizziness, as well as problems with the gastrointestinal tract. Heartburn, diarrhea, or constipation may occur. Sometimes there is an increase in temperature, as well as pain syndromes in the liver. The problem can be eliminated solely by observing a special diet. Observation by a gastroenterologist is mandatory.

Purulent cholangitis

This pathology is clinically manifested in the form of fever and jaundice. A person may have confusion, as well as arterial hypotension. May develop over time renal failure, as a consequence of this - thrombocytopenia. The condition must be corrected by medical intervention.

You can diagnose everything with the help of laboratory tests. Usually, a person is sent for a blood culture, the number of leukocytes. Consider indicators of kidney function. An ultrasound scan is performed. Even with negative results, endoscopic cholangiography is recommended.

Treatment is with a broad spectrum of antibiotics. Detailed information on this type of medication will be provided below. It is not so difficult to fix the problem, but the work is painstaking. Therefore, it is advisable to seek help from a doctor when the first symptoms appear. Comprehensive elimination of the problem will help remove the disease once and for all.

Cholangitis after removal of the gallbladder

From the liver, bile must flow into the gallbladder. Here it accumulates and reaches a certain concentration. As soon as food enters the body, concentrated bile is sent to duodenum and then participates in the digestion and assimilation of fats.

When an operation is performed to remove the gallbladder, bile begins to flow directly into the duodenum. It comes directly from the liver. But bile is less concentrated, it is simply unable to perform its main function. In the process of digestion, it does not participate, or rather does not give the desired result.

In order to avoid complications, a person must follow a special diet. Otherwise, there will be stagnation of bile in the liver. The risk of developing an inflammatory process is at a high level. Cholangitis may appear first. The patient should eat a little and often, 6-7 times. In this case, there will be no complications.

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Calculous cholangitis

This pathology does not arise just like that. For its development, a special impetus must occur. As a rule, it consists in the presence of an infectious focus in the body. In order to defeat the immune system, the infection must be very severe and the body's functions significantly weakened. Only, in this way, the development of the disease is possible.

Often everything occurs against the background of the presence of cholecystitis. The fact is that the site of infection is located too close to the liver and ducts. Therefore, its penetration into the biliary tract is quite likely. Plus, there is stagnation of bile, which greatly exacerbates the situation. Stagnation always leads to the development of a severe infection.

Inflammation can lead to swelling and redness. They are the satellites of inflammation. It is important to pay attention to the main symptoms in time and start treatment. A person suffering from cholangitis at this stage is characterized by high fever, jaundice and dull pain in the liver.

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Autoimmune cholangitis

The disease resembles primary biliary cirrhosis in its histological characteristics. However, it is characterized by the presence of anti-myochondrial antibodies, as well as antinuclear antibodies and / or antibodies to smooth muscles. Thus, the disease is considered idiopathic, with a mixed pattern of hepatitis and cholestasis.

The main symptoms are immune cholangitis. However, the definition of the disease is ambiguous. After all, it is not clear for what reasons it developed. More precisely, how the disease intersects with the syndrome of primary biliary cirrhosis, as well as hepatitis. Cholangitis of this type can take the form of an independent disease. Seeing this fine line is not easy. The problem does not occur so often, but only in 5-10% of cases.

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

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Biliary cholangitis

The disease is an idiopathic liver disorder. Basically, the problem affects exclusively adults. Mostly middle-aged women suffer from it. Young men are also susceptible to it. The disease is characterized by diffuse inflammatory and fibrotic changes in the entire biliary tree.

The root cause of the problem has not yet been identified. There are several main signs that indicate the presence of a disease. So, cholangitis is often associated with other autoimmune diseases. The presence of antibodies circulating in the blood often provokes the development of pathology. During it, the bile ducts are affected. A family predisposition is capable of provoking the disease.

Finding the problem is not easy. It usually comes in conjunction with another problem. It is necessary to take blood tests and examine the liver. This will help track your white blood cell count, as well as other basic indicators. Then quality treatment is prescribed.

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Stenosing cholangitis

The onset of the disease is asymptomatic. Everything develops gradually, therefore long time the person is not worried about anything. The first manifestation is an increase in the activity of g-glutamyl transpeptidase (GGTP) and serum alkaline phosphatase (ALP). I mean, there are no visual manifestations. The only way to identify the problem is by donating blood.

The asymptomatic course is especially dangerous, because it can lead to the development of cirrhosis of the liver, as well as portal hypertension. But at the same time, there are no signs of cholestasis. Most often, "cryptogenic cirrhosis" is directly diagnosed.

It is much better when the disease begins to manifest itself. This will avoid possible complications and save the person. Everything manifests itself in the form of fever, fatigue, constant pain. Changes in body weight are possible, as well as skin itching. Jaundice develops at a progressive stage. Gradually, hepatic cell failure appears, as a consequence of this, biliary cirrhosis is formed.

Pathology can be diagnosed exclusively through laboratory tests. The disease is manifested by mild hyperbilirubinemia and an increase in the IgM level, an increase in the CEC level (70% of cases).

Recurrent cholangitis

If the outflow of bile is constantly disturbed, then the disease progresses and becomes chronic. Repeated repetition of this process leads to the fact that pathology is constantly present and pesters a person everywhere. Naturally, everything alternates with periods of calm and serious manifestations of the disease.

The exacerbation period is characterized by the presence acute pain in the right hypochondrium. All this is accompanied by fever, jaundice, and itching of the skin. The outflow of bile is able to spontaneously recover. But this happens during the so-called periods of calm. Then the pain gradually subsides, the person's condition improves, signs of jaundice are not observed. The person feels much better. But this state is not for long. Over time, the phase of active manifestation of pathology will begin. The symptomatology is constantly repeated. It is important to maintain a person's condition. Otherwise, the condition will worsen significantly. Constantly occurring relapses predict the development of a chronic form.

Hematogenous cholangitis

It is characterized by hematogenous spread of the infectious agent. The disease can proceed in different ways. So, its forms can be varied. The development option depends on the reason why cholangitis appeared.

All forms of development are based on bacteria or protozoan microorganisms that enter the body. Most often these are opportunistic microflora, lamblia, helminths. Inflammation of the gallbladder, the presence of stones in it, as well as helminthic invasion can serve as a background for the development of the disease. Stagnation of bile provokes the development of cholangitis.

Pathology is characterized by an acute onset. Usually, a sharp rise in temperature is recorded, up to 40 degrees. In parallel with this, the person feels pain in the right side. Moreover, the pain syndrome can be of varying intensity. Sometimes it just looks like colic. The entire right half, side, shoulder, neck and scapula area can pull. In these places there are bundles of nerve endings. With progression, itching, nausea, vomiting, and impaired appetite appear.

Cholangitis in children

The acute form of the disease in children is extremely rare. Basically, it has a secondary form. Initially, the baby can undergo streptococcal etiology, and then this pathology will already arise. Sometimes it has dire consequences. So, pleurisy, lung abscess, sepsis and pancreatitis are not excluded. If the treatment method is chosen incorrectly, the development of toxic liver dystrophy is possible.

Primary pathology has acute symptoms... If it is chronic, then there are no signs. Only occasionally does the baby feel pain in the right hypochondrium, he is pestered by weakness, chills and fever. Usually this manifestation is characteristic of the acute phase. With secondary development, biliary cirrhosis of the liver is not excluded. It is very difficult to diagnose, and the disease itself has a complex course.

It is better to treat this form surgically... Because the further condition of the child depends on this. It is not worthwhile to allow a chronic form. There can be many consequences. It is important to observe proper nutrition.

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Cholangitis classification

By etiology:

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

With the flow:

1. Spicy.
2. Chronic.

By pathogenesis:

Most often, cholangitis is of a bacterial nature and the causative agents are most often Escherichia coli, enterococci, Friedlander's bacillus, pneumococci, streptococci.

Effects

If timely treatment is absent, the inflammatory process may become more serious. Gradually, it spreads to the peritoneum, because of this, the development of peritonitis is possible. Pathology is capable of "spreading" to the surrounding tissues. As a result, subphrenic and intrahepatic abscesses begin to form. Sepsis and toxic shock are common. The last complication develops against the background of the bacterial form of cholangitis.

The condition of the patients becomes extremely difficult. Sometimes it is impossible to do without resuscitation measures. The inflammatory process for a long time can lead to sclerotic changes... As a result, the disease takes on a chronic form and leads to the development of biliary cirrhosis.

Self-medication and attempts to eliminate pathology with folk remedies, on the contrary, will aggravate the situation. In general, such interference is unacceptable. After all, time may be lost, and the pathology will take on a more serious character. In the later stages, the prognosis is far from the most favorable.

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Complications

If a person is not prescribed timely treatment, complications can be aggravating. Most often, it all ends with cirrhosis of the liver. In order to prevent such a development of events, it is enough to start treatment on time. Cholangitis often leads to peritonitis. The peritoneum becomes inflamed, and the surrounding tissues are also affected. As a consequence of this, the development of toxic shock is possible. The patient has a hard time tolerating all the symptoms, he needs help in the form of resuscitation measures.

A prolonged inflammatory process leads to the appearance of a chronic form of the disease. This can lead to changes in liver tissue. Ultimately, biliary cirrhosis of the liver takes its development.

To deal with self-elimination of the problem in this case is stupid. While a person tries to remove all the signs, the disease will begin to progress and it is not always possible to save the victim. This should be taken seriously.

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Cholangitis diagnostics

To suspect the existence of a problem simply by the Charcot triad. So, diagnostics is carried out against the background of laboratory and instrumental studies. Biochemical tests can indicate cholestasis. In the presence of cholangitis, an increase in the level of bilirubin, as well as a-amylase and alkaline phosphatase, is noted.

There are imaging methods for assessing the condition. As a rule, this is an ultrasound of the abdominal cavity and liver. It will allow you to determine the presence of an inflammatory process, an increase in organs. Computed tomography is rarely done. This will allow you to see an accurate image of the bile ducts and their expansion, as well as the presence of focal changes.

Instrumental diagnostics is also widely used. She occupies a leading position in the definition of pathology. So, it is endoscopic retrograde cholangiopancreatography, as well as magnetic resonance cholangiopancreatography. On the images obtained, you can see the biliary tract and the cause of their obstruction.

Differential diagnosis is only necessary if there is viral hepatitis, right-sided pneumonia, as well as primary biliary cirrhosis.

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Cholangitis tests

An experienced specialist is able to diagnose only one examination. After all, it is worth listening to the patient and palpating so that the picture becomes more and less clear. But, nevertheless, analyzes are necessary in order to clarify in what phase the disease is. This will make it possible to identify the accompanying processes and assess the situation as a whole. After all, an important place in this matter is given to the functionality of the liver and other organs.

First of all, the patient is offered to take a blood test. Thanks to him, the level of leukocytes is determined. Their significant increase indicates an inflammatory process in the gallbladder. A urine test is also taken. This pathology is characterized by the presence positive reaction for bilirubin.

A biochemical blood test is performed. It shows the level of bilirubin, as well as gamma globulins, amylase, alkaline phosphase and alpha-2 globulins. It is recommended to take a blood test for sterility. This will rule out or confirm the presence of bacteria. This analysis is carried out exclusively in specialized institutions, because it requires compliance certain rules... Duodenal intubation is also prescribed. This procedure will allow the bile to be taken and examined.

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Instrumental diagnostics

This research methodology includes several main areas. So, the first of them is ultrasound, in other words, usually ultrasound. Thanks to it, you can identify an increase in the size of the liver and notice the expansion of the bile ducts.

Second option instrumental diagnostics consists in retrograde cholangipancreatography (ERCP). This is the main method. It is an X-ray examination of the bile ducts by introducing a special contrast agent into them using an endoscope. The technique allows you to study changes in the biliary tract. In primary cholangitis, changes in the person are visible.

Magnetic resonance cholangiography is also widely used. A special place is given to computed tomography... Duodenal intubation is also used. It allows you to examine bile and see any changes in it. All techniques can be used both independently and in combination. Much depends on the condition of the patient himself.

Ultrasound diagnostics

You can notice changes in the liver and abdominal cavity using ultrasound examination... Focuses of infections, changes in size and shape should immediately prompt a specialist to think that the victim has cholangitis. Naturally, everything is combined with laboratory tests and symptomatic manifestations.

The study clearly shows the uneven width of the lumen of the bile ducts. They increase significantly inside the kidneys or outside, and they are echogenic. The unevenness is clearly visible. The portal arteries are protruding. With complications, changes in the contours of the liver are visible. Echogenic material is observed in the duct lumen.

Ultrasound examination allows for an accurate diagnosis. It can be confirmed by endoscopic retrograde cholangiography. Naturally, everything is supported by biopsy and clinical data. Based on the data obtained, a diagnosis is made and a quality treatment is prescribed to the person.

Differential Dianostics

This technique includes a blood test. Thanks to him, you can identify the presence of an inflammatory process in the body. This is usually evidenced by an increase in ESR and leukocytes. Not the last role is given to the biochemical analysis of blood. This study shows the level of bilirubin, especially the direct fraction. The level of alkaline phosphase and gama-glutamyl transpeptidase is determined. These indicators are closely related to the outflow of bile. Any changes in them indicate the presence of violations during this process. An increase in transaminase activity indicates toxic liver damage. In principle, it is impossible to do without differential diagnostics. Lab tests are especially important.

There is also general analysis urine. The appearance of bile pigments can be noticed here. Feces are given for the presence of helminth eggs and other protozoa in it. Differential diagnostics strictly interacts with instrumental diagnostics.

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With conservative elimination, the patient should refuse food for the first three days, and then proceed to a gentle diet. This will suppress the vital activity of pathogens. After all, they have nowhere to receive recharge. Along with a special diet, broad spectrum antibiotics are used. Metronidazole is commonly used. In order to reduce pain, antispasmodics and analgesics are used. It is recommended to pay attention to Drotaverin and Meverin. If a person has severe intoxication, glucose-saline solution is administered to him.

Surgery is a liver transplant. It is commonly used for cirrhosis, recurrent bacterial cholangitis, and persistent jaundice.

Medicines

As mentioned above, drugs are widely used that reduce pain, eliminate infection and promote rapid recovery of the body. The most popular drugs are: Drotaverin, Meverin, Albendazole, Ademeteonin, Hollestiramine, Ursodeoxycholic acid and Rifampicin. Antibiotics are considered separately.

Broad spectrum antibiotics are used to suppress infection. These include Metronidazole, Tetracycline and Levomecitin. You can take them for no more than 2 weeks in an individual dosage.

• Metronidazole. It is an antimicrobial drug. Apply it one tablet 2-3 times a day. In special cases, the dosage is increased to 4-5 tablets. It is not worth making adjustments on your own, the tool has a number of side effects. So, nausea, vomiting, weakness, presence of metallic taste in the mouth, dizziness. If symptoms appear, you should consult a doctor. Contraindications: pregnancy, childhood, hypersensitivity and lactation.
• Tetracycline. This drug has a bacteriostatic effect. It should be used 200-250 mg 2-3 times a day. For children, 20-25 mg / kg is enough. The duration of treatment is assigned on an individual basis. Contraindications: hypersensitivity, pregnancy, lactation, impaired liver and kidney function. Side effects: skin pigmentation, inflammation of the mucous membranes, dysbiosis, allergic reactions. The drug is usually well tolerated.
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Traditional treatment

It should be noted right away that in the presence of such a disease, resort to help traditional medicine not worth it. After all, while a person will choose for himself optimal treatment, the pathology will begin to progress. Liver cirrhosis and other complications pose a colossal threat to human life. You need to understand this fact and not try to fix the problem yourself. Yes there are folk methods treatment, but still it is impossible to do without specialized drugs.

• Recipe 1. For its preparation, you need to take 6 tablespoons of dioecious nettle, 3 tablespoons of grass of a turnip and flowers of sandy immortelle. In the amount of 2 tablespoons, corn stigmas and St. John's wort are taken. All this is mixed with each other. For cooking, it is enough to take only 2 spoons of the collection and mix them with honey. Then everything is poured with boiling water in the amount of 500 ml. You need to insist on the remedy for 2 hours. Then apply 3-6 times a day for half a glass.
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Herbal treatment

Herbs can help in many situations and even cope with bile outflow problems. True, they can be used exclusively as supportive therapy. You should not use them on your own.

• Recipe 1. You need to take a tablespoon of St. John's wort and pour it with a glass of boiling water. Then put on fire and boil for about 15 minutes. The resulting product is taken in a quarter of a glass 3 times a day. The broth is able to have a pronounced anti-inflammatory effect, as well as provoke the outflow of bile.
• Recipe 2. A spoonful of oregano herb should be poured with a glass of boiling water. The remedy is infused for 2 hours. It is necessary to take it in a quarter of a glass 3 times a day. The remedy is really effective, but pregnant girls should not take it.
• Recipe 3. Take 100 grams of corn stigmas and mix with 75 grams of marigold and yarrow. All this is poured with two glasses of boiling water (collecting it is enough to take 2 tablespoons). At night, the agent is left alone. In the morning, everything is filtered and used in 100 ml up to 4 times a day.

Homeopathy

Homeopathic remedies have long gained popularity and special distribution. Nevertheless, it is recommended to resort to the help of standard methods of treatment. When it comes to homeopathy, it is effective, but not for everyone. A variety of remedies are used to combat cholangitis.

• Arsenicum album. It is a poisonous substance. It is prescribed for people who suffer from itchy skin, worsening at night. Often the drug causes allergic reaction, nausea and indigestion.
• Baptisia tinctoria (wild indigo of the legume family). The drug is widely used in the chronic form of the course of the disease. Especially if it proceeds along with fever, vivid dreams and sensations of heat in the morning.
• Berberis vulgaris (barberry). It is used when there is bitterness in the mouth, aching pains as well as dryness in the mouth. The development of pain syndrome during movement is possible.
• Briony alba (white step). A remedy is prescribed for very painful palpation and the presence of a pathological process in the liver.
• Cuprum (copper) and zinc (zinc). They are widely used for severe spasms of the gallbladder. They are able to have an anti-inflammatory effect.
• Lycopodium clavatum. It is used for cholangitis accompanied by liver disease. Especially when there is a pronounced symptomatology. In this case, we mean bitterness in the mouth, impaired appetite, heartburn.

A complete list of medications is available from a homeopathic physician. It is he who prescribes this or that remedy, depending on the person's condition and symptoms.

Diet for cholangitis

• Diet number 5. You need to eat food 5 times a day, in small portions. It is forbidden to eat before bedtime, in any case, to eat too much. Spicy and spicy dishes are prohibited. You will have to give up garlic, horseradish and radish. Alcoholic drinks are strictly prohibited. Fatty meat and fish should be deposited until better times. A person consumes up to 3500 kilocalories per day. Daily rate 90-100 grams of protein, 100 grams of lipids and 400 grams of carbohydrates. Buckwheat, lean meat, fish, cottage cheese and oatmeal should be included in the diet. As soon as the condition improves, you can switch to vegetable and milk soups. Lean meat and fish are allowed. You can eat cookies, fresh vegetables (cabbage, carrots and potatoes). Bread is allowed, but slightly dried. Honey, sugar and berry infusions are very useful. You can compose a diet yourself, starting from the list of permitted foods.
• Diet number 5a. You can eat absolutely any cereals, but they need to be boiled down a lot. Meat and fish are eaten steamed. You can't fry anything! Don't eat raw fruits and vegetables. Under the ban is Rye bread... It is advisable to spend mono-diet days on apples or cottage cheese. To eliminate constipation, the diet is diluted with dried fruits, beets and vegetable juices. When the condition improves, you can switch to diet number 5.

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All patients who suffer from a chronic form of pathology should always be under dispensary supervision... It is important to carry out anti-relapse treatment, this is done 1-2 times a year, depending on the person's condition and the progression of the pathology. Must be consumed constantly mineral water, choleretic agents and health food... It is advisable to periodically refer patients to health resorts and dispensaries.

Forecast

The prognosis for the disease depends entirely on the condition of the person and the form of the flow, as well as the outflow of bile. If the treatment was carried out in a timely manner, then there should be no complications. Rapid intervention leads to positive outcome... But, it is important to support the body so that a relapse does not occur. The constant repetition of the pattern of pathology leads to chronic course... In this case, the prognosis can be extremely unfavorable.

If we talk about the later stages of pathology, then everything here depends on the treatment. But still, the probability of an unfavorable prognosis is several times higher. It is not always possible to save a person, especially if he has cirrhosis of the liver. Here only organ transplantation is needed. Additional symptoms related to acute liver failure, cirrhosis and liver abscess can worsen the prognosis. Women over the age of 50 are at risk. Therefore, it is important to get tested and respond to any symptoms in a timely manner.

Cholangitis is a malfunction of the liver in which the bile ducts become inflamed.

All people are at risk. A similar violation of the gastrointestinal tract occurs in men and women of different age categories. However, most often the disease is diagnosed in the fairer sex at the age of 50-60 years. Doctors attribute this to what is changing hormonal background, the metabolism slows down, the level of immunity decreases.

What it is?

Cholangitis - infection biliary tract. It occurs due to a bacterial infection. There are acute and chronic forms. Sometimes it develops as an independent disease, more often it is a consequence of other diseases internal organs... It usually occurs in women in old age.

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

Classification

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

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

Chronic cholangitis is divided into the following forms:

• sclerosing (with overgrowth of connective tissue);
• latent;
• recurrent;
• septic long-running;
• abscessing.

By the location of the inflammatory process, there are:

• choledochitis (common duct is inflamed);
• angiocholitis (intra- and extrahepatic biliary tract is affected);
• papillitis (large duodenal papilla is inflamed).

By origin, cholangitis is:

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

Sclerosing cholangitis is a special form of the disease. Initially, having a chronic form of the course, inflammation in the bile ducts occurs without preliminary penetration of the infection. The inflammatory process leads to hardening of tissues - hardening, they completely block the lumen of the ducts, thereby causing cirrhosis of the liver. This disease does not respond to treatment, slow progress (about 10 years) ends in the formation of severe disorders with subsequent death.

Reasons for development

The main cause of cholangitis is a violation of the patency of the bile ducts and the addition of infection. Violation of the patency of the bile ducts often occurs with choledocholithiasis - the formation gallstones in the biliary tract. Other causes of impaired outflow of bile can be cicatricial narrowing of the biliary tract due to chronic cholecystitis, removal of the gallbladder (postcholecystectomy syndrome), cysts or tumors of the common bile duct.

Infection in the biliary tract mainly comes from the intestines, since with stagnation of bile, the mechanism is disrupted that prevents the penetration of intestinal contents into the upper parts of the gastrointestinal tract. In addition to the ascending (intestinal) route of infection, there is also a descending route when the infection enters the biliary tract with the flow of blood or lymph from another inflammatory focus in the abdominal cavity.

Symptoms

Disease in acute form arises suddenly. But like any disease, cholangitis also has symptoms and signs:

1. Very high temperatures up to 40 ° C.
2. Characteristic pains on the right in the ribs.
3. Yellowness of the skin and mucous membranes of the eyes.
4. Chills, intense sweating.
5. General intoxication of the body, which is characterized by diarrhea, general weakness, vomiting and loss of appetite.
6. Itching of the skin appears due to jaundice.
7. If the form of the disease is severe, the patient may faint.

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

Sclerosing primary cholangitis (PSC)

A few statistics about this form:

• In 55% of people, the disease occurs without symptoms or with minimal manifestations;
• In 20-60% of cases, the disease is detected only at the stage of the appearance of liver cirrhosis;
• Up to 20% of patients with PSC suffer from cholangiocarcinoma ( malignant tumor), which developed as a result of pathology.
  These moments clearly demonstrate how difficult the diagnosis is. On the one hand, patients often do not pay attention to "minor" symptoms, which leads to late seeking medical help. On the other hand, not every city has a specialist who will suspect this rare but dangerous pathology.

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

Diagnostics

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

Examination of such a patient reveals:

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

With the phenomena of jaundice, 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 due to blockage of the biliary tract);
• due to the ingress of bile pigments into the bloodstream, and then into the kidneys, urine may darken (a characteristic symptom of "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.

Instrumental methods that are used to diagnose cholangitis are:

1. Ultrasound diagnostics of the liver (ultrasound) and ultrasonography (ultrasound) of the biliary tract - these methods allow you to evaluate the biliary tract, determine pathological changes in them - in particular, their expansion, as well as changes in the liver that occur due to a violation of the flow of bile in the biliary tract ;
2. Computed tomography of the bile ducts (CT) - an assessment of the very parameters that are assessed using ultrasound, will help to conduct computer sections of the biliary tract;
3. Endoscopic retrograde cholangiopancreatography (ERPCG) - using an endoscope inserted into gastrointestinal tract, a contrast agent is injected into the biliary tract, an X-ray is taken and evaluated;
4. Magnetic resonance cholangiopancreatography (MRPCG) - bile ducts with injected contrast are examined using magnetic resonance imaging;
5. Percutaneous transhepatic cholangiography - contrast is injected into the bile ducts not through the digestive tract, but by puncturing (piercing) the skin and liver;
6. Duodenal intubation - with its help, bile is taken with subsequent bacteriological culture on nutrient media.

In the diagnosis of cholangitis, such laboratory methods, how:

1. Complete blood count - 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 revealed;
2. Biochemical liver tests - determine an increase in the amount of bilirubin, alkaline phosphatase, as well as transaminases and alpha-amylase. Such data indirectly indicate cholestasis (stagnation of bile), which is observed with cholangitis;
3. Bacteriological seeding of bile obtained during duodenal intubation - thanks to it, the causative agent of cholangitis is identified;
4. Stool analysis - thanks to it, the presence in the body of helminths or protozoa that can cause inflammation of the biliary tract is confirmed or excluded.

Effects

If there is no timely treatment, then the inflammatory process can become more serious. Gradually, it spreads to the peritoneum, because of this, the development of peritonitis is possible. Pathology is capable of "spreading" to the surrounding tissues. As a result, subphrenic and intrahepatic abscesses begin to form. Sepsis and toxic shock are common. The last complication develops against the background of the bacterial form of cholangitis.

The condition of the patients becomes extremely difficult. Sometimes it is impossible to do without resuscitation measures. The inflammatory process for a long time can lead to sclerotic changes. As a result, the disease takes on a chronic form and leads to the development of biliary cirrhosis.

Self-medication and attempts to eliminate pathology with folk remedies, on the contrary, will aggravate the situation. In general, such interference is unacceptable. After all, time may be lost, and the pathology will take on a more serious character. In the later stages, the prognosis is far from the most favorable.

Cholangitis treatment

There are several fundamental points in the cholangitis treatment regimen that every patient should know:

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

Treatment of the acute process

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

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

1. Intravenous infusion of solutions that improve metabolism in tissues and reduce the concentration of blood toxins: glucose or sodium chloride solutions, Ringer's solution, Disol or Trisol preparations, etc.;
2. A combination of antimicrobial drugs;
3. Hepatoprotectors, to maintain the functioning of liver cells: Essentiale, ademetionine, ursodeoxycholic acid and others;
4. If necessary, drugs are used to relieve pain and to eliminate spasms in digestive tract(antispasmodics).

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

Treatment of the chronic form

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

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

1. Adhere to a diet (table number 5 according to Pevzner), which implies frequent fractional meals 5-6 times a day, in a small amount, with the exception of fatty foods;
2. If possible, exclude physical and psychological stress;
3. Quit smoking, drinking alcoholic and caffeinated beverages;
4. Take multivitamin complexes with the presence of vitamins K, D, E and A. Absorption of these particular substances is impaired with prolonged inflammation of the biliary system.

Prevention

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

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

In addition, it is recommended to systematically undergo a complete medical examination. This will detect chronic diseases on early stages. Preventive examination in no way should be neglected. It is better to spend a little free time on a doctor's consultation than a long and tedious treatment neglected form pathology.

Forecast for life

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 stated in diseases such as:

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

Filtration of toxins, storage of vitamins, production of glycogen - these are the main tasks performed by the liver in the body of every person. If for some reason these functions cannot be fully executed, then. Yellowing of the skin or sclera of the eyes are clear signs that the liver is starting to malfunction.

What is cholangitis?

What is cholangitis? This is an 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. By forms it is divided into:

1. 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 necrotization of the mucous membrane, destruction of the walls of the bile duct, purulent fusion of the surrounding tissue.

1. Chronic. According to the inflammatory nature, they are divided into types:
   • Hidden (latent).
   • Septic.
   • Recurrent.
   • Absolute.
2. Sclerosing (autoimmune) cholangitis - it is assumed that it develops as a result of the body's autoimmune response to itself. There is hardening, narrowing and overgrowth of the bile ducts, which leads to cirrhosis of the liver.
3. Bacterial.

Causes

What can be the reasons for such an unpleasant disease as cholangitis? Let's consider the most common:

• Cholelithiasis in the bile ducts (choledocholithiasis).
• Scarring and narrowing of the bile duct due to removal of a cyst, tumor, or chronic cholecystitis.
• Ascaris, helminthic invasion.
• Hepatitis.
• The penetration of infection from the intestines, through the flow of lymph or blood. A favorable environment for her is a violation of the outflow (stagnation) of bile.

The contributing factors for these anomalies are:

1. Genetic predisposition.
2. Psychogenic factor.
3. Congenital anomalies.
4. Giardiasis.
5. Dyskinesia.
6. Endocrine Disorders.
7. Immunological reactions.
8. Pancreatobiliary reflux.
9. 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.
   • Dyshormonal disorders.
   • Alcoholism, smoking.

Symptoms and signs of bile duct cholangitis

Symptoms and signs of bile duct cholangitis should be considered according to the form of their course:

1. Spicy:
   • A fit of pain in right side chest (shoulder, scapula) and abdomen.
   • Raising the temperature to 40 ° C.
   • Nausea.
   • Lowering blood pressure.
   • Weakness.
   • Vomit.
   • Itchy skin.
   • Chills.
   • Yellowness of the skin, mucous membranes, sclera.
   • Impaired consciousness.
   • Development of a hepatic coma is possible.
2. Chronic:
   • The pain is mild, but intense in the presence of stones.
   • Itchy skin.
   • Distension or squeezing in the right hypochondrium.
   • Weakness.
   • Periodically high fever.
   • Fatigue.
   • Thickening of the fingers, redness of the palms.
3. Sclerosing:

• Pain in the upper abdomen and right hypochondrium.
• Stool disorder, as in ulcerative colitis or Crohn's disease.
• Jaundice and itching of the skin.
• Temperature up to 38 ° C.

Cholangitis in children

In children, cholangitis occurs mainly for reasons of genetic or congenital... In other cases, the disease is not seen 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. In men, it occurs due to the presence of bad habits or untreated diseases. An unhealthy lifestyle and poor nutrition are major contributors to 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 intubation.
• X-ray cholegraphy.
• Cholangiomanometry.
• Choledochoscopy.
• Liver biopsy.
• Radioisotope examination of the bile ducts.

Treatment

Cholangitis is treated only in a hospital. Folk remedies that a person wishes to carry out at home do not contribute to recovery. It requires medication, therapeutic and sometimes surgical treatment.

How to treat cholangitis? The doctor prescribes medications if there is a normal outflow of bile:

• Antibiotics
• Antispasmodics.
• Sulfonamides.
• Medicines that reduce intoxication.
• Medicines that improve the outflow of bile.
• Anthelmintic drugs.

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

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

1. Eating small portions at least 5 times.
2. A ban on eating before bedtime.
3. Exclusion from the menu of fresh bread, spicy, fried, spicy, onion, bacon, sour berries and fruits, garlic, strong tea, alcohol.
4. The menu includes lean fish, cottage cheese, buckwheat, oatmeal, warm milk, egg whites, boiled meat, vegetables, milk soups, kefir, stale bread, honey, jam.
5. Ban on hunger strike.
6. Tea drinking of special herbal preparations. Compotes, jelly, mineral waters.

Sclerosing cholangitis is treated as follows:

• Vitamin therapy.
• Antihistamines.
• Ursodeoxyisolic acid.
• Sedatives.

Physiotherapy procedures are used:

1. Amplipulse therapy.
2. Diathermy.
3. Microwave therapy.
4. Paraffin and mud applications.
5. Sanatorium treatment.
6. Physiotherapy.

Life span

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

• Peritonitis.
• Abdominal abscess.
• Liver failure.
• Intrahepatic abscesses.
• Sepsis.
• Biliary cirrhosis.
• Cholangiocarcinoma.

Here you should not delay treatment and do not self-medicate. Seek medical attention at the first symptoms.